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Alimsijah PI, Ang CY, Han HS. Old World Screwworm myiasis: First report of auricular Chrysomya bezziana myiasis in a dog in Singapore. Vet Parasitol Reg Stud Reports 2024; 48:100991. [PMID: 38316506 DOI: 10.1016/j.vprsr.2024.100991] [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: 09/11/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
A German Shepherd dog was presented to a referral practice for screwworm myiasis affecting the ear. The successful management involved killing the larvae with afoxolaner plus milbemycin oxime and using video otoscopy to completely remove dead larvae. To the best of our knowledge, this is the first case report of auricular myiasis by Chrysomya bezziana in a dog in Singapore and the first report of video otoscopic management of myiasis.
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Affiliation(s)
- P I Alimsijah
- Mount Pleasant Animal Clinic East, 152 East Coast Road, Singapore 428855.
| | - C Y Ang
- Veterinary Emergency and Specialty Hospital, 232 Whitley Road, Singapore 297824
| | - H S Han
- Veterinary Emergency and Specialty Hospital, 232 Whitley Road, Singapore 297824
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Park SH, Jeong S, Yu H, Woo D, Chong GO, Han HS, Kim J. Deep Learning vs. Handcrafted Radiomics to Predict Chemoradiotherapy Response for Locally Advanced Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e480. [PMID: 37785521 DOI: 10.1016/j.ijrobp.2023.06.1700] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To predict CRT response in locally advanced cervical cancer (LACC) with handcrafted radiomics (HCR) and deep learning radiomics (DLR) using pretreatment MRI. Furthermore, we investigate whether the incorporation of clinical factors improves prediction performance. MATERIALS/METHODS Two hundred and fifty-two patients with LACC are enrolled. All patients are treated with external beam radiotherapy, followed by high-dose-rate intracavitary brachytherapy with concurrent cisplatin. The patients are randomly divided into two independent groups for the training (167 patients) and test datasets (85 patients). Contrast-enhanced T1- and T2-weighted MR scans are obtained. Patients in the training and test sets have similar characteristics in terms of age, tumor size, FIGO stage, HPV infection status, or CRT response. For HCR analysis, 1890 imaging features are extracted and a support vector machine classifier with a five-fold cross-validation is trained using training dataset to predict CRT response and validated using test dataset. For DLR analysis, a 3-dimensional convolutional neural network was trained and validated using test dataset. RESULTS A comparison of the DLR and HCR models reveals that the DLR model exhibits better prediction performance than the HCR model for the test dataset (AUC = 0.721 vs. 0.597, p = 0.097). The incorporation of clinical factors could improve performance in both DLR and HCR models. CONCLUSION The DLR models outperform the HCR models in predicting CRT responses in patients with LACC. Combining clinical factors and MRI may improve the prediction performance in both HCR and DLR analyses.
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Affiliation(s)
- S H Park
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of (South) Korea
| | - S Jeong
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of (South) Korea; Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Korea, Republic of (South) Korea
| | - H Yu
- Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Korea, Republic of (South) Korea
| | - D Woo
- Research Center for Artificial Intelligence in Medicine, Kyungpook National University Hospital, Daegu, Korea, Republic of (South) Korea
| | - G O Chong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of (South) Korea; Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of (South) Korea
| | - H S Han
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of (South) Korea; Department of Physiology, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of (South) Korea
| | - J Kim
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Korea, Republic of (South) Korea
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Hong JY, Han HS, Youn JH, Kim HW, Ryu HS, Park KY. Irradiation with 590-nm yellow light-emitting diode light attenuates oxidative stress and modulates UVB induced change of dermal fibroblasts. Exp Dermatol 2022; 31:931-935. [PMID: 35181944 DOI: 10.1111/exd.14542] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/27/2022]
Abstract
Recently, light-emitting diode (LED)-based devices have emerged as effective and safe tools for the treatment of photoaged skin. However, few studies have been conducted to elucidate the underlying mechanism behind the effect on photoaging of LED light. In this study, we induced photoaging of human dermal fibroblasts (HDFs) with Ultraviolet B (UVB) irradiation and evaluated the ability of 590 nm LED radiation to induce recovery from oxidative stress, restore collagen formation, and regulate inflammatory changes. Photoaging was induced in cultured human dermal fibroblasts (HDFs) using UVB irradiaton of 50 mJ/cm2 . Then, the photoaged HDFs were irradiated with LED using a custom-built 590 nm LED device which emits light with an intensity of 38 mW/cm2 (irradiated for 900 s with 34.2 J/cm2 of total energy). LED irradiation significantly attenuated UVB-induced reactive oxygen species generation and UVB-induced phosphorylation of JNK, c-Fos, and c-Jun. In addition, the procollagen levels were recovered significantly, and MMP-9 levels were significantly suppressed after LED irradiation. The UVB-induced phosphorylation levels of NF-κB and pro-inflammatory enzyme COX-2 also significantly decreased. Our results suggest that 590-nm yellow light irradiation may be an effective and safe anti-oxidative and anti-inflammatory treatment modality for photoaged skin.
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Affiliation(s)
- J Y Hong
- Department of Dermatology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - H S Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - H W Kim
- CG Bio Co. Ltd, Seoul, Korea
| | - H S Ryu
- CG Bio Co. Ltd, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Park SJ, Han HS, Shin SH, Yoo KH, Li K, Kim BJ, Seo SJ, Park KY. Adverse skin reactions due to use of face masks: a prospective survey during the COVID-19 pandemic in Korea. J Eur Acad Dermatol Venereol 2021; 35:e628-e630. [PMID: 34131961 PMCID: PMC8447351 DOI: 10.1111/jdv.17447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S J Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H S Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S H Shin
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K H Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Li
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - S J Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Han HS, Park JW, Yoo KH, Kim BJ. A phase I clinical trial to evaluate the safety of HU-045 for treating moderate-to-severe glabellar lines: a pilot study. J Eur Acad Dermatol Venereol 2021; 35:e614-e617. [PMID: 34014571 DOI: 10.1111/jdv.17369] [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: 11/27/2022]
Affiliation(s)
- H S Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - J W Park
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K H Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - B J Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Yoo KH, Park SJ, Han HS, Won CH, Lee YW, Kim BJ. Randomized, double-blind, active-controlled, multicentre, phase III clinical trial with two stages to assess the safety and efficacy of letibotulinum toxin a vs. onabotulinum toxin a for subjects with moderate to severe crow's feet. J Eur Acad Dermatol Venereol 2021; 35:1587-1594. [PMID: 33721365 DOI: 10.1111/jdv.17217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Letibotulinum toxin A (LeBA) was approved by the Ministry of Food and Drug Safety (known as the Korea Food & Drug Administration) for cosmetic indications in 2012. However, the efficacy and safety of this newly introduced LeBA have not been investigated in crow's feet lines (CFL) treatment and standardization before its universal use. OBJECTIVE The aim of this multicentre, double-blind, randomized, parallel, active-controlled Phase III clinical trial with two stages (ClinicalTrials.gov identifier: NCT03408236) was to investigate the non-inferiority of LeBA vs. the existing onabotulinum toxin A (OnBA) for the treatment of CFL. METHODS A total of 240 subjects were randomized to either the test (LeBA) or control (OnBA) group. At the baseline and at weeks 4 while maximum smiling (primary efficacy assessment), 8, 12 and 16, investigator's on-site evaluation, independent evaluator, evaluation by the subjects, subjects' satisfaction assessment and safety assessment were performed. RESULTS At week 4, the response rate of primary efficacy assessment was 69.75% and 68.33% in the test (LeBA) and control (OnBA) groups, respectively, without a significant difference. Other minor secondary evaluation results showed significant differences suggesting that LeBA offered better improvement than OnBA, but the overall results did not show significant differences between the two groups. CONCLUSION This study showed that LeBA was as effective and safe as OnBA for the treatment of CFL at the same doses.
