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Semenkovich NP, Badiyan SN, Samson PP, Stowe HB, Wang YE, Star R, Devarakonda S, Govindan R, Waqar SN, Robinson CG, Vlacich G, Pellini B, Chaudhuri AA. Pre-radiotherapy ctDNA liquid biopsy for risk stratification of oligometastatic non-small cell lung cancer. NPJ Precis Oncol 2023; 7:100. [PMID: 37783809 PMCID: PMC10545784 DOI: 10.1038/s41698-023-00440-6] [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: 03/13/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023] Open
Abstract
The optimal treatment paradigm for patients with oligometastatic non-small cell lung cancer (NSCLC) remains unclear. Some patients with oligometastatic disease experience prolonged remission after locally consolidative radiation therapy (RT), while others harbor micrometastatic disease (below limits of detection by imaging) and benefit from systemic therapy. To risk-stratify and identify the patients most likely to benefit from locally consolidative RT, we performed a multi-institutional cohort study of 1487 patients with oligometastatic NSCLC undergoing liquid biopsy analysis of circulating tumor DNA (ctDNA). In total, 1880 liquid biopsies were performed and approximately 20% of patients (n = 309) had ctDNA measured prior to RT and after their diagnosis of oligometastatic disease. Patients with undetectable ctDNA (pathogenic or likely pathogenic variants in plasma using the Tempus xF assay) before RT had significantly improved progression-free survival (PFS) (P = 0.004) and overall survival (OS) (P = 0.030). ctDNA maximum variant allele frequency (VAF) pre-RT and ctDNA mutational burden pre-RT were both significantly inversely correlated with PFS (maximum VAF P = 0.008, mutational burden P = 0.003) and OS (maximum VAF P = 0.007, mutational burden P = 0.045). These findings were corroborated by multivariate Cox proportional hazards models that included eight additional clinical and genomic parameters. Overall, these data suggest that in patients with oligometastatic NSCLC, pre-RT ctDNA can potentially identify the patients most likely to benefit from locally consolidative RT and experience prolonged PFS and OS. Similarly, ctDNA may be useful to identify undiagnosed micrometastatic disease where it may be appropriate to prioritize systemic therapies.
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Affiliation(s)
- Nicholas P Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Shahed N Badiyan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Siddhartha Devarakonda
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ramaswamy Govindan
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Saiama N Waqar
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Bruna Pellini
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Aadel A Chaudhuri
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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Price AT, Schiff JP, Laugeman E, Maraghechi B, Schmidt M, Zhu T, Reynoso F, Hao Y, Kim T, Morris E, Zhao X, Hugo GD, Vlacich G, DeSelm CJ, Samson PP, Baumann BC, Badiyan SN, Robinson CG, Kim H, Henke LE. Initial clinical experience building a dual CT- and MR-guided adaptive radiotherapy program. Clin Transl Radiat Oncol 2023; 42:100661. [PMID: 37529627 PMCID: PMC10388162 DOI: 10.1016/j.ctro.2023.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/12/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Our institution was the first in the world to clinically implement MR-guided adaptive radiotherapy (MRgART) in 2014. In 2021, we installed a CT-guided adaptive radiotherapy (CTgART) unit, becoming one of the first clinics in the world to build a dual-modality ART clinic. Herein we review factors that lead to the development of a high-volume dual-modality ART program and treatment census over an initial, one-year period. Materials and Methods The clinical adaptive service at our institution is enabled with both MRgART (MRIdian, ViewRay, Inc, Mountain View, CA) and CTgART (ETHOS, Varian Medical Systems, Palo Alto, CA) platforms. We analyzed patient and treatment information including disease sites treated, radiation dose and fractionation, and treatment times for patients on these two platforms. Additionally, we reviewed our institutional workflow for creating, verifying, and implementing a new adaptive workflow on either platform. Results From October 2021 to September 2022, 256 patients were treated with adaptive intent at our institution, 186 with MRgART and 70 with CTgART. The majority (106/186) of patients treated with MRgART had pancreatic cancer, and the most common sites treated with CTgART were pelvis (23/70) and abdomen (20/70). 93.0% of treatments on the MRgART platform were stereotactic body radiotherapy (SBRT), whereas only 72.9% of treatments on the CTgART platform were SBRT. Abdominal gated cases were allotted a longer time on the CTgART platform compared to the MRgART platform, whereas pelvic cases were allotted a shorter time on the CTgART platform when compared to the MRgART platform. Our adaptive implementation technique has led to six open clinical trials using MRgART and seven using CTgART. Conclusions We demonstrate the successful development of a dual platform ART program in our clinic. Ongoing efforts are needed to continue the development and integration of ART across platforms and disease sites to maximize access and evidence for this technique worldwide.
