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Naaktgeboren WR, Koevoets EW, Stuiver MM, van Harten WH, Aaronson NK, van der Wall E, Velthuis M, Sonke G, Schagen SB, Groen WG, May AM. Effects of physical exercise during adjuvant chemotherapy for breast cancer on long-term tested and perceived cognition: results of a pragmatic follow-up study. Breast Cancer Res Treat 2024:10.1007/s10549-023-07220-7. [PMID: 38285111 DOI: 10.1007/s10549-023-07220-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Cancer-related cognitive impairment (CRCI) following chemotherapy is commonly reported in breast cancer survivors, even years after treatment. Data from preclinical studies suggest that exercise during chemotherapy may prevent or diminish cognitive problems; however, clinical data are scarce. METHODS This is a pragmatic follow-up study of two original randomized trials, which compares breast cancer patients randomized to exercise during chemotherapy to non-exercise controls 8.5 years post-treatment. Cognitive outcomes include an online neuropsychological test battery and self-reported cognitive complaints. Cognitive performance was compared to normative data and expressed as age-adjusted z-scores. RESULTS A total of 143 patients participated in the online cognitive testing. Overall, cognitive performance was mildly impaired on some, but not all, cognitive domains, with no significant differences between groups. Clinically relevant cognitive impairment was present in 25% to 40% of all participants, regardless of study group. We observed no statistically significant effect of exercise, or being physically active during chemotherapy, on long-term cognitive performance or self-reported cognition, except for the task reaction time, which favored the control group (β = -2.04, 95% confidence interval: -38.48; -2.38). We observed no significant association between self-reported higher physical activity levels during chemotherapy or at follow-up and better cognitive outcomes. CONCLUSION In this pragmatic follow-up study, exercising and being overall more physically active during or after adjuvant chemotherapy for breast cancer was not associated with better tested or self-reported cognitive functioning, on average, 8.5 years after treatment. Future prospective studies are needed to document the complex relationship between exercise and CRCI in cancer survivors.
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Affiliation(s)
- Willeke R Naaktgeboren
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emmie W Koevoets
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
- Rijnstate Hospital, Arnhem, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Miranda Velthuis
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Gabe Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Brain and Cognition Group, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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van Roozendaal LM, Vane MLG, Colier E, Strobbe LJA, de Boer M, Sonke G, Van Maaren MC, Smidt ML. Gene expression profiles in clinically T1-2N0 ER+HER2- breast cancer patients treated with breast-conserving therapy: their added value in case sentinel lymph node biopsy is not performed. Breast Cancer Res Treat 2024; 203:103-110. [PMID: 37794289 PMCID: PMC10771349 DOI: 10.1007/s10549-023-07128-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Omitting sentinel lymph node biopsy (SLNB) in breast cancer treatment results in patients with unknown positive nodal status and potential risk for systemic undertreatment. This study aimed to investigate whether gene expression profiles (GEPs) can lower this risk in cT1-2N0 ER+ HER2- breast cancer patients treated with BCT. METHODS Patients were included if diagnosed between 2011 and 2017 with cT1-2N0 ER+ HER2- breast cancer, treated with BCT and SLNB, and in whom GEP was applied. Adjuvant chemotherapy recommendations based on clinical risk status (Dutch breast cancer guideline of 2020 versus PREDICT v2.1) with and without knowledge on SLNB outcome were compared to GEP outcome. We examined missing adjuvant chemotherapy indications, and the number of GEPs needed to identify one patient at risk for systemic undertreatment. RESULTS Of 3585 patients, 2863 (79.9%) had pN0 and 722 (20.1%) pN + disease. Chemotherapy was recommended in 1354 (37.8% guideline-2020) and 1888 patients (52.7% PREDICT). Eliminating SLNB outcome (n = 722) resulted in omission of chemotherapy recommendation in 475 (35.1% guideline-2020) and 412 patients (21.8% PREDICT). GEP revealed genomic high risk in 126 (26.5% guideline-2020) and 82 patients (19.9% PREDICT) in case of omitted chemotherapy recommendation in the absence of SLNB. Extrapolated to the whole group, this concerns 3.5% and 2.3%, respectively, resulting in the need for 28-44 GEPs to identify one patient at risk for systemic undertreatment. CONCLUSION If no SLNB is performed, clinical risk status according to the guideline of 2020 and PREDICT predicts a very low risk for systemic undertreatment. The number of GEPs needed to identify one patient at risk for undertreatment does not justify its standard use.
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Affiliation(s)
- L M van Roozendaal
- Department of Surgical Oncology, Zuyderland Medical Center, Heerlen - Sittard, The Netherlands.
| | - M L G Vane
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Colier
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M de Boer
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Sonke
- Department of Medical Oncology, Netherlands-Cancer Institute, Amsterdam, The Netherlands
| | - M C Van Maaren
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - M L Smidt
- Department of Surgical Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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van Wagensveld L, Walker C, Hahn K, Sanders J, Kruitwagen R, van der Aa M, Sonke G, Rottenberg S, de Vijver KV, Janowczyk A, Horlings H. The prognostic value of tumor-stroma ratio and a newly developed computer-aided quantitative analysis of routine H&E slides in high-grade serous ovarian cancer. Res Sq 2023:rs.3.rs-3511087. [PMID: 38014112 PMCID: PMC10680933 DOI: 10.21203/rs.3.rs-3511087/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Tumor-stroma ratio (TSR) is prognostic in multiple cancers, while its role in high-grade serous ovarian cancer (HGSOC) remains unclear. Despite the prognostic insight gained from genetic profiles and tumor-infiltrating lymphocytes (TILs), the prognostic use of histology slides remains limited, while it enables the identification of tumor characteristics via computational pathology reducing scoring time and costs. To address this, this study aimed to assess TSR's prognostic role in HGSOC and its association with TILs. We additionally developed an algorithm, Ovarian-TSR (OTSR), using deep learning for TSR scoring, comparing it to manual scoring. Methods : 340 patients with advanced-stage who underwent primary debulking surgery (PDS) or neo-adjuvant chemotherapy (NACT) with interval debulking (IDS). TSR was assessed in both the most invasive (MI) and whole tumor (WT) regions through manual scoring by pathologists and quantification using OTSR. Patients were categorized as stroma-rich (≥ 50% stroma) or stroma-poor (< 50%). TILs were evaluated via immunohistochemical staining. Result s: In PDS, stroma-rich tumors were significantly associated with a more frequent papillary growth pattern (60% vs 34%), while In NACT stroma-rich tumors had a lower Tumor Regression Grading (TRG 4&5, 21% vs 57%) and increased pleural metastasis (25% vs 16%). Stroma-rich patients had significantly shorter overall and progression-free survival compared to stroma-poor (31 versus 45 months; P < 0.0001, and 15 versus 17 months; P = 0.0008, respectively). Combining stromal percentage and TILs led to three distinct survival groups with good (stroma-poor, high TIL), medium (stroma-rich, high TIL, or; stroma-poor, Low TIL), and poor(stroma-rich, low TIL) survival. These survival groups remained significant in CD8 and CD103 in multivariable analysis (Hazard ratio (HR) = 1.42, 95% Confidence-interval (CI) = 1.02-1.99; HR = 1.49, 95% CI = 1.01-2.18, and HR = 1.48, 95% CI = 1.05-2.08; HR = 2.24, 95% CI = 1.55-3.23, respectively). OTSR was able to recapitulate these results and demonstrated high concordance with expert pathologists (correlation = 0.83). Conclusions : TSR is an independent prognostic factor for survival assessment in HGSOC. Stroma-rich tumors have a worse prognosis and, in the case of NACT, a higher likelihood of pleural metastasis. OTSR provides a cost and time-efficient way of determining TSR with high reproducibility and reduced inter-observer variability.
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Naaktgeboren WR, Stuiver MM, van Harten WH, Aaronson NK, Scott JM, Sonke G, van der Wall E, Velthuis M, Leiner T, Teske AJ, May AM, Groen WG. Effects of exercise during chemotherapy for breast cancer on long-term cardiovascular toxicity. Open Heart 2023; 10:e002464. [PMID: 37903570 PMCID: PMC10619040 DOI: 10.1136/openhrt-2023-002464] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE Animal data suggest that exercise during chemotherapy is cardioprotective, but clinical evidence to support this is limited. This study evaluated the effect of exercise during chemotherapy for breast cancer on long-term cardiovascular toxicity. METHODS This is a follow-up study of two previously performed randomised trials in patients with breast cancer allocated to exercise during chemotherapy or non-exercise controls. Cardiac imaging parameters, including T1 mapping (native T1, extracellular volume fraction (ECV)), left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), cardiorespiratory fitness, and physical activity levels, were acquired 8.5 years post-treatment. RESULTS In total, 185 breast cancer survivors were included (mean age 58.9±7.8 years), of whom 99% and 18% were treated with anthracyclines and trastuzumab, respectively. ECV and Native T1 were 25.3%±2.5% and 1026±51 ms in the control group, and 24.6%±2.8% and 1007±44 ms in the exercise group, respectively. LVEF was borderline normal in both groups, with an LVEF<50% prevalence of 22.5% (n=40/178) in all participants. Compared with control, native T1 was statistically significantly lower in the exercise group (β=-20.16, 95% CI -35.35 to -4.97). We found no effect of exercise on ECV (β=-0.69, 95% CI -1.62 to 0.25), LVEF (β=-1.36, 95% CI -3.45 to 0.73) or GLS (β=0.31, 95% CI -0.76 to 1.37). Higher self-reported physical activity levels during chemotherapy were significantly associated with better native T1 and ECV. CONCLUSIONS In long-term breast cancer survivors, exercise and being more physically active during chemotherapy were associated with better structural but not functional cardiac parameters. The high prevalence of cardiac dysfunction calls for additional research on cardioprotective measures, including alternative exercise regimens. TRIAL REGISTRATION NUMBER NTR7247.