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Affiliation(s)
- K H Yoo
- Department of Dermatology, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - S J Park
- Department of Dermatology, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - H S Han
- Department of Dermatology, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - C H Won
- Department of Dermatology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Y W Lee
- Department of Dermatology, College of Medicine, Konkuk University Hospital, Seoul, Korea
| | - B J Kim
- Department of Dermatology, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
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Hong JK, Han HS, Yoo KH. Inflammatory linear verrucous epidermal naevus successfully treated with a combination of triple topical agents (corticosteroid, calcipotriol and 20% urea). Clin Exp Dermatol 2021; 46:940-942. [PMID: 33577097 DOI: 10.1111/ced.14603] [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] [Received: 01/04/2021] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J K Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - H S Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K H Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
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Troisi RI, Berardi G, Morise Z, Cipriani F, Ariizumi S, Sposito C, Panetta V, Simonelli I, Kim S, Goh BKP, Kubo S, Tanaka S, Takeda Y, Ettorre GM, Russolillo N, Wilson GC, Cimino M, Montalti R, Giglio MC, Igarashi K, Chan CY, Torzilli G, Cheung TT, Mazzaferro V, Kaneko H, Ferrero A, Geller DA, Han HS, Kanazawa A, Wakabayashi G, Aldrighetti L, Yamamoto M. Laparoscopic and open liver resection for hepatocellular carcinoma with Child-Pugh B cirrhosis: multicentre propensity score-matched study. Br J Surg 2021; 108:196-204. [PMID: 33711132 DOI: 10.1093/bjs/znaa041] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/03/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child-Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child-Pugh B cirrhosis. METHODS Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables. RESULTS Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child-Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2-243) days for laparoscopic liver resection and 18 (3-104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742). CONCLUSION Patients without preoperative portal hypertension and Child-Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
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Affiliation(s)
- R I Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - G Berardi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Centre for Advanced Treatment of Hepato-Biliary-Pancreatic Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - Z Morise
- Department of Surgery, Fujita Health University Hospital, Toyoake, Japan
| | - F Cipriani
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - S Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - C Sposito
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Istituto Nazionale Tumori, Milan, Italy
| | - V Panetta
- Biostatistics Department, Sapienza University of Rome, Rome, Italy
| | - I Simonelli
- Biostatistics Department, Sapienza University of Rome, Rome, Italy
| | - S Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul,South Korea
| | - B K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - S Kubo
- Department of Surgery, Osaka City University Hospital, Osaka, Japan
| | - S Tanaka
- Department of Surgery, Osaka City University Hospital, Osaka, Japan
| | - Y Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - G M Ettorre
- Department of General and Hepato-Biliary-Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy
| | - N Russolillo
- Department of Surgery, Mauriziano Hospital, Turin, Italy
| | - G C Wilson
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M Cimino
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - R Montalti
- Department of Public Health, Federico II University, Naples, Italy
| | - M C Giglio
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - K Igarashi
- Centre for Advanced Treatment of Hepato-Biliary-Pancreatic Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - C-Y Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - G Torzilli
- Department of General Surgery, Humanitas University and Research Hospital, IRCCS, Milan, Italy
| | - T T Cheung
- Division of Hepato-Biliary-Pancreatic and Liver Transplantation, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - V Mazzaferro
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Istituto Nazionale Tumori, Milan, Italy
| | - H Kaneko
- Department of Surgery, Toho University of Tokyo, Tokyo, Japan
| | - A Ferrero
- Department of Surgery, Mauriziano Hospital, Turin, Italy
| | - D A Geller
- Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - H-S Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul,South Korea
| | - A Kanazawa
- Department of Surgery, Osaka City General Hospital, Osaka, Japan
| | - G Wakabayashi
- Centre for Advanced Treatment of Hepato-Biliary-Pancreatic Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - L Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - M Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Kwon SB, Ro DH, Song MK, Han HS, Lee MC, Kim HC. Identifying key gait features associated with the radiological grade of knee osteoarthritis. Osteoarthritis Cartilage 2019; 27:1755-1760. [PMID: 31400498 DOI: 10.1016/j.joca.2019.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/22/2018] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Knee osteoarthritis (KOA) is characterized by pain and decreased gait function. This study assessed key features that can be used as mechanical biomarkers for KOA severity and progression. The identified features were validated statistically and were further examined by developing a classification model based on a machine-learning algorithm. METHODS The study included 227 volunteers with various grades of KOA. The severity of KOA was graded using the Kellgren-Lawrence (KL) system. A total of 165 features were extracted from the gait data. The key features were selected using neighborhood component analysis. The selected features were validated using the t-test. Then, the features were examined by building a classification model using a random forest algorithm. RESULTS Twenty features were identified that could discriminate the grade of KOA, including nine features extracted from the knee joint, seven from the hip, two from the ankle and two from the spatiotemporal gait parameters. The t-test showed that some features differed significantly between health and sever group, while some were significantly different among the severe group, and others were significantly different for all KL grades. The areas under the receiver operating characteristic curves for classification were 0.974, 0.992, 0.845, 0.894, and 0.905 for KL grades 0 through 4, respectively. CONCLUSION Key gait features reflecting the grade of KOA were identified. The results of the statistical analysis and machine-learning algorithm show that the features can discriminate the severity of disease according to the KL grade.
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Affiliation(s)
- S B Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, South Korea
| | - D H Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - M K Song
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - H-S Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - M C Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, South Korea
| | - H C Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, South Korea; Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea; Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, South Korea.
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Silverstein J, Suleiman L, Yau C, Price ER, Singhrao R, Yee D, DeMichele A, Isaacs C, Albain KS, Chien AJ, Forero-Torres A, Wallace AM, Pusztai L, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Leyland-Jones B, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Berry DA, Asare SM, Esserman LJ, Boughey JC, Mukhtar RA. Abstract P2-14-01: The impact of local therapy on locoregional recurrence in women with high risk breast cancer in the neoadjuvant I-SPY2 TRIAL. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-14-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In women with breast cancer receiving neoadjuvant chemotherapy, residual cancer burden (RCB) predicts distant recurrence and survival. In those with high risk tumors, locoregional recurrence (LRR) remains a concern, and has been associated with type of local therapy received. We evaluated the impact of local therapy on LRR in the ISPY-2 TRIAL.
Methods: Data were analyzed in Stata 14.2, using Chi2 test, log rank test, and a Cox proportional hazards model. RCB was considered a categorical variable (0/1 versus 2/3), as described in prior publications. Breast surgery categories were lumpectomy +/- radiotherapy, or mastectomy +/- radiotherapy. Axillary surgery was defined as sentinel lymph node (SLN) surgery (≤6 nodes removed) or axillary dissection (>6 nodes).
Results: Follow up data from the I-SPY2 TRIAL were available for 630 patients (median follow up 2.76 yrs, range 0.4-7.2). Type of local therapy was significantly associated with clinical stage at presentation, with stage III patients most frequently undergoing mastectomy + radiation (p<0.001). Women with higher RCB were more likely to undergo mastectomy than those with lower RCB (61.3% vs 48.8% mastectomy rate, p=0.002), and more likely to receive adjuvant radiotherapy (62.0% vs 53.9%, p=0.048). There was no association between clinical stage, type of surgery, or radiotherapy and LRR (Table). Higher RCB was significantly associated with LRR, with 3 year locoregional recurrence free rate of 95.1% in RCB 0/1 versus 89.9% in RCB 2/3 (p=0.003).
In a Cox model adjusting for clinical stage, tumor subtype, surgical therapy, RCB status, nodal radiation, and age, significant predictors for LRR were tumor subtype and RCB status. Hazard ratio (HR) for LRR in those with RCB 0/1 was 0.39 compared to those with RCB 2/3 (95% CI 0.17-0.87, p=0.021). There was no difference in LRR between breast conservation and mastectomy; within the breast conservation group, those who had lumpectomy alone had higher hazard of LRR compared to those having lumpectomy + radiation (HR 3.1, 95% CI 1.1-9.2, p=0.043).
Conclusions: Extent of surgical therapy was not associated with local tumor control, regardless of advanced tumor stage at presentation. Rather, tumor biology and response to therapy were the best predictors of LRR. These data highlight the opportunity to minimize the morbidity of extensive surgical therapy for patients with excellent response to systemic therapy.
LRR rates by clinical features and treatment status FrequencyLRR RateP valueClinical Stage 0.5I240 (47.5%)5.8% II185 (36.6%)8.7% III80 (15.8%)6.3% Tumor Subtype 0.014ER+PR+Her2-161 (26.4%)3.1% ER+PR-Her2-56 (9.2%)3.6% Her2+176 (28.9%)6.3% Triple negative216 (35.5%)11.1% Local therapy 0.169Lumpectomy85 (13.5%)11.8% Lumpectomy with radiation198 (31.4%)5.6% Mastectomy173 (27.5%)5.2% Mastectomy with radiation174 (27.6%)8.6% Axillary surgery 0.23None5 (0.8%)20% SLN329 (52.2%)5.8% ALND296 (47%)8.5% Axillary radiation 0.535Yes42 (6.7%)9.5% No588 (93.3%)7.0% Axillary management 0.2No surgery or radiation5 (0.8%)20.0% SLN312 (50%)5.3% SLN+Axillary radiation17 (2.7%)8.3% ALND271 (43%)10.3% ALND+Axillary radiation25 (4%)5.4% RCB 0.0020/1293 (50.1%)3.8% 2/3292 (49.9%)10.3%
Citation Format: Silverstein J, Suleiman L, Yau C, Price ER, Singhrao R, Yee D, DeMichele A, Isaacs C, Albain KS, Chien AJ, Forero-Torres A, Wallace AM, Pusztai L, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Leyland-Jones B, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, I-SPY 2 TRIAL Consortium, Berry DA, Asare SM, Esserman LJ, Boughey JC, Mukhtar RA. The impact of local therapy on locoregional recurrence in women with high risk breast cancer in the neoadjuvant I-SPY2 TRIAL [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-01.
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Affiliation(s)
- J Silverstein
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Suleiman
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - C Yau
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - ER Price
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Singhrao
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - D Yee
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - A DeMichele
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - C Isaacs
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - KS Albain
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AJ Chien
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - A Forero-Torres
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AM Wallace
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Pusztai
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - ED Ellis
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AD Elias
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JE Lang
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - J Lu
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - HS Han
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AS Clark
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Korde
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Nanda
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DW Northfelt
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - QJ Khan
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - RK Viscusi
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DM Euhus
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - KK Edmiston
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SY Chui
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - K Kemmer
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - WC Wood
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JW Park
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - MC Liu
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - O Olopade
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - B Leyland-Jones
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - D Tripathy
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SL Moulder
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - HS Rugo
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Schwab
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - S Lo
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - T Helsten
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - H Beckwith
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DA Berry
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SM Asare
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - LJ Esserman
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JC Boughey
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - RA Mukhtar
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
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O'Shaughnessy J, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Cheung E, Han HS, Daniel BR, Vojnovic Z, Vasev N, Ling M, Richards DA, Wilks ST, Milenkovic D, Sorrentino JA, Roberts PJ, Bomar M, Yang Z, Antal JM, Malik RK, Morris SR, Tan A. Abstract PD1-01: Trilaciclib (T), a CDK4/6 inhibitor, dosed with gemcitabine (G), carboplatin (C) in metastatic triple negative breast cancer (mTNBC) patients: Preliminary phase 2 results. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd1-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Cytotoxic chemotherapy-induced damage of hematopoietic stem and progenitor cells (HSPCs) results in acute toxicities consisting of multi-lineage myelosuppression, and late onset toxicities consisting of progressive bone marrow suppression with increased incidence of therapy-related myeloid neoplasms. T is an IV CDK4/6 inhibitor in development to preserve HSPC and immune system function during cytotoxic chemotherapy (myelopreservation). Proof of concept for myelopreservation with T was observed in a randomized, placebo-controlled Phase 2 trial in small-cell lung cancer patients receiving 1st-line chemotherapy. This trial in mTNBC patients (NCT02978716) was designed to explore the utility of T in combination with GC.