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Affiliation(s)
- Alex T. Price
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, USA
| | - Joshua P. Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Eric Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Borna Maraghechi
- City of Hope Orange County, Department of Radiation Oncology, Irvine, CA, USA
| | - Matthew Schmidt
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Tong Zhu
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Francisco Reynoso
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Yao Hao
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Taeho Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Eric Morris
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Xiaodong Zhao
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Geoffrey D. Hugo
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Gregory Vlacich
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Carl J. DeSelm
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Pamela P. Samson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Brian C. Baumann
- Springfield Clinic, Department of Radiation Oncology, Springfield, IL, USA
| | - Shahed N. Badiyan
- University of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, USA
| | - Clifford G. Robinson
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Hyun Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Lauren E. Henke
- University Hospitals/Case Western Reserve University, Department of Radiation Oncology, Cleveland, OH, USA
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Semenkovich NP, Samson PP, Badiyan SN, Vlacich G, Stowe HB, Wang YE, Star R, Devarakonda S, Govindan R, Waqar SN, Robinson CG, Pellini B, Chaudhuri AA. Pre-radiotherapy ctDNA liquid biopsy for risk stratification of oligometastatic non-small cell lung cancer. Res Sq 2023:rs.3.rs-2688927. [PMID: 36993328 PMCID: PMC10055612 DOI: 10.21203/rs.3.rs-2688927/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
The optimal treatment for patients with oligometastatic non-small cell lung cancer (NSCLC) remains unclear. Some patients with oligometastatic disease can experience prolonged remission after locally consolidative radiation therapy (RT), while others harbor micrometastatic disease (below current limits of detection by imaging) that may benefit from further prioritization of systemic therapy. To better risk-stratify this population and identify the patients most likely to benefit from locally consolidative radiation therapy, we performed a multi-institutional cohort study of patients with oligometastatic NSCLC undergoing liquid biopsy analysis of circulating tumor DNA (ctDNA). Among this real-world cohort of 1,487 patients undergoing analysis (using the Tempus xF assay), a total of 1,880 ctDNA liquid biopsies along with paired clinical data were obtained across various timepoints. Approximately 20% (n=309) of patients had ctDNA obtained prior to RT and after their diagnosis of oligometastatic disease. Samples were de-identified and analyzed for mutational burden and variant frequencies of detectable deleterious (or likely deleterious) mutations in plasma. Patients with undetectable ctDNA before RT had significantly improved progression-free survival and overall survival compared to patients with detectable ctDNA prior to RT. In patients that received RT, 598 pathogenic (or likely deleterious) variants were identified. ctDNA mutational burden pre-RT and ctDNA maximum variant allele frequency (VAF) pre-RT were both significantly inversely correlated with both progression-free (P = 0.0031 for mutational burden, P = 0.0084 for maximum VAF) and overall survival (P = 0.045 for mutational burden, P = 0.0073 for maximum VAF). Patients without detectable ctDNA prior to RT had significantly improved progression-free survival (P = 0.004) and overall survival (P = 0.03) compared to patients with detectable ctDNA prior to RT. These data suggest that in patients with oligometastatic NSCLC, pre-radiotherapy ctDNA analysis can potentially identify the patients most likely to benefit from locally consolidative RT and experience prolonged progression-free and overall survival. Similarly, ctDNA may be useful to identify those patients with undiagnosed micrometastatic disease, in whom it may be appropriate to prioritize systemic therapy.
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Affiliation(s)
- Nicholas P. Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Pamela P. Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Shahed N. Badiyan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Hayley B. Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Siddhartha Devarakonda
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ramaswamy Govindan
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Saiama N. Waqar
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Clifford G. Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Bruna Pellini
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Aadel A. Chaudhuri
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri
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Vlacich G, Ballard A, Badiyan SN, Spraker M, Henke L, Kim H, Lockhart AC, Park H, Suresh R, Huang Y, Robinson CG, Bradley JD, Samson PP. A single-institution phase I feasibility study of dose-escalated IMRT for non-operative locally advanced esophageal carcinoma. Clin Transl Radiat Oncol 2021; 30:19-25. [PMID: 34278011 PMCID: PMC8267428 DOI: 10.1016/j.ctro.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 12/29/2022] Open
Abstract
Dose escalation with IMRT to 60 Gy for esophageal cancer is feasible. Dose escalation with cisplatin/5-FU still results in significant toxicity. Improved local control, but comparable survival compared to historical controls. Pretreatment weight loss was found to be an independent predictor of poor survival. Our dose escalation study is one of few with predominant adenocarcinoma histology.