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Affiliation(s)
- Willeke R Naaktgeboren
- Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Martijn M Stuiver
- Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim H van Harten
- Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
- Rijnstate Hospital, Arnhem, Netherlands
| | - Neil K Aaronson
- Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jessica M Scott
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Gabe Sonke
- Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Elsken van der Wall
- Division of Internal Medicine and Dermatology, University Medical Centre, Utrecht, The Netherlands
| | - Miranda Velthuis
- Netherlands Comprehensive Cancer Organisation, Nijmegen, The Netherlands
| | - Tim Leiner
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Arco J Teske
- Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Aging & Later Life, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Amsterdam Movement Sciences, Ageing & Vitality, Rehabilitation & Development, Amstermdam, Netherlands
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Van Egeren D, Kohli K, Warner JL, Bedard PL, Riely G, Lepisto E, Schrag D, LeNoue-Newton M, Catalano P, Kehl KL, Michor F, Fiandalo M, Foti M, Khotskaya Y, Lee J, Peters N, Sweeney S, Abraham J, Brenton JD, Caldas C, Doherty G, Nimmervoll B, Pinilla K, Martin JE, Rueda OM, Sammut SJ, Silva D, Cao K, Heath AP, Li M, Lilly J, MacFarland S, Maris JM, Mason JL, Morgan AM, Resnick A, Welsh M, Zhu Y, Johnson B, Li Y, Sholl L, Beaudoin R, Biswas R, Cerami E, Cushing O, Dand D, Ducar M, Gusev A, Hahn WC, Haigis K, Hassett M, Janeway KA, Jänne P, Jawale A, Johnson J, Kehl KL, Kumari P, Laucks V, Lepisto E, Lindeman N, Lindsay J, Lueders A, Macconaill L, Manam M, Mazor T, Miller D, Newcomb A, Orechia J, Ovalle A, Postle A, Quinn D, Reardon B, Rollins B, Shivdasani P, Tramontano A, Van Allen E, Van Nostrand SC, Bell J, Datto MB, Green M, Hubbard C, McCall SJ, Mettu NB, Strickler JH, Andre F, Besse B, Deloger M, Dogan S, Italiano A, Loriot Y, Ludovic L, Michels S, Scoazec J, Tran-Dien A, Vassal G, Freeman CE, Hsiao SJ, Ingham M, Pang J, Rabadan R, Roman LC, Carvajal R, DuBois R, Arcila ME, Benayed R, Berger MF, Bhuiya M, Brannon AR, Brown S, Chakravarty D, Chu C, de Bruijn I, Galle J, Gao J, Gardos S, Gross B, Kundra R, Kung AL, Ladanyi M, Lavery JA, Li X, Lisman A, Mastrogiacomo B, McCarthy C, Nichols C, Ochoa A, Panageas KS, Philip J, Pillai S, Riely GJ, Rizvi H, Rudolph J, Sawyers CL, Schrag D, Schultz N, Schwartz J, Sheridan R, Solit D, Wang A, Wilson M, Zehir A, Zhang H, Zhao G, Ahmed L, Bedard PL, Bruce JP, Chow H, Cooke S, Del Rossi S, Felicen S, Hakgor S, Jagannathan P, Kamel-Reid S, Krishna G, Leighl N, Lu Z, Nguyen A, Oldfield L, Plagianakos D, Pugh TJ, Rizvi A, Sabatini P, Shah E, Singaravelan N, Siu L, Srivastava G, Stickle N, Stockley T, Tang M, Virtaenen C, Watt S, Yu C, Bernard B, Bifulco C, Cramer JL, Lee S, Piening B, Reynolds S, Slagel J, Tittel P, Urba W, VanCampen J, Weerasinghe R, Acebedo A, Guinney J, Guo X, Hunter-Zinck H, Yu T, Dang K, Anagnostou V, Baras A, Brahmer J, Gocke C, Scharpf RB, Tao J, Velculescu VE, Alexander S, Bailey N, Gold P, Bierkens M, de Graaf J, Hudeček J, Meijer GA, Monkhorst K, Samsom KG, Sanders J, Sonke G, ten Hoeve J, van de Velde T, van den Berg J, Voest E, Steinhardt G, Kadri S, Pankhuri W, Wang P, Segal J, Moung C, Espinosa-Mendez C, Martell HJ, Onodera C, Quintanar Alfaro A, Sweet-Cordero EA, Talevich E, Turski M, Van’t Veer L, Wren A, Aguilar S, Dienstmann R, Mancuso F, Nuciforo P, Tabernero J, Viaplana C, Vivancos A, Anderson I, Chaugai S, Coco J, Fabbri D, Johnson D, Jones L, Li X, Lovly C, Mishra S, Mittendorf K, Wen L, Yang YJ, Ye C, Holt M, LeNoue-Newton ML, Micheel CM, Park BH, Rubinstein SM, Stricker T, Wang L, Warner J, Guan M, Jin G, Liu L, Topaloglu U, Urtis C, Zhang W, D’Eletto M, Hutchison S, Longtine J, Walther Z. Genomic analysis of early-stage lung cancer reveals a role for TP53 mutations in distant metastasis. Sci Rep 2022; 12:19055. [PMID: 36351964 PMCID: PMC9646734 DOI: 10.1038/s41598-022-21448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Patients with non-small cell lung cancer (NSCLC) who have distant metastases have a poor prognosis. To determine which genomic factors of the primary tumor are associated with metastasis, we analyzed data from 759 patients originally diagnosed with stage I-III NSCLC as part of the AACR Project GENIE Biopharma Collaborative consortium. We found that TP53 mutations were significantly associated with the development of new distant metastases. TP53 mutations were also more prevalent in patients with a history of smoking, suggesting that these patients may be at increased risk for distant metastasis. Our results suggest that additional investigation of the optimal management of patients with early-stage NSCLC harboring TP53 mutations at diagnosis is warranted in light of their higher likelihood of developing new distant metastases.
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Affiliation(s)
- Debra Van Egeren
- grid.65499.370000 0001 2106 9910Department of Data Science, Dana-Farber Cancer Institute, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Systems Biology, Harvard Medical School, Boston, MA USA ,grid.2515.30000 0004 0378 8438Stem Cell Program, Boston Children’s Hospital, Boston, MA USA ,grid.5386.8000000041936877XDepartment of Medicine, Weill Cornell Medicine, New York, NY USA
| | - Khushi Kohli
- grid.65499.370000 0001 2106 9910Department of Data Science, Dana-Farber Cancer Institute, Boston, MA USA
| | - Jeremy L. Warner
- grid.152326.10000 0001 2264 7217Department of Medicine, Vanderbilt University, Nashville, TN USA ,grid.152326.10000 0001 2264 7217Department of Biomedical Informatics, Vanderbilt University, Nashville, TN USA
| | - Philippe L. Bedard
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Gregory Riely
- grid.51462.340000 0001 2171 9952Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Eva Lepisto
- grid.65499.370000 0001 2106 9910Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA USA ,grid.429426.f0000 0000 9350 5788Present Address: Multiple Myeloma Research Foundation, Norwalk, CT USA
| | - Deborah Schrag
- grid.51462.340000 0001 2171 9952Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Michele LeNoue-Newton
- grid.412807.80000 0004 1936 9916Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN USA
| | - Paul Catalano
- grid.65499.370000 0001 2106 9910Department of Data Science, Dana-Farber Cancer Institute, Boston, MA USA
| | - Kenneth L. Kehl
- grid.65499.370000 0001 2106 9910Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA USA
| | - Franziska Michor
- grid.65499.370000 0001 2106 9910Department of Data Science, Dana-Farber Cancer Institute, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA USA ,grid.66859.340000 0004 0546 1623Broad Institute of MIT and Harvard, Cambridge, MA USA ,grid.38142.3c000000041936754XDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA ,grid.65499.370000 0001 2106 9910The Center for Cancer Evolution, Dana-Farber Cancer Institute, Boston, MA USA ,grid.38142.3c000000041936754XThe Ludwig Center at Harvard, Boston, MA USA
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O'Shaughnessy J, Stemmer SM, Burris HA, Yap YS, Sonke G, Hart L, Campone M, Petrakova K, Winer EP, Janni W, Conte P, Cameron DA, André F, Arteaga C, Zarate JP, Chakravartty A, Taran T, Gac FL, Serra P, Hortobagyi GN. Abstract GS2-01: Overall survival subgroup analysis by metastatic site from the phase 3 MONALEESA-2 study of first-line ribociclib + letrozole in postmenopausal patients with advanced HR+/HER2− breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs2-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: MONALEESA-2 (ML-2) recently reported a statistically significant overall survival (OS) benefit with first-line ribociclib (RIB) + letrozole (LET) over placebo (PBO) + LET in postmenopausal patients with HR+/HER2- advanced breast cancer (ABC) (median, 63.9 vs 51.4 months; hazard ratio, 0.76; 95% CI, 0.63-0.93; P = .004). Understanding OS outcomes in clinically relevant subgroups of patients is important for improving personalized care and prognosis. Here, we report the results of a prespecified exploratory OS analysis in select patient subgroups by baseline location and number of metastatic sites.. Methods: Postmenopausal patients with HR+/HER2− ABC were randomized 1:1 to receive first-line RIB or PBO with LET. Prespecified exploratory OS analyses were performed for subgroups of special interest by baseline location (bone only [yes or no], liver involvement [yes or no], liver or lung involvement [yes or no]) and number of metastatic sites (< 3 or ≥ 3). The data are hypothesis generating since this analysis was exploratory and not powered for statistical significance.. Results: A total of 668 patients were included in the analysis. A consistent improvement in OS was observed with RIB + LET vs PBO + LET in all subgroups regardless of baseline metastatic site (Table). RIB + LET demonstrated an OS benefit over PBO + LET in clinically relevant subgroups by baseline location and number of metastatic sites, including subgroups of patients with liver metastases, liver or lung metastases, and ≥ 3 metastatic sites, who generally have a worse prognosis.. Conclusion: Consistent with the intent-to-treat population of ML-2, the results of this prespecified exploratory analysis demonstrated an OS benefit with RIB + LET independent of the site and number of metastatic lesions.
TableTreatment Arm (n)HR (95% CI)Bone-only metastasisYesRIB + LET (69)0.78 (0.50-1.21)PBO + LET (79)NoRIB + LET (265)0.77(0.61-0.96)PBO + LET (255)Liver involvementYesRIB + LET (59)0.81 (0.54-1.24)PBO + LET (72)NoRIB + LET (275)0.77 (0.62-0.97)PBO + LET (262)Liver or lung involvementYesRIB + LET (182)0.81(0.62-1.05)PBO + LET (190)NoRIB + LET (152)0.71 (0.53-0.96)PBO + LET (144)No. of metastatic sites< 3RIB + LET (220)0.78(0.61-1.00)PBO + LET (222)≥ 3RIB + LET (114)0.71(0.51-0.98)PBO + LET (112)
Citation Format: Joyce O'Shaughnessy, Salomon M Stemmer, Howard A Burris, Yoon-Sim Yap, Gabe Sonke, Lowell Hart, Mario Campone, Katarina Petrakova, Eric P Winer, Wolfgang Janni, Pierfranco Conte, David A Cameron, Fabrice André, Carlos Arteaga, Juan Pablo Zarate, Arunava Chakravartty, Tetiana Taran, Fabienne Le Gac, Paolo Serra, Gabriel N Hortobagyi. Overall survival subgroup analysis by metastatic site from the phase 3 MONALEESA-2 study of first-line ribociclib + letrozole in postmenopausal patients with advanced HR+/HER2− breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS2-01.