Methods: This Phase 2, randomized, open-label study enrolled patients in the US and EU with mTNBC who had received 0-2 prior systemic cytotoxic therapies in the locally recurrent or metastatic setting and had no symptomatic brain metastases. Patients were randomized (1:1:1) to GC alone (Group 1) or T plus GC (Group 2) using a standard schedule (D1, 8 every 21 days) or to an alternative schedule (T on D1, 2, 8 and 9 with GC on D2 and 9 every 21 days; Group 3). On those days when both T and GC were scheduled, T was administered iv prior to GC infusion. Prophylactic growth factors were not administered in cycle 1; otherwise supportive care was allowed as needed. Primary objectives were safety and tolerability; tumor response was evaluated using RECIST v1.1 and PFS and OS were assessed. Myelopreservation endpoints reflecting the potential effects of T on multiple cellular lineages include occurrence of Grade 4 neutropenia (primary), RBC and platelet transfusions (primary), and lymphocyte counts with immune profiling (secondary and exploratory). A signature of CDK4/6 independence developed from preclinical data will be used to evaluate archival tumor tissue samples and data analysis is ongoing.
Results: 95 patients were dosed; median age 57 years (range 32,86), ECOG PS 0 (53%) or 1 (47%), 25% had liver metastases at baseline, and approximately 50% had received no systemic therapy in the recurrent/metastatic setting. Fifty-five patients remain on treatment. Disease progression was the most common reason for drug discontinuation (22/40; 55%). Overall the most common (≥ 25%) TEAEs were anemia (47%), nausea (35%), fatigue (34%), neutropenia (32%), platelet count decreased (25%), and vomiting (25%). The most frequent (≥ 15%) Grade 3 or 4 TEAEs were hematologic toxicities, i.e. neutropenia (28%), anemia (21%), neutrophil count decreased (21%) and thrombocytopenia (16%). These were also the most frequent drug-related TEAEs observed. Tumor efficacy data are being evaluated.
Conclusions: This trial, assessing the myelopreservation effects of T when combined with GC in patients with mTNBC, has completed enrollment. Myelopreservation data, immune profiling, as well as ORR and preliminary PFS results will be presented by study arm at the meeting.
Citation Format: O'Shaughnessy J, Wright GS, Thummala AR, Danso MA, Popovic L, Pluard TJ, Cheung E, Han HS, Daniel BR, Vojnovic Z, Vasev N, Ling M, Richards DA, Wilks ST, Milenkovic D, Sorrentino JA, Roberts PJ, Bomar M, Yang Z, Antal JM, Malik RK, Morris SR, Tan A. Trilaciclib (T), a CDK4/6 inhibitor, dosed with gemcitabine (G), carboplatin (C) in metastatic triple negative breast cancer (mTNBC) patients: Preliminary phase 2 results [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD1-01.
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Affiliation(s)
- J O'Shaughnessy
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - GS Wright
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - AR Thummala
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - MA Danso
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - L Popovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - TJ Pluard
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - E Cheung
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - HS Han
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - BR Daniel
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - Z Vojnovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - N Vasev
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - M Ling
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - DA Richards
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - ST Wilks
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - D Milenkovic
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - JA Sorrentino
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - PJ Roberts
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - M Bomar
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - Z Yang
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - JM Antal
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - RK Malik
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - SR Morris
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
| | - A Tan
- Texas Oncology Baylor Sammons, US Oncology Research, Dallas, TX; Florida Cancer Specialists (North), Saint Petersburg, FL; Comprehensive Cancer Centers of Nevada, US Oncology Research, Las Vegas, NV; Virginia Oncology Specialists, US Oncology Research, Norfolk, VA; Oncology Institute of Vojvodina, University of Novi Sad, Sremska Kamenica, Serbia; Saint Luke's Cancer Institute, Kansas City, MO; Innovative Clinical Research Institute, Whittier, CA; Moffitt Cancer Center, Tampa, FL; Tennessee Oncology – Chattanooga, Chattanooga, TN; County Hospital Varazdin, Varaždin, Croatia; University Clinic of Radiotherapy and Oncology, Skopje, Macedonia, The Former Yugoslav Republic of; Rocky Mountain Cancer Centers, US Oncology Research, Denver, CO; Texas Oncology Tyler, US Oncology Research, Tyler, TX; Texas Oncology San Antonio Northeast, US Oncology Research, San Antonio, TX; Clinical Center Nis, Clinic of Oncology, Niš, Serbia; G1 Therapeutics, Research Triangle Park, NC; Levine Cancer Institute, Atrium Health, Charlo
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Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen YY, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Abstract P2-07-03: Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-03] [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: Patients achieving a pathologic complete response (pCR) following neoadjuvant therapy have significantly improved event-free survival relative to those who do not; and pCR is an FDA-accepted endpoint to support accelerated approval of novel agents/combinations in the neoadjuvant treatment of high risk early stage breast cancer. Previous studies have shown that recurrence risk increased with increasing burden of residual disease (as assessed by the RCB index). As well, these studies suggest that patients with minimum residual disease (RCB-I class) also have favorable outcomes (comparable to those achieving a pCR) within high risk tumor subtypes. In this study, we assess whether integrating RCB with MRI functional tumor volume (FTV), which in itself is prognostic, can improve prediction of distant recurrence free survival (DRFS); and identify a subset of patients with minimal residual disease with comparable DRFS as those who achieved a pCR. Imaging tools can then be used to identify the subset that will do well early and guide the timing of surgical therapy.
Method: We performed a pooled analysis of 596 patients from the I-SPY2 TRIAL with RCB, pre-surgical MRI FTV data and known follow-up (median 2.5 years). We first assessed whether FTV predicts residual disease (pCR or pCR/RCB-I) using ROC analysis. We applied a power transformation to normalize the pre-surgical FTV distribution; and assessed its association with DRFS using a bi-variate Cox proportional hazard model adjusting for HR/HER2 subtype. We also fitted a bivariate Cox model of RCB index adjusting for subtype; and assessed whether adding pre-surgical FTV to this model further improves association with DRFS using a likelihood ratio (LR) test. For the Cox modeling, penalized splines approximation of the transformed FTV and RCB index with 2 degrees of freedom was used to allow for non-linear effects of FTV and RCB on DRFS.
Result: Pre-surgical MRI FTV is significantly associated with DRFS (Wald p<0.00001), and more effective at predicting pCR/RCB-I than predicting pCR alone (AUC: 0.72 vs. 0.65). Larger pre-surgical FTV remains associated with worse DRFS adjusting for subtype (Wald p <0.00001). The RCB index is also significantly associated with DRFS adjusting for subtype (Wald p<0.00001). Adding FTV to a model containing RCB and subtype further improves association with DRFS (LR p=0.0007). RCB-I patients have excellent DRFS (94% at 3 years compared to 95% in the pCR group). Efforts are underway to identify an optimal threshold for dichotomizing pre-surgical FTV and FTV change measures for use in combination with pCR/RCB-I class to generate integrated RCB (iRCB) groups as a composite predictor of DRFS.
Conclusion: Pre-surgical MRI FTV is effective at predicting minimal residual disease (RCB0/I) in the I-SPY 2 TRIAL. Despite the association between FTV and RCB, FTV appears to provide independent added prognostic value (to RCB and subtype), suggesting that integrating MRI volume measures and RCB into a composite predictor may improve DRFS prediction.
Citation Format: Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen Y-Y, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, I-SPY 2 TRIAL Consortium, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-03.
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Affiliation(s)
- NM Hylton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WF Symmans
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Yau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Li
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Hatzis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Isaacs
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KS Albain
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - Y-Y Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Krings
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Wei
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Harada
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Datnow
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Fadare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Klein
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Pambuccian
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Adamson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - P Mhawech-Fauceglia
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Magliocco
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Feldman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Rendi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Sattar
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Zeck
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - I Ocal
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Tawfik
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Grasso LeBeau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sahoo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Vinh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Adams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AJ Chien
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Ferero-Torres
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - E Stringer-Reasor
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wallace
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JC Boughey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ED Ellis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AD Elias
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JE Lang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Lu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Han
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AS Clark
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Korde
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Nanda
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DW Northfelt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - QJ Khan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - RK Viscusi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DM Euhus
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KK Edmiston
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SY Chui
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Kemmer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WC Wood
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JW Park
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MC Liu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Olopade
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Tripathy
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SL Moulder
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Rugo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Schwab
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Lo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Helsten
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Beckwith
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PK Haugen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ van't Veer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Perlmutter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ME Melisko
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wilson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Peterson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AL Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MB Buxton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Paoloni
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JL Clennell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - GL Hirst
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Singhrao
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Steeg
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JB Matthews
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Sanil
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Abe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Wolverton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - EP Crane
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KA Ward
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Nelson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - BL Niell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Oh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KR Brandt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DH Bang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Ojeda-Fournier
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Eghtedari
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PA Sheth
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WK Bernreuter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Umphrey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MA Rosen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Dogan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Joe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Yee
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Pusztai
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A DeMichele
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DA Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ Esserman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
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Kim JY, Lee EJ, Park KH, Im SA, Kim SB, Sohn SH, Lee KS, Chae YS, Lee KH, Kim JH, Im YH, Kim TY, Lee KH, Ahn JH, Kim GM, Park IH, Lee SJ, Han HS, Kim SH, Jung KH, Park YH. Abstract P3-11-07: Exploratory biomarker analysis from a phase II, multicenter, randomized trial of eribulin plus gemcitabine(EG) versus paclitaxel plus gemcitabine(PG) as first-line chemotherapy for human epidermal growth factor receptor 2 (HER2)- negative metastatic breast cancer(MBC): Korean cancer study group trial (KCSG BR13-11). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-11-07] [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
Introduction : A phase II, multicenter, randomized clinical trial of the comparison between eribulin plus gemcitabine (EG) and paclitaxel plus gemcitabine (PG) as first-line chemotherapy for patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) found EG was less neurotoxic, but had similar efficacy of PG. In this study, we performed exploratory biomarker analysis of the impact of genetic alterations on the efficacy according to EG and PG chemotherapy.