Background and purpose Radiation dose escalation to improve poor outcomes with chemoradiation in locally advanced esophageal carcinoma is limited in part by increased toxicity. This Phase I study investigates the use of IMRT to improve tolerability of dose escalation. Materials and methods A single-institution, prospective study was conducted between 2007 and 2013 for individuals with inoperable esophageal carcinoma. Gross disease received 60 Gy in 30 fractions and at-risk sites received 54 Gy with simultaneous integrated boost. Concurrent chemotherapy primarily consisted of cisplatin/5-FU. The primary objective was to assess feasibility (<15% rate of grade 4–5 toxicity). Secondary objectives included assessment of overall survival (OS), progression free survival (PFS), and locoregional (LRR) and distant recurrence. Results Twenty-six patients were enrolled with median follow up of 17.6 months (range 0.1 to 152.0). The majority were AJCC 7th edition Stage III (54%), distal esophagus primary (81%), and adenocarcinoma histology (85%). Twenty-one patients (81%) completed their course of radiation therapy, while only 55% received 2 cycles of concurrent cisplatin/5-FU. One grade 5 and one grade 4 cardiac event occurred, both during chemoradiation and before receiving 50 Gy. The 3-year OS was 48.6% (95% CI: 32.5 to 72.2%) and PFS was 28.5% (95% CI: 14.6 to 55.5%). Half developed distant failure with LRR occurring in 10 patients (38%), isolated in 5 patients. Conclusion While feasibility was demonstrated, toxicity and compliance remained limiting factors with outcomes similar to historical controls. There remains an uncertain role for dose escalation in definitive management of locally advanced esophageal cancer.
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Affiliation(s)
- Gregory Vlacich
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - Andrew Ballard
- Southern Illinois University-Edwardsville, Edwardsville, IL, United States
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - Matthew Spraker
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - Lauren Henke
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - Hyun Kim
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - A Craig Lockhart
- Department of Medicine, Division of Oncology, Washington University, St. Louis, MO, United States
| | - Haeseong Park
- Department of Medicine, Division of Oncology, Washington University, St. Louis, MO, United States
| | - Rama Suresh
- Department of Medicine, Division of Oncology, Washington University, St. Louis, MO, United States
| | - Yi Huang
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - Cliff G Robinson
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University, St. Louis, MO, United States
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Crockett C, Chuter R, Cobben D, Dubec M, Green O, Hackett S, McDonald F, Robinson C, Samson P, Shiarli AM, Straza M, Verhoeff J, Vlacich G, Werner-Wasik M, Faivre-Finn C. Magnetic resonance-guided radiotherapy (MRgRT) for patients with lung cancer. Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Crockett CB, Samson P, Chuter R, Dubec M, Faivre-Finn C, Green OL, Hackett SL, McDonald F, Robinson C, Shiarli AM, Straza MW, Verhoeff JJC, Werner-Wasik M, Vlacich G, Cobben D. Initial Clinical Experience of MR-Guided Radiotherapy for Non-Small Cell Lung Cancer. Front Oncol 2021; 11:617681. [PMID: 33777759 PMCID: PMC7988221 DOI: 10.3389/fonc.2021.617681] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Curative-intent radiotherapy plays an integral role in the treatment of lung cancer and therefore improving its therapeutic index is vital. MR guided radiotherapy (MRgRT) systems are the latest technological advance which may help with achieving this aim. The majority of MRgRT treatments delivered to date have been stereotactic body radiation therapy (SBRT) based and include the treatment of (ultra-) central tumors. However, there is a move to also implement MRgRT as curative-intent treatment for patients with inoperable locally advanced NSCLC. This paper presents the initial clinical experience of using the two commercially available systems to date: the ViewRay MRIdian and Elekta Unity. The challenges and potential solutions associated with MRgRT in lung cancer will also be highlighted.