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Affiliation(s)
- Joyce O'Shaughnessy
- Texas Oncology-Baylor University Medical Center and The US Oncology Research Network, Dallas, TX
| | - Salomon M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Yoon-Sim Yap
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Gabe Sonke
- Medical Oncology, Netherlands Cancer Institute and BOOG Study Center, Amsterdam, Netherlands
| | - Lowell Hart
- Florida Cancer Specialists, Sarah Cannon Research Institute, Fort Myers, FL
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest/René Gauducheau, Saint-Herblain, France
| | - Katarina Petrakova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Eric P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Wolfgang Janni
- Department of Gynecology, University of Ulm, Ulm, Germany
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology and Division of Medical Oncology; University of Padua and Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - David A Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Fabrice André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Carlos Arteaga
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | | | | | | | | | | | - Gabriel N Hortobagyi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Francis K, Kim S, Friedlander M, Gebski V, Coquard IR, Clamp A, Penson R, Oza A, Perri T, Huzarski T, Martin-Lorente C, Cecere S, Colombo N, Ataseven B, Fujiwara K, Sonke G, Vergote I, Pujade-Lauraine E, Kim JW, Lee C. The impact of olaparib dose reduction and treatment interruption on treatment outcome in the SOLO2/ENGOT-ov21 platinum-sensitive recurrent ovarian cancer. Ann Oncol 2022; 33:593-601. [DOI: 10.1016/j.annonc.2022.02.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/29/2022] Open
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Arieta C, Velez D, Hannes S, Meda S, McCarthy B, Lenkala D, Harjanto D, Suri P, Kohler J, McGee J, Kallin D, Turcott P, Nijenhuis C, Rohaan M, Sonke G, Haanen J, DeMario M, Gaynor R, Buuren MV. 201 BNT221, an autologous neoantigen-specific T-cell product for adoptive cell therapy of metastatic ovarian cancer. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundNeoantigens are tumor-specific antigens that are important in the anti-tumor immune response. These antigens are not subject to central immune tolerance and are therefore potentially more immunogenic than tumor-associated antigens. Here, we present the results of a proof-of-concept, pre-clinical study with multiple successful patient material runs generating a neoantigen-specific T-cell product (BNT221/NEO-PTC-01) using leukaphereses from patients with ovarian cancer. These products contain specific T-cell responses targeting multiple neoantigens from each individual patient‘s tumor.MethodsLeukapheresis and tumor biopsy samples were obtained from multiple patients with ovarian cancer and metastatic melanoma cancer under IRB approval using the N16NEON protocol at the Netherlands Cancer Institute subsidized by BioNTech US. Patient-specific neoantigens from the patient‘s biopsy were predicted using our RECON® bioinformatics platform and the best scoring neoantigens were encoded into synthetic peptides or mRNA molecules and were utilized in our ex vivo stimulation protocol, NEO-STIM®, which is used to prime, activate, and expand memory and de novo T-cell responses from both the CD4+ and the CD8+ compartment. High-throughput flow cytometric analysis was performed to characterize the specificity and functionality (cytokine production and cytolytic capacity) of the induced T-cell responses.ResultsNEO-STIM generates T-cell products specific to neoantigens from the peripheral blood of patients. Data will be presented showing the successful induction of 2–10 CD8+ and 4–13 CD4+ T-cell responses per patient, generated using peripheral blood mononuclear cells from patients with ovarian cancer using our NEO-STIM platform. We extensively characterized these T-cell responses and demonstrate that these responses are polyfunctional, specific and have the capacity to degranulate. T cells in the induced product are of effector memory and central memory phenotypes.ConclusionsNEO-STIM is a novel platform that generates ex vivo T-cell responses to high-quality neoantigen targets. Efforts are ongoing to upscale the manufacturing process and move this into a phase I study. BNT221, the neoantigen-specific T cell product generated from this process, is a potent adoptive cell therapy targeting multiple immunogenic neoantigens in patients with metastatic ovarian cancer.Ethics ApprovalLeukapheresis and tumor biopsy samples were obtained from multiple patients with ovarian cancer and metastatic melanoma cancer under IRB approval using the N16NEON protocol at the Netherlands Cancer Institute subsidized by BioNTech US.
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Bradley W, Moore K, Colombo N, Scambia G, Kim BG, Oaknin A, Friedlander M, Lisyanskaya A, Floquet A, Leary A, Sonke G, Gourley C, Banerjee S, Oza A, González-Martín A, Aghajanian C, Cain T, Lowe E, DiSilvestro P. Maintenance olaparib for patients with newly diagnosed, advanced ovarian cancer and a BRCA mutation: 5-year follow-up from SOLO1. Gynecol Oncol 2021. [DOI: 10.1016/s0090-8258(21)00694-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Voorwerk L, Horlings H, Van Dongen M, Sikorska K, Kemper I, Mandjes I, Van Geel J, Boers J, De Boer M, Salgado R, Sonke G, De Visser K, Schumacher T, Blank C, Jager A, Schroder C, Tjan-Heijnen V, Linn S, Kok M. LBA3 Atezolizumab with carboplatin as immune induction in metastatic lobular breast cancer: First results of the GELATO-trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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van der Noordaa MEM, Yau C, Shad S, Osdoit M, Steenbruggen TG, de Croze D, Hamy AS, Lae M, Reyal F, Del Monte-Millán M, Martin M, Tarruella SL, Boughey JC, Goetz M, Hoskin T, Gould R, Valero V, Sonke G, van Seijen M, Wesseling J, Bartlett J, Edge S, Kim MO, Abraham J, Caldas C, Earl H, Provenzano E, Sammut SJ, Cameron D, Graham A, Hall P, MacKintosh L, Fan F, Godwin AK, Schwensen K, Sharma P, DeMichele A, Dunn J, Hiller L, Hayward L, Thomas J, Cole K, Pusztai L, van 't Veer L, Symmans F, Esserman L. Abstract GS4-07: Assessing prognosis after neoadjuvant therapy: A comparison between anatomic ypAJCC staging, residual cancer burden class and neo-bioscore. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs4-07] [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: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in patients with breast cancer is associated with improved survival. Further assessment of the extent of residual disease, using the pathological anatomic American Joint Committee on Cancer staging method (ypStage) or the Residual Cancer Burden (RCB) method, have been shown to add prognostic information for patients with residual disease. Neo-Bioscore, an alternate system to classify response to NAC, includes clinical stage at diagnosis and biology and defines eight prognostic groups. The goal of this study was to compared three scoring systems (anatomic ypStage (7th ed), RCB Class and Neo-Bioscore) and assess whether RCB Class and Neo-Bioscore provide additional prognostic value in the context above anatomic ypStage, the most commonly used method for post-neoadjuvant residual disease assessment. Methods: Data from 5161 patients treated with NAC was pooled from 12 sites. Patients without clinical and pathological staging were excluded, as were patients with HER2+ breast cancer who did not receive neoadjuvant HER2-targeted therapy, leaving 3730 for analysis. PCR was defined as no residual invasive tumor in breast and nodes, i.e. RCB-0 or ypT0/Tis and ypN0. Patients with discordant pCR status by RCB Class vs ypStage (n=9) were excluded. Associations between each scoring system and event-free survival (EFS) were evaluated using the log rank test. EFS at 5 years was estimated using the Kaplan Meier method. Associations between Neo-Bioscore and EFS were assessed in the pCR group. For patients with residual disease, we assessed RCB and Neo-Bioscore within each ypStage. Analysis was performed overall and within subtype. Subgroups with <5 patients were excluded from the survival analyses. Results: ypAJCC staging, RCB class and Neo-Bioscore were all associated with EFS in the overall population and within each subtype (log rank p<0.0001). Of note, 13 patients with a Neo-Bioscore of 7 all recurred or died within 19 months of follow-up. Overall, 34% (1264/3721) of patients achieved a pCR. Their Neo-Bioscore ranges from 0-5, where 3% (37/1264) has a Neo-Bioscore of 5 despite achieving pCR. The Neo-Bioscore was not associated with EFS in case of a pCR, with EFS estimates at 5 years of 95%, 94%, 92%, 93%, 90% and 92% for Neo-Bioscores 0-5 respectively. As HR and HER2 status are components of the score, the range of Neo-Bioscore in the pCR group differs by subtype. However, similar to the overall analysis, the Neo-Bioscore was not prognostic within subtypes in case of pCR. Overall, among the patients who did not achieve pCR, both RCB class and Neo-Bioscore were associated with EFS within ypStages I, II and III. However, the ypStage within which RCB and Neo-Bioscore are prognostic is different for each subtype. RCB class was prognostic in ypStage I in both HR+ subtypes: patients with ypStage-I/RCB-I had significantly improved survival compared to patients with ypStage-I/RCB-II (5-year EFS: 100% vs 83% in HR+HER2- and 95% vs 77% in HR+HER2+). In contrast, for patients with triple negative breast cancer, RCB class was prognostic within ypStage II and III. Analysis by clinical stage and the components of the three systems that contribute most to prognosis will be presented. Conclusions: The degree of response to NAC adds important information to pCR versus residual disease. The Neo-Bioscore was not prognostic among patients with pCR, suggesting that clinical stage (including subtype and grade) adds little information in the setting of a pCR. In contrast, both RCB and Neo-Bioscore provide additional prognostic information to the conventional ypAJCC staging among non-pCR patients, suggesting that clinical stage, tumor biology as well as extent of residual disease all contribute to prognosis in the setting of residual disease after NAC.
Citation Format: Marieke EM van der Noordaa, Christina Yau, Sonal Shad, Marie Osdoit, Tessa G Steenbruggen, Diane de Croze, Anne-Sophie Hamy, Marick Lae, Fabien Reyal, Maria Del Monte-Millán, Miguel Martin, Sara Lopez Tarruella, I-SPY 2 TRIAL Consortium, Judy C Boughey, Matthew Goetz, Tanya Hoskin, Rebecca Gould, Vincent Valero, Gabe Sonke, Maartje van Seijen, Jelle Wesseling, John Bartlett, Stephan Edge, Mi-Ok Kim, Jean Abraham, Carlos Caldas, Helena Earl, Elena Provenzano, Stephen-John Sammut, David Cameron, Ashley Graham, Peter Hall, Lorna MacKintosh, Fang Fan, Andrew K Godwin, Kelsey Schwensen, Priyanka Sharma, Angela DeMichele, Janet Dunn, Louise Hiller, Larry Hayward, Jeremy Thomas, Kimberley Cole, Lajos Pusztai, Laura van 't Veer, Fraser Symmans, Laura Esserman. Assessing prognosis after neoadjuvant therapy: A comparison between anatomic ypAJCC staging, residual cancer burden class and neo-bioscore [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS4-07.
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Affiliation(s)
| | - Christina Yau
- 1University of California, San Francisco, San Francisco, CA
| | - Sonal Shad
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | - Miguel Martin
- 4Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | - Gabe Sonke
- 3Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | - John Bartlett
- 7Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Stephan Edge
- 8Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Mi-Ok Kim
- 1University of California, San Francisco, San Francisco, CA
| | - Jean Abraham
- 9University of Cambridge, Cambridge, United Kingdom
| | | | - Helena Earl
- 9University of Cambridge, Cambridge, United Kingdom
| | | | | | - David Cameron
- 10University of Edinburgh, Edinburgh, United Kingdom
| | - Ashley Graham
- 10University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Hall
- 10University of Edinburgh, Edinburgh, United Kingdom
| | | | - Fang Fan
- 11University of Kansas, Kansas City, KS
| | | | | | | | | | - Janet Dunn
- 13University of Warwick, Coventry, United Kingdom
| | | | - Larry Hayward
- 14Western General Hospital, Edinburgh, United Kingdom
| | - Jeremy Thomas
- 14Western General Hospital, Edinburgh, United Kingdom
| | | | | | | | | | - Laura Esserman
- 1University of California, San Francisco, San Francisco, CA
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van der Voort A, Liefaard M, van Ramshorst M, van Werkhoven E, Scholten A, Wesseling J, Peeters MJV, de Munck L, Sonke G. Abstract PS10-07: Pathologic complete response and 3-year survival with or without pertuzumab using real-world data of stage II and III HER2-positive breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps10-07] [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 Pertuzumab greatly improves pathologic complete response (pCR) rates in early stage HER2-positive breast cancer. Long-term benefit of pertuzumab, however, is less well established, as follow-up of the NEOSPHERE and APHINITY trials did not show clear improvement in overall survival, although patients with high risk of recurrence (e.g. node positive) appeared to benefit. Since its long-term benefit remains uncertain, we compared outcome of patients treated with or without pertuzumab in a quasi-random experiment using real-world data.