Methods : This biomarker study was conducted using tumor samples from 40patients. When tissue collection was possible after disease progression, we performed paired sample analysis. Tumor DNA and RNA were extracted from formalin-fixed, paraffin-embedded tissues. To perform targeted deep sequencing, we used CancerScanTM, a 375 cancer gene panel. And we performed an nCounter expression assay for gene expression analysis using 730 PanCancer panel and 730 Immune panel.
Results: In total, we obtained 44 tissue samples from 40 patients. Twenty two patients were assigned in EG arm and 18 patients were in PG arm. Thirty-eight were at baseline and six after disease progression. Gene expression assay were performed in 44 tissue samples but only 31 samples were possible to be targeted deep sequencing.
We performed differently expressed gene(DEG) analysis for detecting the association between level of gene expression and disease progression. In this analysis, high expression of CCNE1, TGFB4 and BAMBI and low expression of DDB2, CD14 and SHC3 were associated with disease progression among 730 PanCancer panel genes (p<0.05, respectively). In terms of immune panel genes, most of immune related genes were highly expressed in a group without disease progression compared with that with disease progression. Only 2 genes, C8G and CD24 were highly expressed in a group with disease progression. Paired sample analysis showed that expression levels of THBS4 and CD27 decreased after disease progression while those of CCNE2 and FGFR4 increased.
In targeted deep sequencing, FAT3 (42.3%) was most frequently mutated gene followed by PKHD1, PIK3CA and TP53. Among mutated genes, EWSR1 mutation and upstream mutation of ETV1 were associated with disease progression, respectively (p<0.05, respectively). In mutation signature analysis, signature 1 (S, age related), S3(homologous recombination deficiency, HRD), S6 (mismatch repair, MMR), S20(MMR) and S21(microsatellite instability, MSI) were enriched in this population. Mutation signature 3 related to short disease free survival (p=0.0026).
Conclusion: In gene expression analysis, high expression of TGF-B signaling pathway related genes was associated with disease progression while high expression of immune related genes were related to prolonged disease free survival. In mutation analysis, EWSR1 and ETV1 mutations indicated short disease free interval and HRD mutation signature was also related to poor prognosis.
Citation Format: Kim J-Y, Lee EJ, Park KH, Im S-A, Kim S-B, Sohn SH, Lee KS, Chae YS, Lee KH, Kim JH, Im Y-H, Kim T-Y, Lee K-H, Ahn J-H, Kim GM, Park IH, Lee SJ, Han HS, Kim SH, Jung KH, Park YH. Exploratory biomarker analysis from a phase II, multicenter, randomized trial of eribulin plus gemcitabine(EG) versus paclitaxel plus gemcitabine(PG) as first-line chemotherapy for human epidermal growth factor receptor 2 (HER2)- negative metastatic breast cancer(MBC): Korean cancer study group trial (KCSG BR13-11) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-11-07.
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Affiliation(s)
- J-Y Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - EJ Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - KH Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - S-A Im
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - S-B Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - SH Sohn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - KS Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - YS Chae
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - KH Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - JH Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Y-H Im
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - T-Y Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - K-H Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - J-H Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - GM Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - IH Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - SJ Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - HS Han
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - SH Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - KH Jung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - YH Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Samsung Genome Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Center for Breast Cancer, National Cancer Center, Goyang, Korea; Kyungpook National University Medical Center, Daegu, Korea; Chungbuk National University Hospital, Cheongju, Korea; Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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14
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Joung S, Kim J, Kwak S, Park KR, Hahn SH, Han HS, Kim HS, Bak JG, Lee SG, Ghim YC. Imputation of faulty magnetic sensors with coupled Bayesian and Gaussian processes to reconstruct the magnetic equilibrium in real time. Rev Sci Instrum 2018; 89:10K106. [PMID: 30399691 DOI: 10.1063/1.5038938] [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] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
A Bayesian with Gaussian process-based numerical method to impute a few missing magnetic signals caused by impaired magnetic probes during tokamak operations is developed such that the real-time reconstruction of magnetic equilibria, whose performance strongly depends on the measured magnetic signals and their intactness, is affected minimally. Likelihood of the Bayesian model constructed with Maxwell's equations, specifically Gauss's law for magnetism and Ampère's law, results in an infinite number of solutions if two or more magnetic signals are missing. This undesirable characteristic of the Bayesian model is remediated by coupling the model with the Gaussian process. Our proposed numerical method infers nine non-consecutive missing magnetic signals correctly in less than 1 ms suitable for the real-time reconstruction of magnetic equilibria during tokamak operations.
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Affiliation(s)
- Semin Joung
- Department of Nuclear and Quantum Engineering, KAIST, Daejeon 34141, South Korea
| | - Jaewook Kim
- Department of Nuclear and Quantum Engineering, KAIST, Daejeon 34141, South Korea
| | - Sehyun Kwak
- Department of Nuclear and Quantum Engineering, KAIST, Daejeon 34141, South Korea
| | - Kyeo-Reh Park
- Department of Nuclear and Quantum Engineering, KAIST, Daejeon 34141, South Korea
| | - S H Hahn
- National Fusion Research Institute, Daejeon 34133, South Korea
| | - H S Han
- National Fusion Research Institute, Daejeon 34133, South Korea
| | - H S Kim
- National Fusion Research Institute, Daejeon 34133, South Korea
| | - J G Bak
- National Fusion Research Institute, Daejeon 34133, South Korea
| | - S G Lee
- National Fusion Research Institute, Daejeon 34133, South Korea
| | - Y-C Ghim
- Department of Nuclear and Quantum Engineering, KAIST, Daejeon 34141, South Korea
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15
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Kim J, Suh BK, Ko CW, Lee KH, Shin CH, Hwang JS, Kim HS, Chung WY, Kim CJ, Han HS, Kwon NY, Cho SY, Yoo HW, Jin DK. Recombinant growth hormone therapy for prepubertal children with idiopathic short stature in Korea: a phase III randomized trial. J Endocrinol Invest 2018; 41:475-483. [PMID: 29103133 PMCID: PMC5852196 DOI: 10.1007/s40618-017-0786-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/25/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Several studies have evaluated the effects of growth hormone (GH) on auxological and biochemical parameters in children with non-GH-deficient, idiopathic short stature (ISS). This study evaluated the efficacy and safety of Growtropin®-II (recombinant human GH) in Korean patients with ISS. METHODS This was a 1-year, open-label, multicenter, phase III randomized trial of Growtropin®-II in Korean patients with ISS. In total, 70 prepubertal subjects (39 males, 31 females) between 4 and 12 years of age were included in the study. All patients were naive to GH treatment. RESULTS Annual height velocity was significantly higher in the treatment group (10.68 ± 1.95 cm/year) than the control group (5.72 ± 1.72, p < 0.001). Increases in height and weight standard deviation scores (SDSs) at 26 weeks were 0.63 ± 0.16 and 0.64 ± 0.46, respectively, for the treatment group, and 0.06 ± 0.15 and 0.06 ± 0.28, respectively, for the control group (p < 0.001). Serum insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) increased significantly in the treatment group at week 26 compared to baseline. However, the SDS for body mass index (BMI) at 26 weeks did not change significantly in either group. Growtropin®-II was well tolerated and safe over 1 year of treatment. CONCLUSIONS One-year GH treatment for prepubertal children with ISS demonstrated increased annualized velocity, height and weight SDSs, and IGF-1 and IGFBP-3 levels, with a favorable safety profile. Further evaluations are needed to determine the optimal dose, final adult height, and long-term effects of ISS treatment.