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Affiliation(s)
- Cathryn B. Crockett
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Robert Chuter
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Michael Dubec
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Olga L. Green
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Sara L. Hackett
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Fiona McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - Anna-Maria Shiarli
- Department of Radiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Michael W. Straza
- Department of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joost J. C. Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, United States
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO, United States
| | - David Cobben
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
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Samson PP, Spraker MB, Badiyan SN, Vlacich G, Robinson CG, Chaudhuri AA. Local consolidative therapy for oligometastatic non-small cell lung cancer. J Thorac Dis 2020; 11:5649-5651. [PMID: 32030290 DOI: 10.21037/jtd.2019.11.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Pamela P Samson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew B Spraker
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory Vlacich
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Clifford G Robinson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
| | - Aadel A Chaudhuri
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA
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Park H, Johanns TM, Lockhart AC, Bradley J, Roach M, Vlacich G, Amin M, Suresh R, Bagegni N, Robinson CG. Abstract CT212: Combining pembrolizumab with locally delivered radiation therapy for the treatment of metastatic esophageal cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct212] [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 Intraluminal brachytherapy for advanced esophageal cancer allows durable control of tumor-related obstructive symptoms by safely delivering large local doses of radiation over just one or a few sessions. Localized, intense doses of hypofractionated radiotherapy elicits more effective anti-tumor immune response than standard doses. In addition, abscopal effect of radiation in distant metastases may be augmented by addition of immune checkpoint inhibitor. Pembrolizumab is approved for treatment of PD-L1 positive gastroesophageal cancer. We therefore propose to evaluate the combination of brachytherapy and pembrolizumab in patients with advanced esophageal cancer. Correlative studies of this study aim to identify predictive biomarkers of response and to characterize the immune response before and after brachytherapy and pembrolizumab to assess immunologic parameters associated with the abscopal effect.
METHODS This is a single institution, open-label, single-dose-level phase I study combining hypofractionated brachytherapy with standard dose pembrolizumab. Primary objective of this trial is to determine the tolerability of localized esophageal hypofractionated brachytherapy administered in two fractions when combined with pembrolizumab in patients with metastatic esophageal cancer. Secondary objective is to assess the antitumor efficacy of the combination. Exploratory objectives are to determine the expression profile of immunologic biomarkers and to annotate the local and distant immune response before and after treatments.Brachytherapy is delivered using a high-dose-rate iridium-192 afterloader via a dedicated esophageal applicator at 16 Gy in 2 fractions, 7-10 days apart. Pembrolizumab is given 1 week after completion of brachytherapy at 200 mg IV every 3 weeks. Endoscopic biopsies are performed before and after brachytherapy, and optionally after 8 weeks on pembrolizumab. Peripheral blood is collected at the same time points, at 3, 6, and 12 months on pembrolizumab, and at the time of progression. Patients with metastatic esophageal cancer who are candidates for brachytherapy for treatment of dysphagia are considered eligible for this trial. Exclusion criteria included prior treatment with PD-(L)1 targeting agent, symptomatic brain metastases, or other contraindication to pembrolizumab, such as active autoimmune disease. We plan to enroll 18 patients which will provide a reasonable ability to detect serious adverse event rates as well as early efficacy signals. There is at least 85% chance of observing at least 1 protocol-specified event if the true rate is 0.1 or greater. We will estimate 95% exact binomial confidence interval of true response rate based on observed responses. 80% of patient accrual is complete as of January 2019. NCT02642809.
Citation Format: Haeseong Park, Tanner M. Johanns, A. Craig Lockhart, Jeffrey Bradley, Michael Roach, Gregory Vlacich, Manik Amin, Rama Suresh, Nusayba Bagegni, Clifford G. Robinson. Combining pembrolizumab with locally delivered radiation therapy for the treatment of metastatic esophageal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT212.