Methods We identified all patients with stage II-III HER2-positive breast cancer in the Netherlands treated with neoadjuvant trastuzumab containing chemotherapy between November 2013 and January 2016 from the nationwide Netherlands Cancer Registry. During this period, reimbursement of pertuzumab in the Netherlands was pending and pertuzumab was only available as trial medication for patients in 37 hospitals that participated in the TRAIN-2 study. This setting created a unique opportunity to compare two quasi-random cohorts of patients treated with or without pertuzumab. We used logistic regression analysis to evaluate the association between pertuzumab use and pCR (ypT0/is, ypN0) and Kaplan-Meier estimates and Cox regression analysis for the association with overall survival (OS). Multivariate analyses included age, cT-status, cN-status, hormone receptor (HR) status and grade. Multiple imputation was used to impute missing data for multivariate analysis.
Results We identified 1,124 eligible patients of whom 453 (40%) had received pertuzumab. Baseline characteristics were comparable with and without pertuzumab: 61% of tumors were cT2, 22% cT3, 66% were node positive and 62% ER and/or PR-positive. Grade was missing for 17% in patients treated with and 46% in patients treated without pertuzumab and therefor imputed. PCR in breast and axilla could be determined in 1,091 patients. Pertuzumab use improved pCR rates (65% vs 41%, adjusted odds ratio [aOR] 3.01; 95% confidence interval [CI] 2.29-3.97; p<0.001). At a median follow-up of 59 months (IQR 53-66) 23 deaths had occurred in the pertuzumab group and 68 in the non-pertuzumab group (3-year OS 98% vs 95%; adjusted hazard ratio [aHR]: 0.61; 95% CI:0.38-1.00, p=0.048). Pertuzumab benefit appeared largest in ER/PR negative and cN+ tumors, although the number of events in each subgroup was too small for formal comparisons. Complete-case analysis showed similar aHRs, but with broader 95% confident intervals.
Conclusion This real-world quasi-experiment confirms the efficacy of pertuzumab to achieve a pCR in stage II and III HER2-positive breast cancer. In addition, these data suggest a small absolute overall survival benefit with pertuzumab, most prominently in hormone receptor negative and node positive tumors. Despite the unique setting of two quasi-random cohorts treated with or without pertuzumab and very similar baseline characteristics, residual confounding cannot be fully excluded. Breast cancer specific evaluation and translational work including central revision of tumor grade for missing cases is pending.
pCR (%)3-yr OS (%)Ptzno PtzPtzno PtzaHR (95%CI)Overall65%41%98%95%0.61 (0.38-1.00)HR-positive51%32%98%97%0.70 (0.36-1.33)HR-negative86%55%97%92%0.54 (0.26-1.13)cN071%46%99%100%0.54 (0.14-2.00)cN+62%38%97%93%0.65 (0.39-1.09)
Citation Format: Anna van der Voort, Marte Liefaard, Mette van Ramshorst, Erik van Werkhoven, Astrid Scholten, Jelle Wesseling, Marie-Jeanne Vrancken Peeters, Linda de Munck, Gabe Sonke. Pathologic complete response and 3-year survival with or without pertuzumab using real-world data of stage II and III HER2-positive breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-07.
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Affiliation(s)
| | | | | | | | | | | | | | - Linda de Munck
- 4the Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Gabe Sonke
- 1Netherlands Cancer Institute, Amsterdam, Netherlands
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Shad S, van der Noordaa M, Osdoit M, de Croze D, Hamy AS, Lae M, Reyal F, Martin M, Del Monte-Millán M, López-Tarruella S, Boughey JC, Goetz MP, Hoskin T, Gould R, Valero V, Sonke G, Steenbruggen TG, van Seijen M, Wesseling J, Bartlett J, Edge S, Kim MO, Abraham J, Caldas C, Earl H, Provenzano E, Sammut SJ, Cameron D, Graham A, Hall P, Mackintosh L, Fang F, Godwin AK, Schwensen K, Sharma P, DeMichele A, Dunn J, Hiller L, Hayward L, Thomas J, Cole K, Pusztai L, Van't Veer L, Symmans F, Esserman L, Yau C. Abstract PD13-02: Site of recurrence after neoadjuvant therapy: A multi-center pooled analysis. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd13-02] [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: Achieving a pathologic complete response (pCR) has been shown on the patient level to predict excellent long-term event-free survival outcomes. Residual cancer burden (RCB) quantifies the extent of residual disease for patients who did not achieve pCR. We have previously observed in the I-SPY 2 TRIAL that while metastatic events outside the central nervous system (CNS) were dramatically reduced in the setting of pCR, the incidence of CNS metastasis remained similar across RCB classes, raising the possibility that these CNS events may be independent of response in the breast. In this study, we evaluate the type and sites of recurrences by RCB in a large pooled dataset, which allows for analysis within subtype, to validate these findings. Methods: 5161 patients pooled across 12 institutions/trials with available RCB and event-free survival (EFS) data were included in this analysis. EFS was calculated as the interval between treatment initiation, and locoregional recurrence, distant recurrence or death from any cause; patients without event are censored at time of last follow-up. The median follow-up is 4.6 years. We summarized the EFS event type, further sub-dividing the distant recurrence events (DR) by their site of relapse (CNS-only, CNS and other sites, Non-CNS). We used a competing risk (Fine-Gray) model to assess which of these site-specific relapses differ between RCB classes and estimated the cumulative incidence of CNS-only and non-CNS events at 5 years. Analyses were performed across the entire study population and within HR/HER2 defined subtypes. Results: Among the 5161 subjects, there were 1164 EFS events, including 92 (7.9%) local recurrences (without distant recurrence and/or death) and 1072 distant recurrence-free survival (DRFS) events. Among the DRFS events, 158 patients died without a distant recurrence. 914 experienced distant recurrences, including 90 (9.8%) with CNS-only, 145 (15.9%) with CNS and other sites, 664 (72.6%) with non-CNS distant recurrence; 15 (1.6%) patients had missing recurrence site information. Table 1 summarizes the cumulative incidence of CNS-only and non-CNS recurrence at 5 years and the proportion of CNS-only recurrences among DR events by RCB class overall and within each HR/HER2 subtypes. The incidence of CNS-only recurrences was low and similar across RCB classes. In contrast, the incidence of non-CNS recurrences increases with increasing RCB. As a result, CNS-only recurrences are proportionally higher within the RCB-0 and RCB-I than in the RCB-II and RCB-III groups, largely because of the low DR event rate and relative low frequency of non-CNS recurrence events within the RCB-0 and RCB-I classes. Overall, 27% of the recurrences in the setting of pCR (RCB-0) are due to CNS-only recurrences.Conclusions: Consistent with previous studies, our large pooled analysis confirmed that CNS-only recurrences are uncommon but appear similar across RCB groups, independent of response, suggesting that the CNS is a treatment sanctuary site. In contrast, non-CNS recurrence rates increase as RCB increases. These findings suggest that inclusion of CNS-only recurrences as an outcome event may impact the association between neoadjuvant therapy response and long-term outcomes in the context of current therapies. Novel therapies that cross the blood brain barrier will be needed to impact CNS recurrence rates.
Table 1: Cumulative Incidence of CNS Only and non-CNS Distant Recurrences at 5 years and proportion of CNS-only events among DR eventsRCB Class0IIIIIIpOverall (5161)N16766622017806Cum. Inc. CNS Only2%2%2%1%0.627Cum. Inc. Non-CNS3%6%16%27%<0.001# CNS-Only / # DR events (%)26/96 (27%)14/74 (19%)39/443 (9%)11/301 (4%)HR-HER2- (1774)N770212590202Cum. Inc. CNS Only2%3%2%4%0.298Cum. Inc. Non-CNS4%11%19%42%<0.001# CNS-Only / # DR events (%)13/50 (26%)6/32 (19%)13/148 (9%)8/111 (7%)HR-HER2+ (572)N3766710029Cum. Inc. CNS Only1%5%5%0%0.022Cum. Inc. Non-CNS2%5%18%38%<0.001# CNS-Only / # DR events (%)4/17 (24%)3/10 (30%)6/31 (19%)0/13 (0%)HR+HER2+ (858)N31317229182Cum. Inc. CNS Only1%1%2%0%0.37Cum. Inc. Non-CNS2%3%15%26%<0.001# CNS-Only / # DR events (%)3/10 (30%)2/16 (12%)7/68 (10%)0/29 (0%)HR+HER2- (1957)N2172111036493Cum. Inc. CNS Only3%2%1%0.2%0.087Cum. Inc. Non-CNS5%4%13%20%<0.001# CNS-Only / # DR events (%)6/19 (32%)3/16 (19%)13/196 (7%)3/148 (2%)
Citation Format: Sonal Shad, Marieke van der Noordaa, Marie Osdoit, Diane de Croze, Anne-Sophie Hamy, Marick Lae, Fabien Reyal, Miguel Martin, María Del Monte-Millán, Sara López-Tarruella, I-SPY 2 TRIAL Consortium, Judy C Boughey, Matthew P Goetz, Tanya Hoskin, Rebekah Gould, Vicente Valero, Gabe Sonke, Tessa G Steenbruggen, Maartje van Seijen, Jelle Wesseling, John Bartlett, Stephen Edge, Mi-Ok Kim, Jean Abraham, Carlos Caldas, Helena Earl, Elena Provenzano, Stephen-John Sammut, David Cameron, Ashley Graham, Peter Hall, Lorna Mackintosh, Fan Fang, Andrew K Godwin, Kelsey Schwensen, Priyanka Sharma, Angela DeMichele, Janet Dunn, Louise Hiller, Larry Hayward, Jeremy Thomas, Kimberly Cole, Lajos Pusztai, Laura Van't Veer, Fraser Symmans, Laura Esserman, Christina Yau. Site of recurrence after neoadjuvant therapy: A multi-center pooled analysis [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD13-02.