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Affiliation(s)
- J Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - B-K Suh
- Department of Pediatrics, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - C W Ko
- Department of Pediatrics, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - K-H Lee
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - C H Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - J S Hwang
- Department of Pediatrics, Ajou University Hospital, Suwon, Republic of Korea
| | - H S Kim
- Department of Pediatrics, Severance Hospital, Onsei University Health System, Seoul, Republic of Korea
| | - W Y Chung
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - C J Kim
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H-S Han
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - N Y Kwon
- Data Management and Clinical Statistics Team, Dong-A ST Co., LTD, Seoul, Republic of Korea
| | - S Y Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - H-W Yoo
- Department of Pediatrics, Medical Genetics Clinic and Laboratory, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - D-K Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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16
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Forero A, Han HS, Dees EC, Wesolowski R, Bardia A, Kabos P, Kern KA, Perea R, Pierce KJ, Houk B, Rugo HS. Abstract OT2-07-06: Phase Ib study to assess the safety, tolerability, and clinical activity of gedatolisib in combination with palbociclib and either letrozole or fulvestrant in women with metastatic or locally advanced/recurrent breast cancer (B2151009). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot2-07-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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:Hormone receptor positive (HR+) disease is the most common subset of advanced breast cancer (BC). The majority of women with HR+ metastatic BC (MBC) develop resistance to endocrine therapy (ET), with a median survival of 2-3 years. A new strategy to treat HR+ MBC involves the combination of ET and a cyclin-dependent kinase 4/6 inhibitor (CDKi 4/6), which has demonstrated improved progression-free survival (PFS) in both first-and later-line MBC. Preclinical evidence in PI3K-mutant cell-line xenografts demonstrated that combinations of PI3K and CDK4/6i reduced intrinsic and adaptive resistance to ET, leading to tumor regression (Vara, 2004; Pfizer data). Inhibition of the PI3K/mTOR pathway by gedatolisib (G) may provide a new therapy to overcome ET resistance. These findings support developing the triplet combination of G with the CDKi 4/6 palbociclib (P)+letrozole (L) or fulvestrant (F) for the treatment of patients (pts) with ER+/HER2- BC.
Methods: This ongoing study in women with ER+/HER2- MBC, in first- and later-line settings, includes a dose-escalation (DE) to evaluate dose-limiting toxicities (DLTs, primary endpoint [pEP]) and determine the maximum tolerated dose and recommended phase 2 dose (RP2D) for a triplet regimen of G+P+L or G+P+F. The escalation rules follow the modified toxicity probability interval method (G doses: 180 and 215 mg IV weekly). Treatment assignment to the triplet is based on investigator decision and bone-only disease is permitted. After RP2D determination for each triplet, a 3-arm expansion for early signs of efficacy (ESOE) will investigate objective response rate (ORR) compared to historical controls [pEP] of Arm A) G+P+L in first-line, B) G+P+F in pts with no prior CDKi 4/6 in second-line and C) G+P+F in pts who have received prior CDKi 4/6. Pts receive G+P (125 mg oral daily for 21 days [D] on and 7 D off) + L (2.5 mg oral daily) or F (500 mg IM on D1, 15 of cycle [C] 1; D1 of C2 and then 500 mg IM on D1 of all 28-D cycles). Secondary endpoints include safety, tumor response (DE), PFS (ESOE), pharmacokinetics (PK), and biomarker correlations associated with the PI3K/mTOR pathway.
Results: 27 pts received G (180 mg/week) in combination with P+L (L cohort, n=12) or P+F (F cohort, n=15). Median prior therapies were: L cohort: 1 (range: 0-4); F cohort: 2 (range 1-5). The 3 most common, drug-related adverse events (%) were in L cohort: nausea (75), neutropenia (67), and stomatitis (67); F cohort: stomatitis (67), nausea (60), and neutropenia (53). C1 DLTs were: L cohort: grade (gr) 3 neutropenia (n=1); F cohort: gr 3 stomatitis (n=1). Preliminary rates of stable disease/partial response were: L cohort: 33%/16%; F cohort: 40%/13%. PK parameters and next-generation sequencing of PI3K-related mutations are pending.
Conclusions: G can be combined with P+L or P+F with manageable toxicity and promising preliminary antitumor activity, even in heavily pretreated pts. Dose escalation, followed by expansion for ESOE, is ongoing.
This study is sponsored by Pfizer. Editorial support was provided by Engage Scientific Solutions and was funded by Pfizer.
Citation Format: Forero A, Han HS, Dees EC, Wesolowski R, Bardia A, Kabos P, Kern KA, Perea R, Pierce KJ, Houk B, Rugo HS. Phase Ib study to assess the safety, tolerability, and clinical activity of gedatolisib in combination with palbociclib and either letrozole or fulvestrant in women with metastatic or locally advanced/recurrent breast cancer (B2151009) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-07-06.
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Affiliation(s)
- A Forero
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - HS Han
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - EC Dees
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - R Wesolowski
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - A Bardia
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - P Kabos
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - KA Kern
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - R Perea
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - KJ Pierce
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - B Houk
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - HS Rugo
- University of Alabama Comprehensive at Birmingham Cancer Center, Birmingham, AL; Moffitt Cancer Center, Tampa, FL; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Ohio State University Comprehensive Cancer Center, Columbus, OH; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA; University of Colorado, Denver, CO; Pfizer Inc, San Diego, CA; Pfizer Inc, Groton, CT; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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17
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Modi S, Pusztai L, Forero A, Mita M, Miller KD, Weise A, Krop I, Burris H, Kalinsky K, Tsai M, Liu MC, Hurvitz SA, Wilks S, Ademuyiwa F, Diab S, Han HS, Kato G, Nanda R, O'Shaughnessy J, Kostic A, Li M, Specht J. Abstract PD3-14: Phase 1 study of the antibody-drug conjugate SGN-LIV1A in patients with heavily pretreated triple-negative metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd3-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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
LIV-1, a transmembrane protein and downstream target of STAT3, is highly expressed in breast cancer cells. It is associated with lymph node involvement and metastatic progression. SGN-LIV1A is an anti-LIV-1 antibody conjugated via a protease-cleavable linker to monomethyl auristatin E (MMAE). Upon binding to cell-surface LIV-1, SGN-LIV1A is internalized and releases MMAE, which disrupts microtubulin and induces apoptosis.
Methods
This ongoing, phase 1 study evaluates safety, tolerability, pharmacokinetics, and antitumor activity of SGN-LIV1A (q3wks IV) in women with LIV-1-positive, unresectable, locally advanced or metastatic breast cancer (LA/MBC) (NCT01969643). Patients (pts) with measurable disease and ≥2 prior cytotoxic regimens for LA/MBC are eligible. Pts with ≥ Grade 2 neuropathy are excluded. Response is assessed per RECIST v1.1; pts with stable disease (SD) or better can continue treatment until disease progression or intolerable toxicity. At completion of dose escalation in hormone receptor-positive/HER2-negative (HR+/HER2–) and triple-negative (TN) pts, expansion cohorts were opened to further evaluate safety and antitumor activity of monotherapy in TN pts. Tumor biopsies are evaluated for LIV-1 expression.
Results
To date, 69 pts (18 HR+/HER2–, 51 TN) have received a median of 3 cycles (range, 1–12) of SGN-LIV1A at doses of 0.5–2.8 mg/kg. Median age was 56 yrs. Pts had a median of 3 prior cytotoxic regimens for LA/MBC; 58 had visceral disease and 37 had bone metastases. No dose-limiting toxicities (DLTs) occurred in 19 DLT-evaluable pts; maximum tolerated dose was not exceeded at 2.8 mg/kg. Expansion cohorts of TN pts were opened at 2.0 and 2.5 mg/kg. Treatment-emergent adverse events (AEs) reported in ≥25% of pts were fatigue (59%), nausea (51%), peripheral neuropathy (44%), alopecia (36%), decreased appetite (33%), constipation (30%), abdominal pain, diarrhea, and neutropenia (25% each). Most AEs were Grade 1/2; AEs ≥ Grade 3 included neutropenia (25%) and anemia (15%). Febrile neutropenia occurred in 2 pts whose total dose exceeded 200 mg per cycle, including 1 treatment-related death due to sepsis. No other treatment-related deaths occurred on-study. Seven pts discontinued treatment due to AEs. In dose escalation, activity was observed in 17 efficacy evaluable (EE) HR+/HER2- pts, with a disease control rate (DCR= CR+PR+SD) of 59% (10 SD), including 1 pt with SD ≥24 wks. Among the 44 EE TN pts (dose escalation plus expansion cohorts), the objective response rate (ORR) was 32% (14 PR) with a confirmed PR rate of 21%, DCR was 64% (14 PR, 14 SD), and clinical benefit rate (CBR=CR+PR+SD ≥24 wks) was 36% (16 pts). For TN pts, median PFS was 11.3 wks (95% CI: 6.1, 17.1); 10 pts remain on treatment.
Of 631 MBC tumor samples of all clinical subtypes evaluated for LIV-1, 91% were positive; 75% had moderate-to-high expression (H-score ≥100).
Conclusions
LIV-1 is expressed in almost all MBC tumors. SGN-LIV1A monotherapy was generally well tolerated and showed encouraging antitumor activity in heavily pretreated TN MBC, with a PR rate of 32%, confirmed PR rate of 21%, and CBR (≥24 wks) of 36%. Response duration data continue to evolve. Enrollment continues in the TN monotherapy expansion cohort.
Citation Format: Modi S, Pusztai L, Forero A, Mita M, Miller KD, Weise A, Krop I, Burris III H, Kalinsky K, Tsai M, Liu MC, Hurvitz SA, Wilks S, Ademuyiwa F, Diab S, Han HS, Kato G, Nanda R, O'Shaughnessy J, Kostic A, Li M, Specht J. Phase 1 study of the antibody-drug conjugate SGN-LIV1A in patients with heavily pretreated triple-negative metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD3-14.