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Affiliation(s)
- Haeseong Park
- 1Washington University in Saint Louis, Saint Louis, MO
| | | | - A. Craig Lockhart
- 2University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | | | - Michael Roach
- 1Washington University in Saint Louis, Saint Louis, MO
| | | | - Manik Amin
- 1Washington University in Saint Louis, Saint Louis, MO
| | - Rama Suresh
- 1Washington University in Saint Louis, Saint Louis, MO
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Choi E, Lantz TL, Vlacich G, Keeley TM, Samuelson LC, Coffey RJ, Goldenring JR, Powell AE. Lrig1+ gastric isthmal progenitor cells restore normal gastric lineage cells during damage recovery in adult mouse stomach. Gut 2018; 67:1595-1605. [PMID: 28814482 PMCID: PMC5815959 DOI: 10.1136/gutjnl-2017-313874] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Lrig1 is a marker of proliferative and quiescent stem cells in the skin and intestine. We examined whether Lrig1-expressing cells are long-lived gastric progenitors in gastric glands in the mouse stomach. We also investigated how the Lrig1-expressing progenitor cells contribute to the regeneration of normal gastric mucosa by lineage commitment to parietal cells after acute gastric injury in mice. DESIGN We performed lineage labelling using Lrig1-CreERT2/+;R26R-YFP/+ (Lrig1/YFP) or R26R-LacZ/+ (Lrig1/LacZ) mice to examine whether the Lrig1-YFP-marked cells are gastric progenitor cells. We studied whether Lrig1-YFP-marked cells give rise to normal gastric lineage cells in damaged mucosa using Lrig1/YFP mice after treatment with DMP-777 to induce acute injury. We also studied Lrig1-CreERT2/CreERT2 (Lrig1 knockout) mice to examine whether the Lrig1 protein is required for regeneration of gastric corpus mucosa after acute injury. RESULTS Lrig1-YFP-marked cells give rise to gastric lineage epithelial cells both in the gastric corpus and antrum, in contrast to published results that Lgr5 only marks progenitor cells within the gastric antrum. Lrig1-YFP-marked cells contribute to replacement of damaged gastric oxyntic glands during the recovery phase after acute oxyntic atrophy in the gastric corpus. Lrig1 null mice recovered normally from acute gastric mucosal injury indicating that Lrig1 protein is not required for lineage differentiation. Lrig1+ isthmal progenitor cells did not contribute to transdifferentiating chief cell lineages after acute oxyntic atrophy. CONCLUSIONS Lrig1 marks gastric corpus epithelial progenitor cells capable of repopulating the damaged oxyntic mucosa by differentiating into normal gastric lineage cells in mouse stomach.
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Affiliation(s)
- Eunyoung Choi
- Nashville VA Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Section of Surgical Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Epithelial Biology Center, Nashville, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Tyler L Lantz
- Department of Biology, Institute of Molecular Biology, University of Oregon, Oregon, USA
| | - Gregory Vlacich
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Theresa M Keeley
- Department of Molecular & Integrative Physiology, The University of Michigan, Michigan, USA
| | - Linda C Samuelson
- Department of Molecular & Integrative Physiology, The University of Michigan, Michigan, USA
| | - Robert J Coffey
- Nashville VA Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Epithelial Biology Center, Nashville, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James R Goldenring
- Nashville VA Medical Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Section of Surgical Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Epithelial Biology Center, Nashville, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Anne E Powell
- Department of Biology, Institute of Molecular Biology, University of Oregon, Oregon, USA
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10
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Vlacich G, Samson PP, Perkins SM, Roach MC, Parikh PJ, Bradley JD, Lockhart AC, Puri V, Meyers BF, Kozower B, Robinson CG. Treatment utilization and outcomes in elderly patients with locally advanced esophageal carcinoma: a review of the National Cancer Database. Cancer Med 2017; 6:2886-2896. [PMID: 29139215 PMCID: PMC5727236 DOI: 10.1002/cam4.1250] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022] Open
Abstract
For elderly patients with locally advanced esophageal cancer, therapeutic approaches and outcomes in a modern cohort are not well characterized. Patients ≥70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment type. Variables associated with treatment utilization were evaluated using logistic regression and survival evaluated using Cox proportional hazards analysis. Propensity matching (1:1) was performed to help account for selection bias. A total of 21,593 patients were identified. Median and maximum ages were 77 and 90, respectively. Treatment included palliative therapy (24.3%), chemoradiation (37.1%), trimodality therapy (10.0%), esophagectomy alone (5.6%), or no therapy (12.9%). Age ≥80 (OR 0.73), female gender (OR 0.81), Charlson–Deyo comorbidity score ≥2 (OR 0.82), and high‐volume centers (OR 0.83) were associated with a decreased likelihood of palliative therapy versus no treatment. Age ≥80 (OR 0.79) and Clinical Stage III (OR 0.33) were associated with a decreased likelihood, while adenocarcinoma histology (OR 1.33) and nonacademic cancer centers (OR 3.9), an increased likelihood of esophagectomy alone compared to definitive chemoradiation. Age ≥80 (OR 0.15), female gender (OR 0.80), and non‐Caucasian race (OR 0.63) were associated with a decreased likelihood, while adenocarcinoma histology (OR 2.10) and high‐volume centers (OR 2.34), an increased likelihood of trimodality therapy compared to definitive chemoradiation. Each treatment type demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49) to trimodality therapy (HR 0.25) with significance between all groups. Any therapy, including palliative care, was associated with improved survival; however, subsets of elderly patients with locally advanced esophageal cancer are less likely to receive aggressive therapy. Care should be taken to not unnecessarily deprive these individuals of treatment that may improve survival.