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Affiliation(s)
- Sonal Shad
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | | | | | | | - Miguel Martin
- 4Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | - Gabe Sonke
- 2Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | | | | | - John Bartlett
- 7Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Stephen Edge
- 8Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Mi-Ok Kim
- 1University of California, San Francisco, San Francisco, CA
| | - Jean Abraham
- 9University of Cambridge, Cambridge, United Kingdom
| | | | - Helena Earl
- 9University of Cambridge, Cambridge, United Kingdom
| | | | | | - David Cameron
- 10University of Edinburgh, Edinburgh, United Kingdom
| | - Ashley Graham
- 10University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Hall
- 10University of Edinburgh, Edinburgh, United Kingdom
| | | | - Fan Fang
- 11University of Kansas, Kansas City, KS
| | | | | | | | | | - Janet Dunn
- 13University of Warwick, Coventry, United Kingdom
| | | | - Larry Hayward
- 14Western General Hospital, Edinburgh, United Kingdom
| | - Jeremy Thomas
- 14Western General Hospital, Edinburgh, United Kingdom
| | | | | | | | | | - Laura Esserman
- 1University of California, San Francisco, San Francisco, CA
| | - Christina Yau
- 1University of California, San Francisco, San Francisco, CA
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De Haan R, Pluim D, Verwijs M, Sonke G, Van den Heuvel M, Van Triest B, Vens C, Verheij M. OC-0438: Clinical pharmacodynamics support biological effectivity of low dose olaparib as radiosensitizer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Koole SN, Bruijs L, Fabris C, Sikorska K, Engbersen M, Schagen van Leeuwen JH, Schreuder HWR, Hermans RH, van der Velden J, Arts HJG, van Ham M, Van Dam P, Vuylsteke P, Lahaye M, Sonke G, Driel WV. Central radiology assessment of the randomized phase III open-label OVHIPEC-1 trial in ovarian cancer. Int J Gynecol Cancer 2020; 30:1928-1934. [DOI: 10.1136/ijgc-2020-001825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
IntroductionHyperthermic intraperitoneal chemotherapy (HIPEC) improved investigator-assessed recurrence-free survival and overall survival in patients with stage III ovarian cancer in the phase III OVHIPEC-1 trial. We analyzed whether an open-label design affected the results of the trial by central blinded assessment of recurrence-free survival, and tested whether HIPEC specifically targets the peritoneal surface by analyzing the site of disease recurrence.MethodsOVHIPEC-1 was an open-label, multicenter, phase III trial that randomized 245 patients after three cycles of neoadjuvant chemotherapy to interval cytoreduction with or without HIPEC using cisplatin (100 mg/m2). Patients received three additional cycles of chemotherapy after surgery. Computed tomography (CT) scans and serum cancer antigen 125 (CA125) measurements were performed during chemotherapy, and during follow-up. Two expert radiologists reviewed all available CT scans. They were blinded for treatment allocation and clinical outcome. Central revision included Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 measurements and peritoneal cancer index scorings at baseline, during treatment, and during follow-up. Time to centrally-revised recurrence was compared between study arms using Cox proportional hazard models. Subdistribution models compared time to peritoneal recurrence between arms, accounting for competing risks.ResultsCT scans for central revision were available for 231 patients (94%) during neoadjuvant treatment and 212 patients (87%) during follow-up. Centrally-assessed median recurrence-free survival was 9.9 months in the surgery group and 13.2 months in the surgery+HIPEC group (HR for disease recurrence or death 0.72, 95% CI 0.55 to 0.94; p=0.015). The improved recurrence-free survival and overall survival associated with HIPEC were irrespective of response to neoadjuvant chemotherapy and baseline peritoneal cancer index. Cumulative incidence of peritoneal recurrence was lower after surgery+HIPEC, but there was no difference in extraperitoneal recurrences.ConclusionCentrally-assessed recurrence-free survival analysis confirms the benefit of adding HIPEC to interval cytoreductive surgery in patients with stage III ovarian cancer, with fewer peritoneal recurrences. These results rule out radiological bias caused by the open-label nature of the study.
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Tjokrowidjaja A, Lee CK, Friedlander M, Gebski V, Gladieff L, Ledermann J, Penson R, Oza A, Korach J, Huzarski T, Manso L, Pisano C, Asher R, Lord SJ, Kim SI, Lee JY, Colombo N, Park-Simon TW, Fujiwara K, Sonke G, Vergote I, Kim JW, Pujade-Lauraine E. Concordance between CA-125 and RECIST progression in patients with germline BRCA-mutated platinum-sensitive relapsed ovarian cancer treated in the SOLO2 trial with olaparib as maintenance therapy after response to chemotherapy. Eur J Cancer 2020; 139:59-67. [PMID: 32977221 DOI: 10.1016/j.ejca.2020.08.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/26/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Limited evidence exists to support CA-125 as a valid surrogate biomarker for progression in patients with ovarian cancer on maintenance PARP inhibitor (PARPi) therapy. We aimed to assess the concordance between CA-125 and Response Evaluation Criteria in Solid Tumours (RECIST) criteria for progression in patients with BRCA mutations on maintenance PARPi or placebo. METHODS We extracted data on progression as defined by Gynecologic Cancer InterGroup CA-125, investigator- and independent central-assessed RECIST from the SOLO2/ENGOT-ov21(NCT01874353) trial. We excluded those with progression other than by RECIST, progression on date of randomisation, and no repeat CA-125 beyond baseline. We evaluated the concordance between CA-125 progression and RECIST progression, and assessed the negative (NPV) and positive predictive value (PPV). RESULTS Of 295 randomised patients, 275 (184 olaparib, 91 placebo) were included. 171 patients had investigator-assessed RECIST progression. Of 80 patients with CA-125 progression, 77 had concordant RECIST progression (PPV 96%, 95% confidence interval 90-99%). Of 195 patients without CA-125 progression, 94 had RECIST progression (NPV 52%, 45-59%). Within treatment arms, PPV was similar (olaparib: 95% [84-99%], placebo: 97% [87-100%]) but NPV was lower in patients on placebo (olaparib: 60% [52-68%], placebo: 30% [20-44%]). Of 94 patients with RECIST but without CA-125 progression, 64 (68%) had CA-125 that remained within normal range. We observed similar findings using independent-assessed RECIST. CONCLUSIONS Almost half the patients without CA-125 progression had RECIST progression, and most of these had CA-125 within the normal range. Regular computed tomography imaging should be considered as part of surveillance in patients treated with or without maintenance olaparib rather than relying on CA-125 alone.
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Affiliation(s)
- Angelina Tjokrowidjaja
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; Department of Medical Oncology, St George Hospital, Kogarah, NSW 2217, Australia.
| | - Chee K Lee
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; Department of Medical Oncology, St George Hospital, Kogarah, NSW 2217, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Laurence Gladieff
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, 31059 Toulouse, France
| | | | - Richard Penson
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Amit Oza
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C1, Canada
| | - Jacob Korach
- Gynecologic Oncology Department, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, 52621 Tel Aviv, Israel
| | - Tomasz Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Luis Manso
- Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Carmela Pisano
- Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), 80131 Naples, Italy
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia
| | - Sarah J Lord
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW 2050, Australia; School of Medicine, The University of Notre Dame, Sydney, NSW 2007, Australia
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Nicoletta Colombo
- Gynecology Program, European Institute of Oncology, IRCCS, 20141 Milan, Italy; School of Medicine and Surgery, University Milan Bicocca, 20126 Milan, Italy
| | - Tjoung-Won Park-Simon
- Department of Gynaecology and Obstetrics, Medical University Hannover, 30625 Hannover, Germany
| | - Keiichi Fujiwara
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama 350-0495, Japan
| | - Gabe Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Ignace Vergote
- Department of Oncology, KU Leuven - University of Leuven, B-3000 Leuven, Belgium; Division of Gynaecological Oncology, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, South Korea
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Koole S, van Stein R, Sikorska K, Barton D, Perrin L, Brennan D, Zivanovic O, Mosgaard BJ, Fagotti A, Colombo PE, Sonke G, Driel WJV. Primary cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (HIPEC) for FIGO stage III epithelial ovarian cancer: OVHIPEC-2, a phase III randomized clinical trial. Int J Gynecol Cancer 2020; 30:888-892. [PMID: 32205449 DOI: 10.1136/ijgc-2020-001231] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to interval cytoreductive surgery improves recurrence-free and overall survival in patients with FIGO stage III ovarian cancer who are ineligible for primary cytoreductive surgery. The effect of HIPEC remains undetermined in patients who are candidates for primary cytoreductive surgery. PRIMARY OBJECTIVE The primary objective is to evaluate the effect of HIPEC on overall survival in patients with FIGO stage III epithelial ovarian cancer who are treated with primary cytoreductive surgery resulting in no residual disease, or residual disease up to 2.5 mm in maximum dimension. STUDY HYPOTHESIS We hypothesize that the addition of HIPEC to primary cytoreductive surgery improves overall survival in patients with primary FIGO stage III epithelial ovarian cancer. TRIAL DESIGN This international, randomized, open-label, phase III trial will enroll 538 patients with newly diagnosed FIGO stage III epithelial ovarian cancer. Following complete or near-complete (residual disease ≤2.5 mm) primary cytoreduction, patients are randomly allocated (1:1) to receive HIPEC or no HIPEC. All patients will receive six courses of platinum-paclitaxel chemotherapy, and maintenance PARP-inhibitor or bevacizumab according to current guidelines. MAJOR ELIGIBILITY CRITERIA Patients with FIGO stage III primary epithelial ovarian, fallopian tube, or primary peritoneal cancer are eligible after complete or near-complete primary cytoreductive surgery. Patients with resectable umbilical, spleen, or local bowel lesions may be included. Enlarged extra-abdominal lymph nodes should be negative on FDG-PET or fine-needle aspiration/biopsy. PRIMARY ENDPOINT The primary endpoint is overall survival. SAMPLE SIZE To detect a HR of 0.67 in favor of HIPEC, 200 overall survival events are required. With an expected accrual period of 60 months and 12 months additional follow-up, 538 patients need to be randomized. ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS The OVHIPEC-2 trial started in January 2020 and primary analyses are anticipated in 2026. TRIAL REGISTRATION ClinicalTrials.gov:NCT03772028.
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Affiliation(s)
- Simone Koole
- Department of Gynaecology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ruby van Stein
- Department of Gynaecology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Department of Biostatistics, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Desmond Barton
- Department of Gynaecological Oncology, Royal Marsden Hospital NHS Trust, London, UK
| | - Lewis Perrin
- Queensland Centre for Gynaecological Cancer, Herston, Queensland, Australia
| | - Donal Brennan
- Gynaecology Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Oliver Zivanovic
- Department of Gynecologic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Berit Jul Mosgaard
- Department of Gynaecology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Fagotti
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pierre-Emmanuel Colombo
- Department of Surgical Oncology, Institut régional du Cancer de Montpellier, Montpellier, France
| | - Gabe Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - W J van Driel
- Department of Gynaecology, Netherlands Cancer Institute, Amsterdam, The Netherlands .,Center for Gynaecologic Oncology Amsterdam, Center for Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands.,Dutch Gynecological Oncology Group (DGOG), the Netherlands, the Netherlands.,Dutch Peritoneal Oncology Group (DPOG), the Netherlands, the Netherlands
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Kjoe PLM, van der Wall E, Konings I, Jager A, Sonke G, van Ommen-Nijhof A, Schagen S. Abstract OT1-04-06: Evaluation of cognitive functioning in patients with metastatic breast cancer treated with endocrine or combined therapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot1-04-06] [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: A subset of patients with breast cancer is vulnerable to treatment-related cognitive problems. However, relatively little is known about the cognitive effects of endocrine treatment and the novel cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors in the metastatic setting. Research on possible cognitive effects of these therapies is needed, since cognitive impairment can affect role functioning, independence and quality of life.