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Affiliation(s)
- S Modi
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - L Pusztai
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - A Forero
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - M Mita
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - KD Miller
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - A Weise
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - I Krop
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - H Burris
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - K Kalinsky
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - M Tsai
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - MC Liu
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - SA Hurvitz
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - S Wilks
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - F Ademuyiwa
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - S Diab
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - HS Han
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - G Kato
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - R Nanda
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - J O'Shaughnessy
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - A Kostic
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - M Li
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - J Specht
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
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Han HS, Diéras V, Robson M, Palácová M, Marcom PK, Jager A, Bondarenko I, Citrin D, Campone M, Telli ML, Domchek SM, Friedlander M, Kaufman B, Garber JE, Shparyk Y, Chmielowska E, Jakobsen EH, Kaklamani V, Gradishar W, Ratajczak CK, Nickner C, Qin Q, Qian J, Shepherd SP, Isakoff SJ, Puhalla S. Veliparib with temozolomide or carboplatin/paclitaxel versus placebo with carboplatin/paclitaxel in patients with BRCA1/2 locally recurrent/metastatic breast cancer: randomized phase II study. Ann Oncol 2018; 29:154-161. [PMID: 29045554 PMCID: PMC5834075 DOI: 10.1093/annonc/mdx505] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [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] [Indexed: 12/23/2022] Open
Abstract
Background Homologous recombination defects in BRCA1/2-mutated tumors result in sensitivity to poly(ADP-ribose) polymerase inhibitors, which interfere with DNA damage repair. Veliparib, a potent poly(ADP-ribose) polymerase inhibitor, enhanced the antitumor activity of platinum agents and temozolomide in early phase clinical trials. This phase II study examined the safety and efficacy of intermittent veliparib with carboplatin/paclitaxel (VCP) or temozolomide (VT) in patients with BRCA1/2-mutated breast cancer. Patients and methods Eligible patients ≥18 years with locally recurrent or metastatic breast cancer and a deleterious BRCA1/2 germline mutation were randomized 1 : 1 : 1 to VCP, VT, or placebo plus carboplatin/paclitaxel (PCP). Primary end point was progression-free survival (PFS); secondary end points included overall survival (OS) and overall response rate (ORR). Results Of 290 randomized patients, 284 were BRCA+, confirmed by central laboratory. For VCP versus PCP, median PFS was 14.1 and 12.3 months, respectively [hazard ratio (HR) 0.789; 95% CI 0.536-1.162; P = 0.227], interim median OS 28.3 and 25.9 months (HR 0.750; 95% CI 0.503-1.117; P = 0.156), and ORR 77.8% and 61.3% (P = 0.027). For VT (versus PCP), median PFS was 7.4 months (HR 1.858; 95% CI 1.278-2.702; P = 0.001), interim median OS 19.1 months (HR 1.483; 95% CI 1.032-2.131; P = 0.032), and ORR 28.6% (P < 0.001). Safety profile was comparable between carboplatin/paclitaxel arms. Adverse events (all grades) of neutropenia, anemia, alopecia, and neuropathy were less frequent with VT versus PCP. Conclusion Numerical but not statistically significant increases in both PFS and OS were observed in patients with BRCA1/2-mutated recurrent/metastatic breast cancer receiving VCP compared with PCP. The addition of veliparib to carboplatin/paclitaxel significantly improved ORR. There was no clinically meaningful increase in toxicity with VCP versus PCP. VT was inferior to PCP. An ongoing phase III trial is evaluating VCP versus PCP, with optional continuation single-agent therapy with veliparib/placebo if chemotherapy is discontinued without progression, in this patient population. Clinical trial information NCT01506609.
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Affiliation(s)
- H S Han
- Moffitt Cancer Center, Tampa, USA
| | - V Diéras
- Institut Curie, Paris, France, USA
| | - M Robson
- Weill Cornell Medical College, New York, USA
| | - M Palácová
- Masarykův Onkologický Ústav, Brno, Czech Republic, Durham, USA
| | | | - A Jager
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - I Bondarenko
- Dnepropetrovsk Medical Academy, City Hospital #4, Dnipro, Ukraine
| | - D Citrin
- Midwestern Regional Medical Center, Zion, USA
| | - M Campone
- Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - M L Telli
- Stanford University School of Medicine, Stanford, USA
| | - S M Domchek
- University of Pennsylvania, Philadelphia, USA
| | | | - B Kaufman
- Sheba Medical Center, Tel Hashomer, Israel
| | - J E Garber
- Dana-Farber Cancer Institute, Boston, USA
| | - Y Shparyk
- Chemotherapy Department, Lviv State Regional Treatment and Diagnostics Oncology Center, Lviv, Ukraine
| | - E Chmielowska
- Department of Clinical Oncology, Oncology Centre, Bydgoszcz, UMK, Torun, Poland
| | - E H Jakobsen
- Department of Oncology, Vejle Hospital/Lillebaelt Hospital, Vejle, Denmark
| | - V Kaklamani
- Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - W Gradishar
- Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | | | - Q Qin
- AbbVie Inc., North Chicago, USA
| | - J Qian
- AbbVie Inc., North Chicago, USA
| | | | | | - S Puhalla
- University of Pittsburgh Cancer Institute, Pittsburgh, USA
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Pistilli B, Pluard T, Urruticoechea A, Farci D, Kong A, Bachelot T, Chan S, Han HS, Jerusalem G, Urban P, Robinson D, Mouhaër SL, Tomaso ED, Massacesi C, Saura C. Phase II study of buparlisib (BKM120) and trastuzumab in patients with HER2+ locally advanced or metastatic breast cancer resistant to trastuzumab-based therapy. Breast Cancer Res Treat 2017; 168:357-364. [PMID: 29198055 DOI: 10.1007/s10549-017-4596-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/22/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE A Phase Ib study in patients with trastuzumab-resistant, human epidermal growth factor receptor-2- (HER2)-positive advanced breast cancer defined the recommended Phase II dose of buparlisib as 100 mg/day in combination with 2 mg/kg weekly trastuzumab, and reported preliminary signs of clinical activity. Here we present results from the Phase II portion. METHODS Patients with trastuzumab-resistant, HER2-positive advanced breast cancer received buparlisib plus trastuzumab. Study endpoints included safety/tolerability and antitumour activity. The study was extended to include a Phase Ib dose-escalation phase, in which patients with progressive brain metastases also received capecitabine. RESULTS In the Phase II portion, of 50 patients treated with buparlisib and trastuzumab, the most common (≥ 30%) all-grade adverse events (AEs) were diarrhoea (54%), nausea (48%), decreased appetite, increased alanine aminotransferase (36% each), increased aspartate aminotransferase (34%), fatigue, rash (32% each), cough and hyperglycemia (30% each). One (2%) patient achieved complete response and four (8%) patients had confirmed partial responses [PR; including two patients with phosphatidylinositol 3-kinase (PI3 K) pathway-activated tumours]. Overall response rate (ORR) was 10%: the primary endpoint (ORR ≥ 25%) was therefore not met. In the Phase Ib portion, all patients with measurable brain lesions at baseline showed tumour shrinkage to some degree; due to low enrollment, maximum tolerated dose of buparlisib in combination with trastuzumab and capecitabine was not determined. CONCLUSION Buparlisib plus trastuzumab, as a chemotherapy-free regimen, demonstrated an acceptable safety profile but limited efficacy in patients with heavily pretreated, trastuzumab-resistant HER2-positive breast cancer, and in patients with progressive brain metastases also receiving capecitabine.
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Affiliation(s)
- B Pistilli
- Breast Cancer Unit, Institut Gustave Roussy, 114 Rue Edouard-Vaillant, 94800, Villejuif, France. .,Macerata Hospital, Macerata, Italy.
| | - T Pluard
- Saint Luke's Health System, Kansas City, MO, USA
| | - A Urruticoechea
- Onkologikoa Foundation, San Sebastian, Spain.,Catalan Institute of Oncology, Barcelona, Spain
| | - D Farci
- Ospedale Oncologico, Cagliari, Italy
| | - A Kong
- University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,University of Oxford and Oxford University Hospitals NHS Trust, Oxford, UK
| | - T Bachelot
- Centre Léon Bérard et Inserm U1052, Lyon, France
| | - S Chan
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H S Han
- Moffitt Cancer Center, Tampa, FL, USA
| | - G Jerusalem
- CHU Sart Tilman Liège and University of Liège, Liège, Belgium
| | - P Urban
- Novartis Pharma AG, Basel, Switzerland
| | - D Robinson
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - S L Mouhaër
- Novartis Pharmaceuticals Corporation, Rueil-Malmaison, France
| | - E D Tomaso
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA.,Syros Pharmaceuticals, Watertown, MA, USA
| | - C Massacesi
- Novartis Pharmaceuticals Corporation, Rueil-Malmaison, France
| | - C Saura
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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20
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Chow LWC, Biganzoli L, Leo AD, Kuroi K, Han HS, Patel J, Huang CS, Lu YS, Zhu L, Chow CYC, Loo WTY, Glück S, Toi M. Toxicity profile differences of adjuvant docetaxel/cyclophosphamide (TC) between Asian and Caucasian breast cancer patients. Asia Pac J Clin Oncol 2017; 13:372-378. [PMID: 28371190 DOI: 10.1111/ajco.12682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/30/2017] [Indexed: 12/01/2022]
Abstract
AIM For early-stage breast cancer, four cycles of docetaxel and cyclophosphamide (TC) was proven superior to doxorubicin plus cyclophosphamide in the US Oncology 9375 trial. Given primary prophylactic antibiotics, 5% febrile neutropenia was recorded in a population comprising 75.5% Caucasians. Smaller trials and retrospective studies reviewing TC use in Asian patients did not produce similar incidence rates. This study aims to discover the variable hematological toxicities with TC use in Caucasian and Asian patients. METHODS Breast cancer data was retrospectively reviewed for patients receiving adjuvant docetaxel 60-75 mg/m2 plus cyclophosphamide 600 mg/m2 from six countries (China, Hong Kong, Japan, Taiwan, Italy, and United States). Similar number of patients with relatively balanced baseline characteristics were chosen for analysis of hematological and nonhematological toxicities and survival data. RESULTS From March 2004 to July 2013, data of 227 patients (127 Asians and 100 Caucasian) patients were analyzed for treatment-related toxicities. During the four cycles of TC, Asians had a significantly higher rate of grade ≥2 neutropenia than Caucasians (45.7% vs 6.0%; P <0.001) and significantly more grade ≥3 neutropenia events were documented (respectively 30.7% vs 4.0%, P <0.001). The prophylactic use of G-CSF was similar; 26.0% in Asians and 28.0% in Caucasian (P = 0.764). There were no differences in nonhematological toxicities. No significant difference in disease-free survival was observed between Asians and Caucasians (log-rank P = 0.910). CONCLUSIONS Ethnic differences in toxicity profile exist between Asian and Caucasian patients given adjuvant TC. Over 30% Asians but less than 5% Caucasians experienced grade ≥3 neutropenia.