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Affiliation(s)
- Gregory Vlacich
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Pamela P Samson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Michael C Roach
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Parag J Parikh
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Jeffrey D Bradley
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - A Craig Lockhart
- Department of Medicine, Division of Oncology, Washington University, St. Louis, Missouri
| | - Varun Puri
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Bryan F Meyers
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Benjamin Kozower
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | - Cliff G Robinson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
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11
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Vlacich G, Stavas MJ, Pendyala P, Chen SC, Shyr Y, Cmelak AJ. A comparative analysis between sequential boost and integrated boost intensity-modulated radiation therapy with concurrent chemotherapy for locally-advanced head and neck cancer. Radiat Oncol 2017; 12:13. [PMID: 28086954 PMCID: PMC5237132 DOI: 10.1186/s13014-016-0756-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Planning and delivery of IMRT for locally advanced head and neck cancer (LAHNC) can be performed using sequential boost or simultaneous integrated boost (SIB). Whether these techniques differ in treatment-related outcomes including survival and acute and late toxicities remain largely unexplored. METHODS We performed a single institutional retrospective matched cohort analysis on patients with LAHNC treated with definitive chemoradiotherapy to 69.3 Gy in 33 fractions. Treatment was delivered via sequential boost (n = 68) or SIB (n = 141). Contours, plan evaluation, and toxicity assessment were performed by a single experienced physician. Toxicities were graded weekly during treatment and at 3-month follow up intervals. Recurrence-free survival, disease-free survival, and overall survival were estimated via Kaplan-Meier statistical method. RESULTS At 4 years, the estimated overall survival was 69.3% in the sequential boost cohort and 76.8% in the SIB cohort (p = 0.13). Disease-free survival was 63 and 69% respectively (p = 0.27). There were no significant differences in local, regional or distant recurrence-free survival. There were no significant differences in weight loss (p = 0.291), gastrostomy tube placement (p = 0.494), or duration of gastrostomy tube dependence (p = 0.465). Rates of acute grade 3 or 4 dysphagia (82% vs 55%) and dermatitis (78% vs 58%) were significantly higher in the SIB group (p < 0.001 and p = 0.012 respectively). Moreover, a greater percentage of the SIB cohort did not receive the prescribed dose due to acute toxicity (7% versus 0, p = 0.028). CONCLUSIONS There were no differences in disease related outcomes between the two treatment delivery approaches. A higher rate of grade 3 and 4 radiation dermatitis and dysphagia were observed in the SIB group, however this did not translate into differences in late toxicity. Additional investigation is necessary to further evaluate the acute toxicity differences.
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Affiliation(s)
- Gregory Vlacich
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Current affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4291 Parkview Place, Campus Box 63110, St. Louis, MO, 63110, USA.
| | - Mark J Stavas
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Praveen Pendyala
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shaeu-Chiann Chen
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Shyr
- Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony J Cmelak
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Cmelak A, Stavas MJ, Murphy BA, Shyr Y, Gilbert J, Chen SC, Vlacich G. Sequential boost versus integrated boost intensity-modulated radiation therapy with concurrent chemotherapy for locally-advanced head and neck cancer (LAHNC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Yu Shyr
- Vanderbilt Ingram Cancer Center, Nashville, TN
| | - Jill Gilbert
- Vanderbilt University School of Medicine, Nashville, TN
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13
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Powell AE, Vlacich G, Zhao ZY, McKinley ET, Washington MK, Manning HC, Coffey RJ. Inducible loss of one Apc allele in Lrig1-expressing progenitor cells results in multiple distal colonic tumors with features of familial adenomatous polyposis. Am J Physiol Gastrointest Liver Physiol 2014; 307:G16-23. [PMID: 24833705 PMCID: PMC4080164 DOI: 10.1152/ajpgi.00358.2013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Individuals with familial adenomatous polyposis (FAP) harbor a germline mutation in adenomatous polyposis coli (APC). The major clinical manifestation is development of multiple colonic tumors at a young age due to stochastic loss of the remaining APC allele. Extracolonic features, including periampullary tumors, gastric abnormalities, and congenital hypertrophy of the retinal pigment epithelium, may occur. The objective of this study was to develop a mouse model that simulates these features of FAP. We combined our Lrig1-CreERT2/+ mice with Apcfl/+ mice, eliminated one copy of Apc in leucine-rich repeats and immunoglobulin-like domains protein 1 (Lrig1)-positive (Lrig1(+)) progenitor cells with tamoxifen injection, and monitored tumor formation in the colon by colonoscopy and PET. Initial loss of one Apc allele in Lrig1(+) cells results in a predictable pattern of preneoplastic changes, culminating in multiple distal colonic tumors within 50 days of induction, as well as the extracolonic manifestations of FAP mentioned above. We show that tumor formation can be monitored by noninvasive PET imaging. This inducible stem cell-driven model recapitulates features of FAP and offers a tractable platform on which therapeutic interventions can be monitored over time by colonoscopy and noninvasive imaging.