Trial design: The current study is a side study of the SONIA (Selecting the optimal position of CDK4/6 inhibitors in hormone-receptor-positive advanced breast cancer) trial: a multicenter, randomized phase III study. The side study is an observational study with nine months of follow-up, comparing two intervention groups (first line non-steroidal aromatase inhibitor + CDK4/6 inhibition vs. single agent non-steroidal aromatase inhibitor) and a reference group of people without a history of cancer. Cognition will be measured at start of treatment (T0) and nine months later (T1), using the Amsterdam Cognition Scan, a validated online neuropsychological test battery that is completed at home without supervision. It includes tests of among others attention, memory, and executive functioning, and two questionnaires on anxiety and depression, and fatigue.
Specific aims: The main objective is to evaluate if there is a difference in cognitive functioning over time in patients with metastatic breast cancer who will undergo first line endocrine treatment + CDK4/6 inhibition vs. endocrine treatment alone.
Eligibility criteria: All patients who participate in the main SONIA study will be eligible for participation: adult women (≥ 18 years of age) with proven diagnosis of hormone receptor-positive, human epidermal growth factor receptor 2 negative adenocarcinoma of the breast with evidence of loco-regional recurrent or metastatic disease not amenable to resection or radiation therapy with curative intent, for whom chemotherapy is not clinically indicated and who have not received any prior systemic anti-cancer therapy for metastatic disease. Participants in the reference group are patients’ female relatives/friends without a history of cancer and without neurological/psychiatric symptoms influencing cognition, who have a sufficient level of Dutch and access to a computer with internet.
Statistical methods: We will use a mixed effects modeling approach to examine changes in cognition from baseline to follow-up between the two intervention groups and the reference group, adjusting for non-ignorable drop-out patterns. The primary endpoint will be the change from baseline to follow-up on the total score of cognition.
Present accrual and target accrual: With an accrual period of 21 months and 9 months of follow-up, inclusion of 260 patients is required. In addition, our already existing reference group (n=157) will be expanded by recruiting participants’ female relatives/friends without a history of cancer.
As of June 2019, 435 patients have enrolled in the main SONIA study. Target accrual is 1050 patients.
Contact information
Study coordinator: Philippe Lee Meeuw Kjoe, Netherlands Cancer Institute, p.lee.meeuw.kjoe@nki.nl
PI: Elsken van der Wall, MD, PhD, UMC Utrecht Cancer Center, E.vanderWall@umcutrecht.nl
PI: Sanne Schagen, PhD, Netherlands Cancer Institute, s.schagen@nki.nl
Citation Format: Philippe Lee Meeuw Kjoe, Elsken van der Wall, Inge Konings, Agnes Jager, Gabe Sonke, Annemiek van Ommen-Nijhof, Sanne Schagen. Evaluation of cognitive functioning in patients with metastatic breast cancer treated with endocrine or combined therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT1-04-06.
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Affiliation(s)
| | | | - Inge Konings
- 3Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Agnes Jager
- 4Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Gabe Sonke
- 1Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Sanne Schagen
- 5Netherlands Cancer Institute and University of Amsterdam, Amsterdam, Netherlands
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Yau C, van der Noordaa M, Wei J, Osdoit M, Reyal F, Hamy AS, Lae M, Martin M, del Monte M, Boughey JC, Gould R, Wesseling J, Steenbruggen T, van Seijen M, Sonke G, Edge S, Sammut SJ, Provenzano E, Abraham J, Hall P, Graham A, Mackintosh L, Cameron D, Wang A, Sharma P, Cole K, Pusztai L, Kim MO, van ‘t Veer L, Esserman L, Symmans WF. Abstract GS5-01: Residual cancer burden after neoadjuvant therapy and long-term survival outcomes in breast cancer: A multi-center pooled analysis. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-gs5-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Recent studies have demonstrated independent validation of the prognostic relevance of residual cancer burden (RCB) after neoadjuvant chemotherapy. However, a pooled subject-level analysis of multiple cohorts is needed to determine estimates of long-term prognosis for each class of RCB in each phenotypic subtype of breast cancer (BC) to better inform on patient outcomes. Also, a pooled subject-level analysis allows more detailed analyses of generalizability of the prognostic meaning of RCB assessments in a broader experience of practice settings. Method: Subject-level RCB results, with relevant clinical and pathologic stage, tumor subtype and grade, demographic, treatment and follow-up data from 11 institutes/trials are being collected for combined analysis. The association between the continuous RCB index and event-free survival (EFS), and distant recurrence free survival (DRFS) were assessed using mixed effect Cox models with the incorporation of random RCB coefficients to account for between-study heterogeneity. We will also allow for differences in baseline hazard across biological BC subtypes and, if needed, across studies as well. In addition to this stratified mixed effect model, a multivariate analysis adjusting for age, T-category, nodal status and grade was performed within each subtype. In addition, mixed effect Cox models will be employed to evaluate association between RCB index with EFS and DRFS within each HR/HER2 subtype. Kaplan Meier estimates of EFS and DRFS at 5 and 10 years were computed for each RCB class within subtype. Results: We analyzed subject-level data from 9 institutes/trials representing 4077 patients currently available from an anticipated final total of 4,800 patients (to be presented at the meeting). There were 950 EFS and 876 DRFS events during follow up (median 65 months, IQR: 70 months). RCB index (continuous) was independently prognostic within each subtype: HR+/HER2- (EFS HR (per unit increase in RCB index) =1.64, 95%CI 1.48-1.82; DRFS HR=1.68, 1.51-1.87), HR+/HER2+ (EFS HR=1.80, 1.57-2.05; DRFS HR=1.93, 1.67-2.24), HR-/HER2+ (EFS HR=2.15, 1.76-2.62; DRFS HR=2.10, 1.77-2.50), and HR-/HER2- (EFS HR=2.05, 1.89-2.22; DRFS HR=2.16, 1.90-2.46); and remained prognostic in multivariate models adjusting for age, grade, and clinical T and N stage at diagnosis. Table 1 contains the response rate and estimated EFS at 5 years and 10 years for each RCB class within each HR/HER2 phenotype (DRFS results were similar). Conclusions: Long-term prognosis after pCR was similarly excellent in all phenotypic subtypes. RCB index and classification was independently and strongly prognostic in all subtypes, and generalizable to multiple practice settings. Prognostic differences by RCB class occurred within 5 years in HR- BC, but extended to 10 years in HR+ BC. RCB-I had slightly worse EFS than pCR in HR- BC and HR+/HER2+ BC (after 5 years), but the same EFS as pCR in HR+/HER2- BC. Complete analysis of all subjects, including neoadjuvant treatments, will be presented at the meeting.
PhenotypeOutcomepCRRCB-IRCB-IIRCB-IIIHR+/HER2-Frequency (%)11%10%52%27%(N=1467)5 yr EFS (95% CI)91% (86-96)93% (89-98)82% (79-85)70% (65-75)10 yr EFS (95% CI)84% (75-93)88% (82-95)71% (67-75)52% (46-58)HR+/HER2+Frequency (%)38%18%35%9%(N=762)5 yr EFS (95% CI)94% (91-97)93% (88-98)78% (73-84)49% (37-65)10 yr EFS (95% CI)91% (86-96)79% (70-90)65% (59-73)42% (29-60)HR-/HER2+Frequency (%)66%11%18%5%(N=550)5 yr EFS (95% CI)93% (90-96)88% (79-97)60% (50-71)45% (30-69)10 yr EFS (95% CI)90% (86-94)84% (74-95)56% (46-68)45% (30-69)HR-/HER2-Frequency (%)41%13%33%13%(N=1293)5 yr EFS (95% CI)92% (90-94)85% (79-91)68% (63-72)28% (21-36)10 yr EFS (95% CI)87% (82-91)80% (72-88)63% (58-68)24% (18-33)
Citation Format: Christina Yau, Marieke van der Noordaa, Jane Wei, Marie Osdoit, Fabien Reyal, Anne-Sophie Hamy, Marick Lae, Miguel Martin, Maria del Monte, I-SPY 2 TRIAL Consortium, Judy C Boughey, Rebekah Gould, Jelle Wesseling, Tessa Steenbruggen, Maartje van Seijen, Gabe Sonke, Stephen Edge, Stephen-John Sammut, Elena Provenzano, Jean Abraham, Peter Hall, Ashley Graham, Lorna Mackintosh, David Cameron, Alice Wang, Priyanka Sharma, Kimberly Cole, Lajos Pusztai, Mi-Ok Kim, Laura van ‘t Veer, Laura Esserman, W. Fraser Symmans. Residual cancer burden after neoadjuvant therapy and long-term survival outcomes in breast cancer: A multi-center pooled analysis [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr GS5-01.