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Affiliation(s)
- L W C Chow
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute of Applied Medicine and Health, Macau University of Science and Technology, Macau.,Organisation for Oncology and Translational Research, Hong Kong.,UNIMED Medical Institute, Hong Kong
| | - L Biganzoli
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Italy
| | - A D Leo
- Sandro Pitigliani Medical Oncology Unit, Hospital of Prato, Italy
| | - K Kuroi
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - H S Han
- Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, USA
| | - J Patel
- Department of Women's Oncology, H. Lee Moffitt Cancer Center and Research Institute, USA
| | - C S Huang
- Department of Surgery, National Taiwan University Hospital, Taiwan
| | - Y S Lu
- Department of Oncology, National Taiwan University Hospital, Taiwan
| | - L Zhu
- Department of Surgery, Shanghai Jiao Tong University, Shanghai, China
| | | | - W T Y Loo
- Organisation for Oncology and Translational Research, Hong Kong.,UNIMED Medical Institute, Hong Kong
| | - S Glück
- Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami, USA
| | - M Toi
- Organisation for Oncology and Translational Research, Hong Kong.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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21
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Han HS, Wilks S, Paplomata E, Modiano MR, Becerra C, Braiteh FS, Spira AI, Pluard TJ, Richards DA, Conzen SD, Baker G, Fishman RS, Marcantonio A, O'Shaughnessy J, Nanda R. Abstract P6-12-15: Efficacy results of a phase 1/2 study of glucocorticoid receptor (GR) antagonist mifepristone (MIFE) in combination with eribulin in GR-positive triple-negative breast cancer (TNBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-12-15] [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: GR is variably expressed in TNBC and high expression is associated with poor prognosis in estrogen receptor-negative (ER-) early stage breast cancer. Treatment with mifepristone (MIFE) potentiates the effectiveness of chemotherapy in GR+ TNBC xenografts. Enrollment is complete in this study of patients with GR+ TNBC treated at the recommended Phase 2 dose (RP2D) of MIFE in combination with eribulin. Objectives: To determine the safety, tolerability, pharmacokinetics (PK) and clinical activity of the MIFE plus eribulin combination in pts with GR+ TNBC at the RP2D. Methods: Eligibility: In Part 1 (dose finding), pts with solid tumors; in Part 2 (expansion phase), pts with TNBC (GR result required at time of screening in Part 1, but could be pending at time of screening in Part 2). Up to 5 prior chemotherapy regimens for advanced disease; ECOG PS 0-1; adequate end-organ function. Design: 3 + 3 dose escalation scheme. After a 7-day lead-in of oral daily MIFE alone, MIFE was continued daily and eribulin was given on days 1 and 8 of a 21-day cycle. GR+ was defined as >10% of tumor cells with any intensity of GR staining. Results: 16 pts with metastatic breast cancer were treated in Part 1, and 21 pts with TNBC were treated in Part 2. Median age was 54 (range 30-81). MTD/RP2D was MIFE 300 mg/day + eribulin 1.1 mg/m2. Safety: DLT in Part 1 was neutropenia. Neutropenia occurred in 23/36 total patients (2 Grade [G] 1, 10 G3, 11 G4); 2 instances included neutropenic fever. Recovery of WBC was brisk with growth factor support. Neuropathy was observed in 8 pts (5 G1, 1 G2, 2 G3). Other most common AEs (fatigue, hypokalemia, nausea, alopecia) were mainly G1 or G2; among these, G3/G4 events were limited to fatigue (4 G3), hypokalemia (3 G3 and 1 G4) and nausea (1 G3). There were 2 instances of G1 vaginal bleeding. There was no impact of MIFE on eribulin PK. Efficacy: There were 23 evaluable pts with TNBC across Parts 1 and 2 treated at the RP2D: 21 GR+, 2 GR status unknown; median of 3 prior chemotherapy regimens; 1 patient had received prior eribulin. Responses were: 3 PR, 8 SD, 11 PD and one too early to assess. Median PFS was 9 weeks. Conclusions: MIFE plus eribulin was well tolerated and appears to be an active treatment regimen. Five TNBC patients had a PFS longer than the upper 95% CI for PFS (i.e., >15 wks) reported by Aogi et al. for TNBC treated with eribulin (Annals of Oncology 2012?23:144148). Clinical trial information: NCT02014337.
Citation Format: Han HS, Wilks S, Paplomata E, Modiano MR, Becerra C, Braiteh FS, Spira AI, Pluard TJ, Richards DA, Conzen SD, Baker G, Fishman RS, Marcantonio A, O'Shaughnessy J, Nanda R. Efficacy results of a phase 1/2 study of glucocorticoid receptor (GR) antagonist mifepristone (MIFE) in combination with eribulin in GR-positive triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-12-15.
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Affiliation(s)
- HS Han
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - S Wilks
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - E Paplomata
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - MR Modiano
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - C Becerra
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - FS Braiteh
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - AI Spira
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - TJ Pluard
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - DA Richards
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - SD Conzen
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - G Baker
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - RS Fishman
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - A Marcantonio
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - J O'Shaughnessy
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
| | - R Nanda
- Texas Oncology San Antonio; ACRC/Arizona Clinical Research Center and Arizona Oncology; Virginia Cancer Specialists Research Institute; Texas Oncology - Baylor Charles A Sammons Cancer Center; Moffitt Cancer Center; The US Oncology Network/Mckesson Specialty Health; Emory University Winship Cancer Institute Midtown; Saint Luke's Cancer Institute; Tyler Cancer Center, US Oncology Research; Baylor University Medical Center Texas Oncology US Oncology, Dallas, TX; Corcept Therapeutics, Inc; University of Chicago Medical Center; Beth Israel Deaconess Medical Center
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22
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Park YH, Im SA, Sohn JH, Lee KS, Chae YS, Lee KH, Kim JH, Im YH, Ahn JS, Kim TY, Lee KH, Kim SB, Ahn JH, Kim GM, Park IH, Lee SJ, Han HS, Kim SH, Jung KH. Abstract OT1-01-12: A phase II, multicenter, randomized trial of eribulin plus gemcitabine (EG) vs. paclitaxel plus gemcitabine (PG) in patients with HER2-negative metastatic breast cancer as first-line chemotherapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-01-12] [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: Metastatic breast cancer (MBC) is an incurable disease and is needed to improve effective chemotherapy. Paclitaxel plus Gemcitabine (PG) combination chemotherapy is one of the preferred chemotherapeutic regimens for patients with MBC, and was found to be proper as a maintenance chemotherapy regimen with survival benefit and feasible toxicity profile. Eribulin mesylate is a non-taxane inhibitor of microtubule dynamics of the halichondrin class of antineoplastic drugs. A recent pooled analysis of two phase II studies with eribulin showed improved overall survival in in various patient subgroups with advanced/metastatic breast cancer who had previously received an anthracycline and a taxane. Furthermore, eribulin may have rational benefit compared with paclitaxel in terms of neurotoxicity. Therefore, Eribulin plus Gemcitabine (EG) combination chemotherapy may have less neurotoxocity comparing to PG.
Trial Design: Prospective randomized phase 2, open-label, two-arm, multi-center study comparing EG chemotherapy with PG chemotherapy for patients with HER-2 negative MBC as first-line chemotherapy.
Eligibility Criteria: Histologically confirmed breast cancer patients, at least 19 years of age, with no prior history of chemotherapy for metastatic, recurrent breast cancer with evaluable lesions (as per RECIST, 1.1) who have adequate hematologic, renal, and hepatic function. Patients either may or may not have a prior anthracycline containing regimen. Prior hormonal therapy as a treatment of metastatic disease is allowed.
Specific Aims:
The primary efficacy endpoint of the trial is Progression-Free Survival (PFS). The secondary efficacy endpoints are: Time to Treatment Failure (TTF); Overall Survival (OS); neuropathic scale (FACT for Taxane QOL assessment); toxicity; duration of response; Objective Response Rate (ORR); Clinical Benefit Rate. The exploratory endpoint of the study includes pharmacogenetic profile.
Statistical Methods:
The initial sample size of the present study was determined based on the data derived from a previous trial on PG maintenance chemotherapy design; 6-month PFS is 70% for PG chemotherapy. This design was hypothesized that EG chemotherapy would not be inferior to PG chemotherapy. Thus, estimated PFS for each arm is 70%. Based on this estimate, we would plan to recruit a total of 100 patients (50 per arm). Considering drop-out rate of 10%, total 112 MBC patients planned to be enrolled.
Present Accrual and Target Accrual:Enrollment has been completed as of March, 2016 with a target enrollment of 112 patients.
Contact information:Kyung Hae Jung MD, Ph.D. khjung@amc.seoul.kr
ClinicalTrials.gov Identifier: NCT02263495.