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Affiliation(s)
- Anne E. Powell
- 1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - Gregory Vlacich
- 2Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - Zhen-Yang Zhao
- 3Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - Eliot T. McKinley
- 1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - M. Kay Washington
- 4Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - H. Charles Manning
- 5Vanderbilt Institute for Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Robert J. Coffey
- 1Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; ,6Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Vlacich G, Spratt DE, Diaz R, Phillips JG, Crass J, Li CI, Shyr Y, Cmelak AJ. Dose to the inferior pharyngeal constrictor predicts prolonged gastrostomy tube dependence with concurrent intensity-modulated radiation therapy and chemotherapy for locally-advanced head and neck cancer. Radiother Oncol 2014; 110:435-40. [DOI: 10.1016/j.radonc.2013.12.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/13/2013] [Accepted: 12/25/2013] [Indexed: 11/24/2022]
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15
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Vlacich G, Diaz R, Thorpe SW, Murphy BA, Kirby W, Sinard RJ, Shakhtour B, Shyr Y, Murphy P, Netterville JL, Yarbrough WG, Cmelak AJ. Intensity-modulated radiation therapy with concurrent carboplatin and paclitaxel for locally advanced head and neck cancer: toxicities and efficacy. Oncologist 2012; 17:673-81. [PMID: 22550060 DOI: 10.1634/theoncologist.2011-0396] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) and alternative chemotherapy regimens strive to maintain efficacy while minimizing toxicity in locally advanced head and neck cancer (LAHNC) treatment. Our experience with concurrent IMRT and taxane-based chemotherapy is presented. METHODS A retrospective review of 150 consecutive patients with LAHNC treated with IMRT and concurrent taxane-based chemotherapy with curative intent was performed. The IMRT fractionation regimen consisted of 69.3 Gy to gross disease (2.1 Gy/fraction) and 56.1 Gy to prophylactic nodal sites (1.7 Gy/fraction). Weekly paclitaxel (30 mg/m(2)) and carboplatin (area under the concentration-time curve [AUC], 1) were given concurrently to all patients, and 69% received weekly induction with paclitaxel (60 mg/m(2)) and carboplatin (AUC, 2). RESULTS Over 90% of patients received the prescribed radiation dose. Ninety-six percent completed five or more cycles of concurrent chemotherapy, with similar tolerability for induction chemotherapy. A percutaneous endoscopic gastrostomy (PEG) tube was required in 80 patients, with 10 maintaining PEG use >18 months. Acute grade 4 mucositis and dermatitis developed in 2.0% and 4.0% of patients, respectively. No patient experienced nadir sepsis, grade ≥3 late xerostomia, or significant nephropathy or gastrointestinal toxicity. Median follow-up was 30 months. The 3-year locoregional control rate was 83.2% with disease-free survival and overall survival rates of 78.8% and 76.5%, respectively. CONCLUSION Rates of acute and late toxicities were low, with excellent radiation dose delivery and impressive tumor control at 3 years, suggesting that concurrent carboplatin and paclitaxel with IMRT is a reasonable therapeutic option for the curative treatment of LAHNC.
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Affiliation(s)
- Gregory Vlacich
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5671, USA
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16
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Abstract
The EGFR-directed antibody cetuximab has proven, albeit modest, clinical benefit as monotherapy in head and neck and colorectal cancers. In a recent study, Yonesaka et al. uncovered a new mechanism of cetuximab resistance mediated by increased ERBB2 signaling via amplification of ERBB2 or increased levels of the ERBB3/ERBB4 ligand heregulin.