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Affiliation(s)
- Christina Yau
- 1University of California, San Francisco, San Francisco, CA
| | | | - Jane Wei
- 1University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Miguel Martin
- 3Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria del Monte
- 3Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | - Gabe Sonke
- 6Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Stephen Edge
- 8Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | - Jean Abraham
- 9University of Cambridge, Cambridge, United Kingdom
| | - Peter Hall
- 10University of Edinburgh, Edinburgh, United Kingdom
| | - Ashley Graham
- 10University of Edinburgh, Edinburgh, United Kingdom
| | | | - David Cameron
- 10University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | | | - Mi-Ok Kim
- 1University of California, San Francisco, San Francisco, CA
| | | | - Laura Esserman
- 1University of California, San Francisco, San Francisco, CA
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Haan RD, Pluim D, Verwijs M, Sonke G, Heuvel MVD, Triest BV, Verheij M, Vens C. Abstract C009: Clinical pharmacokinetic and pharmacodynamic analyses support biological effectivity of the PARP inhibitor olaparib as radiosensitizer at low doses. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-c009] [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
Introduction: PARP inhibitors are promising radiosensitizers. Currently identified recommended phase II doses of PARP inhibitors in combination with radiotherapy are 10-fold lower than the EMA and FDA approved dose as single agent. The purpose of this study is to investigate the biologically effective dose range of olaparib for its use as radiosensitizer by assessing pharmacokinetics (PK) and pharmacodynamics (PD). Both the inhibition of pre-treatment PAR levels and the inhibition of radiation induced PARylation therefore have to be determined. Methods: We included PK and PD samples of all NSCLC and breast cancer patients treated at olaparib doses up to 50mg bi-daily (BID) in two phase 1 trials combining radical radiotherapy with olaparib. Plasma samples were collected for PK analysis (ranging from steady state pre-dose olaparib until +12/24 hrs after intake) and peripheral blood mononuclear cells (PBMCs) for PD analysis (pre-treatment, +3 hrs and +12/24 hrs after olaparib intake). Breast cancer patients with the primary tumor in situ had biopsies taken pre-treatment and during olaparib treatment (+3 hrs after intake) before the first fraction of radiotherapy. Olaparib concentrations were determined by HPLC-MS/MS. PAR levels were determined by commercially available ELISA, following both the NCI protocol and REP assay (de Haan et al, 2017) that includes ex vivo irradiation of intact cells to activate PARylation by PARP. PAR levels determined by the REP assay were used to calculate PAR level inhibition during treatment. Results: PK/PD data from blood samples were available from 28 NSCLC patients and 7 breast cancer patients treated with radical radiotherapy and olaparib (17 at 25mg once daily (QD), 14 at 25mg BID and 4 at 50mg BID). Repeat biopsies were available from six out of seven breast cancer patients. The plasma olaparib concentrations increased with the dose levels and showed an expected wide intra-patient variation. In tumors the olaparib concentration varied between 178 and 1441 ng/g with a median tumor to plasma ratio of 0.47. PD analyses demonstrate a significant reduction in PAR levels in PBMCs during olaparib treatment (>95% at +3 hrs after olaparib intake for all dose levels, >90% at +12 hrs in the 25mg BID dose level and 66-99% at +24 hrs in the 25mg QD dose level; all p<0.0001). In pre-treatment samples, ex vivo radiation induced PAR levels by 66-fold (range 23 to 174). This radiation induced PARylation was abolished during olaparib treatment. Compared to corresponding pre-treatment PBMC samples, PAR levels in pre-treatment tumor biopsy samples were higher in all but one patient (median 7-fold higher, range 0.6-60), and increased by only 1.5-fold after ex vivo radiation. Also in tumors, olaparib abolished radiation induced PARylation. PAR levels were reduced by 89% (range 83-99.7%, p<0.0001). Conclusion: Olaparib doses as low as 25mg once and twice daily inhibit PARP activation by irradiation and reduce PAR levels >95% in PBMCs and >83% in tumors, thereby showing biological effectivity. The tumor olaparib concentrations determined in this study were all within a range that has been shown to radiosensitize in preclinical models. Together this supports further development of PARP inhibitors as radiosensitizer at low doses.
Citation Format: Rosemarie de Haan, Dick Pluim, Manon Verwijs, Gabe Sonke, Michel van den Heuvel, Baukelien van Triest, Marcel Verheij, Conchita Vens. Clinical pharmacokinetic and pharmacodynamic analyses support biological effectivity of the PARP inhibitor olaparib as radiosensitizer at low doses [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr C009. doi:10.1158/1535-7163.TARG-19-C009
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Affiliation(s)
| | - Dick Pluim
- 1the Netherlands Cancer Institute, Amsterdam
| | | | - Gabe Sonke
- 1the Netherlands Cancer Institute, Amsterdam
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Witlox L, Schagen SB, de Ruiter MB, Geerlings MI, Peeters PHM, Koevoets EW, van der Wall E, Stuiver M, Sonke G, Velthuis MJ, Palen JAMVD, Jobsen JJ, May AM, Monninkhof EM. Effect of physical exercise on cognitive function and brain measures after chemotherapy in patients with breast cancer (PAM study): protocol of a randomised controlled trial. BMJ Open 2019; 9:e028117. [PMID: 31227537 PMCID: PMC6597001 DOI: 10.1136/bmjopen-2018-028117] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION After treatment with chemotherapy, many patients with breast cancer experience cognitive problems. While limited interventions are available to improve cognitive functioning, physical exercise showed positive effects in healthy older adults and people with mild cognitive impairment. The Physical Activity and Memory study aims to investigate the effect of physical exercise on cognitive functioning and brain measures in chemotherapy-exposed patients with breast cancer with cognitive problems. METHODS AND ANALYTICS One hundred and eighty patients with breast cancer with cognitive problems 2-4 years after diagnosis are randomised (1:1) into an exercise intervention or a control group. The 6-month exercise intervention consists of twice a week 1-hour aerobic and strength exercises supervised by a physiotherapist and twice a week 1-hour Nordic or power walking. The control group is asked to maintain their habitual activity pattern during 6 months. The primary outcome (verbal learning) is measured at baseline and 6 months. Further measurements include online neuropsychological tests, self-reported cognitive complaints, a 3-tesla brain MRI, patient-reported outcomes (quality of life, fatigue, depression, anxiety, work performance), blood sampling and physical fitness. The MRI scans and blood sampling will be used to gain insight into underlying mechanisms. At 18 months online neuropsychological tests, self-reported cognitive complaints and patient-reported outcomes will be repeated. ETHICS AND DISSEMINATION Study results may impact usual care if physical exercise improves cognitive functioning for breast cancer survivors. TRIAL REGISTRATION NUMBER NTR6104.
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Affiliation(s)
- Lenja Witlox
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne B Schagen
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michiel B de Ruiter
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra H M Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emmie W Koevoets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- ACHIEVE Center of Applied Research, Faculty of Health, University of Applied Sciences, Amsterdam, The Netherlands
| | - Gabe Sonke
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Miranda J Velthuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Job A M van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Research Methodology, Measurement, Universiteit Twente, Enschede, The Netherlands
| | - Jan J Jobsen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Sweegers MG, Altenburg TM, Brug J, May AM, van Vulpen JK, Aaronson NK, Arbane G, Bohus M, Courneya KS, Daley AJ, Galvao DA, Garrod R, Griffith KA, Van Harten WH, Hayes SC, Herrero-Román F, Kersten MJ, Lucia A, McConnachie A, van Mechelen W, Mutrie N, Newton RU, Nollet F, Potthoff K, Schmidt ME, Schmitz KH, Schulz KH, Sonke G, Steindorf K, Stuiver MM, Taaffe DR, Thorsen L, Twisk JW, Velthuis MJ, Wenzel J, Winters-Stone KM, Wiskemann J, Chin A Paw MJ, Buffart LM. Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data. Br J Sports Med 2018; 53:812. [DOI: 10.1136/bjsports-2018-099191] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 01/10/2023]
Abstract
ObjectiveTo optimally target exercise interventions for patients with cancer, it is important to identify which patients benefit from which interventions.DesignWe conducted an individual patient data meta-analysis to investigate demographic, clinical, intervention-related and exercise-related moderators of exercise intervention effects on physical fitness in patients with cancer.Data sourcesWe identified relevant studies via systematic searches in electronic databases (PubMed, Embase, PsycINFO and CINAHL).Eligibility criteriaWe analysed data from 28 randomised controlled trials investigating the effects of exercise on upper body muscle strength (UBMS) and lower body muscle strength (LBMS), lower body muscle function (LBMF) and aerobic fitness in adult patients with cancer.ResultsExercise significantly improved UBMS (β=0.20, 95% Confidence Interval (CI) 0.14 to 0.26), LBMS (β=0.29, 95% CI 0.23 to 0.35), LBMF (β=0.16, 95% CI 0.08 to 0.24) and aerobic fitness (β=0.28, 95% CI 0.23 to 0.34), with larger effects for supervised interventions. Exercise effects on UBMS were larger during treatment, when supervised interventions included ≥3 sessions per week, when resistance exercises were included and when session duration was >60 min. Exercise effects on LBMS were larger for patients who were living alone, for supervised interventions including resistance exercise and when session duration was >60 min. Exercise effects on aerobic fitness were larger for younger patients and when supervised interventions included aerobic exercise.ConclusionExercise interventions during and following cancer treatment had small effects on UBMS, LBMS, LBMF and aerobic fitness. Demographic, intervention-related and exercise-related characteristics including age, marital status, intervention timing, delivery mode and frequency and type and time of exercise sessions moderated the exercise effect on UBMS, LBMS and aerobic fitness.
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Jastrzebski K, Thijssen B, Majewski I, Mulder L, Ramshorst MV, Lips E, Sonke G, Wesseling J, Beijersbergen R, Wessels L. PO-467 Integrative modelling to understand and predict cancer drug response. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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24
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Lips E, Best M, Sol N, Vancura A, Mulder L, Sonke G, Tannous B, Wesseling J, Wurdinger T. PO-498 Spliced RNA panels from tumor-educated platelets (TEP) enable detection of early breast cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Dackus GM, Ter Hoeve ND, Opdam M, Vreuls W, Varga Z, Koop E, Willems SM, Van Deurzen CH, Groen EJ, Cordoba A, Bart J, Mooyaart AL, van den Tweel JG, Zolota V, Wesseling J, Sapino A, Chmielik E, Ryska A, Amant F, Broeks A, Kerkhoven R, Stathonikos N, Veta M, Voogd A, Jozwiak K, Hauptmann M, Hoogstraat M, Schmidt MK, Sonke G, van der Wall E, Siesling S, van Diest PJ, Linn SC. Long-term prognosis of young breast cancer patients (≤40 years) who did not receive adjuvant systemic treatment: protocol for the PARADIGM initiative cohort study. BMJ Open 2017; 7:e017842. [PMID: 29138205 PMCID: PMC5695414 DOI: 10.1136/bmjopen-2017-017842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Currently used tools for breast cancer prognostication and prediction may not adequately reflect a young patient's prognosis or likely treatment benefit because they were not adequately validated in young patients. Since breast cancers diagnosed at a young age are considered prognostically unfavourable, many treatment guidelines recommend adjuvant systemic treatment for all young patients. Patients cured by locoregional treatment alone are, therefore, overtreated. Lack of prognosticators for young breast cancer patients represents an unmet medical need and has led to the initiation of the PAtients with bReAst cancer DIaGnosed preMenopausally (PARADIGM) initiative. Our aim is to reduce overtreatment of women diagnosed with breast cancer aged ≤40 years. METHODS AND ANALYSIS All young, adjuvant systemic treatment naive breast cancer patients, who had no prior malignancy and were diagnosed between 1989 and 2000, were identified using the population based Netherlands Cancer Registry (n=3525). Archival tumour tissues were retrieved through linkage with the Dutch nationwide pathology registry. Tissue slides will be digitalised and placed on an online image database platform for clinicopathological revision by an international team of breast pathologists. Immunohistochemical subtype will be assessed using tissue microarrays. Tumour RNA will be isolated and subjected to next-generation sequencing. Differences in gene expression found between patients with a favourable and those with a less favourable prognosis will be used to establish a prognostic classifier, using the triple negative patients as proof of principle. ETHICS AND DISSEMINATION Observational data from the Netherlands Cancer Registry and left over archival patient material are used. Therefore, the Dutch law on Research Involving Human Subjects Act (WMO) is not applicable. The PARADIGM study received a 'non-WMO' declaration from the Medical Ethics Committee of the Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, waiving individual patient consent. All data and material used are stored in a coded way. Study results will be presented at international (breast cancer) conferences and published in peer-reviewed, open-access journals.
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Affiliation(s)
- Gwen Mhe Dackus
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Natalie D Ter Hoeve
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mark Opdam
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Ziekenhuis, Nijmegen, Gelderland, Netherlands
| | - Zsuzsanna Varga
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Esther Koop
- Department of Pathology, Gelre Ziekenhuizen, Apeldoorn, Gelderland, Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Emilie J Groen
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Alicia Cordoba
- Department of Pathology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jos Bart
- Department of Pathology, IsalaKlinieken Zwolle, Zwolle, Overijssel, Netherlands
| | - Antien L Mooyaart
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, Netherlands
| | - Jan G van den Tweel
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vicky Zolota
- Department of Pathology, Rion University Hospital, University of Patras, Medical School, Patras, Greece
| | - Jelle Wesseling
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Anna Sapino
- Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Piemonte, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Ewa Chmielik
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Ales Ryska
- Faculty of Medicine and University Hospital, Charles University in Prague, Hradec Kralove, Czech Republic
| | - Frederic Amant
- Departmentof Obstetrics and Gynaecology at the Catholic, Universityof Leuven, Leuven, Belgium
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Division of Molecular Pathology, NetherlandsCancer Institute, Amsterdam, Noord-Holland, Netherlands
| | - Ron Kerkhoven
- Genomics Core Facility, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Nikolas Stathonikos
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mitko Veta
- Medical Image Analysis Group (IMAG/e), Technische Universiteit Eindhoven, Eindhoven, Noord-Brabant, Netherlands
| | - Adri Voogd
- Department of Epidemiology, Maastricht University, Maastricht, Limburg, Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Utrecht, UK
| | - Katarzyna Jozwiak
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Michael Hauptmann
- Department of Epidemiology and Biostatistics, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Marlous Hoogstraat
- Department of Computational Cancer Biology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Gabe Sonke
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
| | - Elsken van der Wall
- Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Utrecht, UK
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, Enschede, Overijssel, Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sabine C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Noord-Holland, Netherlands
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Spazzapan S, Conte P, Simoncini E, Campone M, Miller M, Sonke G. Updated results from MONALEESA-2, a phase 3 trial of first-line ribociclib + letrozole in hormone receptor-positive (HR+), HER2-negative (HER2–) advanced breast cancer (ABC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx424.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Koole S, van Driel W, Kieffer J, Sikorska K, van Leeuwen JS, Schreuder H, Hermans R, de Hingh I, van der Velden J, Arts H, Massuger L, Aalbers A, Verwaal V, Van de Vijver K, Aaronson N, Sonke G. Health-related quality of life after hyperthermic intraperitoneal chemotherapy (HIPEC) for stage III ovarian cancer: Results of the phase III OVHIPEC study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Kuijer A, Verloop J, Visser O, Sonke G, Jager A, van Gils C, van Dalen T, Elias S. The influence of socioeconomic status and ethnicity on adjuvant systemic treatment guideline adherence for early-stage breast cancer in the Netherlands. Ann Oncol 2017; 28:1970-1978. [DOI: 10.1093/annonc/mdx204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Siesling S, Witteveen A, de Munck L, Groothuis-Oudshoorn K, Sonke G, Klaase J, Boersma L, Poortmans P, IJzerman M. Abstract P6-09-54: Long-term recurrence risk and risk-based follow-up after breast cancer treatment. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-54] [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
This abstract was not presented at the symposium.
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Affiliation(s)
- S Siesling
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - A Witteveen
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - L de Munck
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - K Groothuis-Oudshoorn
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - G Sonke
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - J Klaase
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - L Boersma
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - P Poortmans
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
| | - M IJzerman
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Comprehensive Cancer Organisation the Netherlands (IKNL), Utrecht, Netherlands; Netherlands Cancer Institute, Amsterdam, Netherlands; Medisch Spectrum Twente, Enschede, Netherlands; Maastro Clinics, Maastricht, Netherlands; Radboud university medical center, Nijmegen, Netherlands
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Witteveen A, Kwast ABG, Sonke G, IJzerman MJ, Siesling S. Survival After Locoregional Recurrence or Second Primary Breast Cancer: Impact of the Disease-Free Interval. Value Health 2014; 17:A620. [PMID: 27202183 DOI: 10.1016/j.jval.2014.08.2193] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Witteveen
- University of Twente, MIRA Institute for Biomedical Technology & Technical Medicine, Enschede, The Netherlands
| | - A B G Kwast
- Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, The Netherlands
| | - G Sonke
- Netherlands Cancer Institute (NKI), Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M J IJzerman
- MIRA Institute for Biomedical Technology & Technical Medicine and University of Twente, Enschede, The Netherlands
| | - S Siesling
- Comprehensive Cancer Centre the Netherlands (IKNL), Utrecht, The Netherlands
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Hannemann J, Mulder L, Linn SC, Sonke G, Vijzelaar R, Errami A, Vrancken-Peeters M, van de Vijver MJ, Rodenhuis S. Homologous recombination defects in sporadic breast cancers. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Hannemann J, Mulder L, Halfwerk H, Linn S, Sonke G, Vijzelaar R, Errami A, Vrancken-Peeters M, Van de Vijver M, Rodenhuis S. Detection of homologous recombination defects in biopsies of sporadic breast cancers. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hopman AHN, Smedts F, Dignef W, Ummelen M, Sonke G, Mravunac M, Vooijs GP, Speel EJM, Ramaekers FCS. Transition of high-grade cervical intraepithelial neoplasia to micro-invasive carcinoma is characterized by integration of HPV 16/18 and numerical chromosome abnormalities. J Pathol 2003; 202:23-33. [PMID: 14694518 DOI: 10.1002/path.1490] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cervical intraepithelial neoplasia (CIN I, II, and III) and cases of CIN III associated with micro-invasive cervical carcinoma (CIN III & mCA) were analysed for evidence of episomal or integrated human papillomavirus (HPV) 16/18 DNA by fluorescence in situ hybridization (FISH). In parallel, numerical aberrations of chromosomes 1, 17, and X were determined in these lesions as indicators of genomic instability. HPV 16/18 DNA was present in 2 of 12 CIN I, 19 of 23 CIN II/III, and 10 of 12 CIN III & mCA. None of the CIN I and only two of the 19 HPV 16/18-positive solitary CIN II/III showed an integrated HPV pattern. However, all ten cases of HPV-positive CIN III & mCA showed this pattern. Transition of CIN II/III to CIN III & mCA therefore correlates strongly with viral integration (p<0.001). Chromosomal aberrations were detected in 23 of 31 HPV 16/18-positive lesions (14 solitary CIN I-III and nine CIN III & mCA) and 5 of 16 HPV-negative lesions. Nine of 21 HPV 16/18-positive solitary CIN I-III showed tetrasomy for all chromosomes tested, while trisomies for a single chromosome were seen in a further five of these HPV-positive lesions. In eight of ten HPV-positive CIN III & mCA, predominantly aneusomies and/or polysomies were detected. A significant correlation (p<0.02) was found between the chromosome copy number and the physical status of HPV, indicating that in its episomal form HPV induces genomic changes such as tetrasomies and single trisomies, while HPV integration correlates with aneusomies and polysomies, predominantly detected in CIN III & mCA. These data indicate that integration of HPV 16/18 DNA is a pivotal step in the transition of CIN to micro-invasive carcinoma.
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MESH Headings
- Adult
- Aged
- Cell Transformation, Neoplastic/pathology
- Chromosome Aberrations
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 17/genetics
- Chromosomes, Human, X/genetics
- DNA Probes, HPV
- DNA, Neoplasm/analysis
- DNA, Viral/analysis
- Female
- Humans
- Immunohistochemistry/methods
- In Situ Hybridization, Fluorescence/methods
- Middle Aged
- Papillomaviridae/genetics
- Papillomavirus Infections/genetics
- Papillomavirus Infections/pathology
- Plasmids/genetics
- Uterine Cervical Neoplasms/genetics
- Uterine Cervical Neoplasms/pathology
- Virus Integration
- Uterine Cervical Dysplasia/genetics
- Uterine Cervical Dysplasia/pathology
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Affiliation(s)
- Anton H N Hopman
- Department of Molecular Cell Biology, Research Institute Growth and Development (GROW), University of Maastricht, The Netherlands.
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Severens JL, Sonke G, Laheij RJ, Verbeek AL, De Vries Robbé PF. Efficient diagnostic test sequence: applications of the probability-modifying plot. J Clin Epidemiol 2001; 54:1228-37. [PMID: 11750191 DOI: 10.1016/s0895-4356(01)00391-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Excessive diagnostic testing rarely leads to complete certainty of the disease status of a patient. Because of constraints of health care budgets, physicians should be aware of the diminishing marginal gain of each subsequent test in a testing strategy related to costs. We developed the probability-modifying plot to determine economically efficient sequence of testing without losing clinical effectiveness. Two applications of the model are presented: diagnosis of Helicobacter pylori and diagnosis of benign prostatic hyperplasia. The probability-modifying plots are drawn to visualize and calculate the economic efficiency of all possible test sequences, meaning that although the different test sequences are equally accurate, some have even lower costs than others.
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Affiliation(s)
- J L Severens
- Medical Department of Technology Assessment (253 MTA), University Medical Centre, St. Radboud, 6500 HB Nijmegen, The Netherlands.
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Xue Y, Sonke G, Schoots C, Schalken J, Verhofstad A, de la Rosette J, Smedts F. Proliferative activity and branching morphogenesis in the human prostate: a closer look at pre- and postnatal prostate growth. Prostate 2001; 49:132-9. [PMID: 11582592 DOI: 10.1002/pros.1127] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To gain further insight into the molecular cell biologic features of prostate development, we investigated the proliferative activity of prostate epithelial and stromal cells and their topographic relationship with neuroendocrine (NE) cell distribution and regional heterogeneity. METHODS Consecutive sections from 43 prostates taken during autopsy representing fetuses (12-38 weeks of gestation), infants, prepubertal males and adults were double stained for chromogranin A and MIB-1. MIB-1 labeling index (LI) was calculated in the budding tips, forming acini, major collecting ducts, adjacent and non-adjacent stromal compartments. Furthermore, the topographic relationship between proliferating cells and NE cells was evaluated. RESULTS In the first half of gestation, cell proliferation as revealed by MIB-1 LI was significantly higher in epithelial structures and stroma than in older fetuses and other age groups. MIB-1 LI was higher in budding tips than in other epithelial regions. MIB-1 LI in stroma adjacent to budding tips was not higher than that adjacent to other epithelial branching segments. Co-expression of chromogranin A and MIB-1 staining was not observed. MIB-1 LI was lower in cells in the direct vicinity of chromogranin A positive NE cells than at a distance from NE cells. CONCLUSIONS Prostate development in the first half of gestation is explosive. Thereafter, the prostate basically is a slow-growing organ. Budding tips are the major growth foci during early prostate development, while stromal growth is evenly distributed throughout the prostate, probably indicating that stromal-epithelial interactions do not manifest in enhanced proliferation at their interface. NE cells may have an inhibitory effect on proliferation of exocrine epithelial cells and are probably only associated with differentiation of prostate exocrine cells in the prostate.
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Affiliation(s)
- Y Xue
- Department of Urology, University Medical Centre Nijmegen, The Netherlands
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