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Affiliation(s)
- Gregory Vlacich
- Department of Radiation Oncology, Vanderbilt University, Nashville, TN, USA
| | - Robert J. Coffey
- Department of Medicine and Cell and Developmental Biology, Vanderbilt University, Nashville, TN, USA
- Department of Veterans Affairs Medical Center, Nashville, TN, USA
- Correspondence:
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17
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Abstract
Pancreatic β-cell response to glucose stimulation is governed by tightly regulated signaling pathways which have not been fully characterized. A screen for novel signaling intermediates identified Pim3 as a glucose-responsive gene in the β cell, and here, we characterize its role in the regulation of β-cell function. Pim3 expression in the β-cell was first observed through microarray analysis on glucose-stimulated murine insulinoma (MIN6) cells where expression was strongly and transiently induced. In the pancreas, Pim3 expression exhibited similar dynamics and was restricted to the β cell. Perturbation of Pim3 function resulted in enhanced glucose-stimulated insulin secretion, both in MIN6 cells and in isolated islets from Pim3-/- mice, where the augmentation was specifically seen in the second phase of secretion. Consequently, Pim3-/- mice displayed an increased glucose tolerance in vivo. Interestingly, Pim3-/- mice also exhibited increased insulin sensitivity. Glucose stimulation of isolated Pim3-/- islets resulted in increased phosphorylation of ERK1/2, a kinase involved in regulating β-cell response to glucose. Pim3 was also found to physically interact with SOCS6 and SOCS6 levels were strongly reduced in Pim3-/- islets. Overexpression of SOCS6 inhibited glucose-induced ERK1/2 activation, strongly suggesting that Pim3 regulates ERK1/2 activity through SOCS6. These data reveal that Pim3 is a novel glucose-responsive gene in the β cell that negatively regulates insulin secretion by inhibiting the activation of ERK1/2, and through its effect on insulin sensitivity, has potentially a more global function in glucose homeostasis.
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Affiliation(s)
- Gregory Vlacich
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Vlacich G, Roe C, Webb GC. Technology insight: microarrays--research and clinical applications. ACTA ACUST UNITED AC 2007; 3:594-605. [PMID: 17643130 DOI: 10.1038/ncpendmet0580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/29/2007] [Indexed: 12/20/2022]
Abstract
For microarrays, the transition from research to clinical and diagnostic applications is well underway. Microarrays use a range of specific probes that are immobilized in known locations on a support matrix; this technique can measure levels of specific DNA, RNA and proteins, as well as carbohydrates and lipids. It is anticipated that analysis of these levels will lead to identification of biomarkers for the diagnosis, treatment and prognosis of a wide range of diseases. So far, this type of analysis has been particularly useful in clinical oncology, but the technology is being actively and successfully explored for diseases such as diabetes, endocrine tumors and endocrine modulators of tumors. There are now many commercial sources of microarrays, which have robust quality-control procedures in place. Progress will be enhanced when biomarkers can be established, statistical approaches can be refined and when we better understand the interactions of genes and of particular gene loci in disease progression.
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Affiliation(s)
- Gregory Vlacich
- Department of Medicine, Section of Endocrinology, Diabetes Research and Training Center, The University of Chicago, Chicago, IL 60637, USA
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19
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Grote E, Vlacich G, Pypaert M, Novick PJ. A snc1 endocytosis mutant: phenotypic analysis and suppression by overproduction of dihydrosphingosine phosphate lyase. Mol Biol Cell 2000; 11:4051-65. [PMID: 11102507 PMCID: PMC15056 DOI: 10.1091/mbc.11.12.4051] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [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: 11/11/2022] Open
Abstract
The v-SNARE proteins Snc1p and Snc2p are required for fusion of secretory vesicles with the plasma membrane in yeast. Mutation of a methionine-based sorting signal in the cytoplasmic domain of either Sncp inhibits Sncp endocytosis and prevents recycling of Sncp to the Golgi after exocytosis. snc1-M43A mutant yeast have reduced growth and secretion rates and accumulate post-Golgi secretory vesicles and fragmented vacuoles. However, cells continue to grow and secrete for several hours after de novo Snc2-M42A synthesis is repressed. DPL1, the structural gene for dihydrosphingosine phosphate lyase, was selected as a high copy number snc1-M43A suppressor. Because DPL1 also partially suppresses the growth and secretion phenotypes of a snc deletion, we propose that enhanced degradation of dihydrosphingosine-1-phosphate allows an alternative protein to replace Sncp as the secretory vesicle v-SNARE.
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Affiliation(s)
- E Grote
- Department of Cell Biology, Yale University School of Medicine, New Haven, Connecticut 06520-8002, USA
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