Citation Format: Park YH, Im S-A, Sohn JH, Lee KS, Chae YS, Lee KH, Kim J-H, Im Y-H, Ahn JS, Kim T-Y, Lee K-H, Kim S-B, Ahn J-H, Kim GM, Park IH, Lee SJ, Han HS, Kim SH, Jung KH. A phase II, multicenter, randomized trial of eribulin plus gemcitabine (EG) vs. paclitaxel plus gemcitabine (PG) in patients with HER2-negative metastatic breast cancer as first-line chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-01-12.
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Affiliation(s)
- YH Park
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - S-A Im
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - JH Sohn
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - KS Lee
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - YS Chae
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - KH Lee
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - J-H Kim
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - Y-H Im
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - JS Ahn
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - T-Y Kim
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - K-H Lee
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - S-B Kim
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - J-H Ahn
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - GM Kim
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - IH Park
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - SJ Lee
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - HS Han
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - SH Kim
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
| | - KH Jung
- Samsung Medical Center; Seoul National University Hospital; Yonsei Cancer Center; National Cancer Center; Kyungpook National University Medical Center; Chungbuk National University Hospital; Seoul National University Bundang Hospital; Asan Medical Center
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23
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Diéras V, Han HS, Robson ME, Palácová M, Marcom PK, Jager A, Bondarenko I, Citrin D, Campone M, Telli ML, Domchek SM, Friedlander M, Kaufman B, Ratajczak C, Coates A, Bonnet P, Qin Q, Qian J, Giranda VL, Shepherd SP, Puhalla S, Isakoff SJ. Abstract P4-22-02: Evaluation of veliparib (V) and temozolomide (TMZ) in a phase 2 randomized study of the efficacy and tolerability of V+TMZ or carboplatin (C) and paclitaxel (P) vs placebo (Plc)+C/P in patients (pts) with BRCA1 or BRCA2 mutations and metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-02] [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: V is a potent, poly(ADP-ribose) polymerase (PARP) inhibitor that obstructs DNA damage repair. BRCA1/2 tumors are defective in homologous recombination, which leads to more error-prone mechanisms of DNA repair and increased sensitivity to PARP inhibition. V enhances the antitumor activity of alkylating agents such as TMZ in preclinical models. In addition, V+TMZ showed promising activity in a single-arm phase 2 study in pts with BRCA1/2 mutations. This phase 2 trial (NCT01506609) investigated the efficacy and tolerability of V+TMZ (or V+C/P) compared to Plc+C/P in pts with locally recurrent or metastatic breast cancer harboring a BRCA1 or BRCA2 mutation. Results from the primary analysis for the V+TMZ arm vs Plc+C/P are presented, and the V+C/P vs Plc+C/P results will be presented separately.
Methods: Male and female pts aged ≥18 years with histologically confirmed locally recurrent or metastatic breast cancer were randomized 1:1:1 to: 1) V 40 mg BID D1–7 + TMZ 150–200 mg/m2 QD D1–5, 28-D cycle; 2) V 120 mg BID D1–7 + C AUC 6, D3 and P 175 mg/m2, D3, 21-D cycle; 3) placebo BID D1–7 + C/P. Key eligibility criteria included known deleterious BRCA1/2 mutation, ≤2 prior chemotherapies for metastatic disease, no prior platinum agent, and no CNS metastases. Randomization was stratified by hormone receptor status, prior cytotoxic therapy (yes vs no), and ECOG PS (0–1 vs 2). The primary endpoint was progression-free survival (PFS) per RECIST 1.1 by independent review. Overall survival (OS), objective response rate (ORR), and safety/tolerability were also evaluated.
Results: A total of 290 pts (284 BRCA+ per central lab) were randomized (V+TMZ, n=94 [91 BRCA+]). Baseline demographics and disease characteristics were comparable among treatment arms; 41.3% of pts had triple-negative breast cancer (TNBC) and 31.7% had received >2 prior regimens. Median study drug exposure was 6 cycles for the V+TMZ arm and 10 cycles for the Plc+C/P arm. Median PFS, median OS (interim), and ORR for V+TMZ were inferior to Plc+C/P (PFS 7.4 vs 12.3 mo, OS 19.1 vs 25.0 mo, and ORR 28.6% vs 61.3%). In pts with TNBC, median PFS was 5.5 (3.1–8.5) mo; 8.4 (6.8–10.6) mo for pts with non-TNBC. Treatment-emergent adverse events (AEs) of interest occurring differentially with V+TMZ are shown in Table 1. Grade ≥3 AEs in ≥30% of pts in the V+TMZ arm were thrombocytopenia (48%) and neutropenia (37%).
Conclusions: V+TMZ provided durable responses, with less neutropenia, alopecia, and neuropathy than Plc+C/P; however, PFS, OS, and ORR were inferior in the TMZ arm compared to C/P.
Table 1Treatment-Emergent AEs, n (%)V+TMZ, n=93Plc+C/P, n=96Neutropenia46 (50)71 (74)Alopecia10 (11)55 (57)Peripheral neuropathy11 (12)56 (58)Thrombocytopenia73 (79)67 (70)Nausea70 (75)56 (58)
Citation Format: Diéras V, Han HS, Robson ME, Palácová M, Marcom PK, Jager A, Bondarenko I, Citrin D, Campone M, Telli ML, Domchek SM, Friedlander M, Kaufman B, Ratajczak C, Coates A, Bonnet P, Qin Q, Qian J, Giranda VL, Shepherd SP, Puhalla S, Isakoff SJ. Evaluation of veliparib (V) and temozolomide (TMZ) in a phase 2 randomized study of the efficacy and tolerability of V+TMZ or carboplatin (C) and paclitaxel (P) vs placebo (Plc)+C/P in patients (pts) with BRCA1 or BRCA2 mutations and metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-22-02.
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Affiliation(s)
- V Diéras
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - HS Han
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - ME Robson
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - M Palácová
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - PK Marcom
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - A Jager
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - I Bondarenko
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - D Citrin
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - M Campone
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - ML Telli
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - SM Domchek
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - M Friedlander
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - B Kaufman
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - C Ratajczak
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - A Coates
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - P Bonnet
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - Q Qin
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - J Qian
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - VL Giranda
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - SP Shepherd
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - S Puhalla
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
| | - SJ Isakoff
- Institut Curie, Paris, France; Moffitt Cancer Center, Tampa, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Masarykův Onkologický ústav, Brno, Czech Republic; Duke University, Durham, NC; Erasmus MC Cancer Institute, Rotterdam, Netherlands; Dnepropetrovsk City Hospital, Dnepropetrovsk, Ukraine; Midwestern Regional Medical Center, Zion, IL; Institut de Cancérologie de l'Ouest, Saint Herblain, France; Stanford University School of Medicine, Stanford, CA; University of Pennsylvania, Philadelphia, PA; Prince of Wales Hospital, Sydney, NSW, Australia; Sheba Medical Center, Tel Hashomer, Israel; AbbVie, Inc, Chicago, IL; University of Pittsburgh Cancer Institute, Pittsburgh, PA; Massachusetts General Hospital, Boston, MA
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Abstract
OBJECTIVES Knee pain is one of the most common symptoms of knee osteoarthritis (OA) that affects the quality of life in the older adults, and identifying the contributing factors of knee pain is important. We hypothesized that higher fruit and vegetable consumption might be associated with the severity of knee pain lower prevalence of severe knee pain by affecting pain perception in the knee joint. Therefore, we investigated the relationship between self-reported knee pain and the consumption of fruits vegetables, carotenoids and vitamin C and self-reported knee pain. DESIGN Nationally representative cross sectional study. SETTING 2010-2011 rounds of the Korean National Health and Nutrition Examination Survey. PARTICIPANTS A total of 6588 subjects aged ≥50 years were participated. METHODS Severity of knee pain was estimated using a 10-point numeric rating scale (NRS). Daily intake of fruits, vegetables, and vitamins were estimated using data from 24-hour recalls and food frequency questionnaires. RESULTS The NRS scores of knee pain decreased significantly with increasing fruit and vegetable intake quartiles. A multivariate logistic regression analysis showed that the fourth quartile of vegetable and fruit consumption was associated with decreased prevalence of severe knee pain (OR 0.59, 95% CI 0.48-0.73) compared with first quartile of vegetable and fruit consumption; however, carotenoids and vitamin C consumption was not associated with the severity of knee pain. CONCLUSIONS In conclusion, severe knee pain was independently associated with fruit and vegetable consumption. Our findings suggest that intake of whole fruits and vegetables may help improve knee pain in older adults.
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Affiliation(s)
- H S Han
- Jee-Yon Lee, M.D. Department of Family Medicine, CHA University College of Medicine, CHA Bundang Medical Center, Chaum Life Center, 335 Pangyo-ro, Bundang-gu, Sungnam-si, Republic of Korea, Tel.: 82-31-881-7596, FAX: 82-2-362-2473, E-mail address:
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25
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Kim YS, Han HS, Sang JH. Adnexal torsion in early pregnancy after assisted reproduction: can the adnexa be saved? CLIN EXP OBSTET GYN 2017; 44:135-137. [PMID: 29714883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Adnexal torsion occurs when the ovary and fallopian tube twist on the axis created between the infundibulopelvic ligament and the utero-ovarian ligament. The symptoms are mostly unspecific and diagnosis is therefore not simple. Early diagnosis is essential to preserve organ function and fertility. The increased use of assisted reproductive technologies has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). A gestational age eight-week pregnant woman who received in vitro fertilization (IVF) came to the clinic and was suspected of adnexal torsion. The patient underwent an operation and the biopsy histologically confirmed ischemia. Here the authors report a case with comparison to other studies, the early diagnosis, and early operation that could save adnexa.
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26
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Lee SY, Masaoka T, Han HS, Matsuzaki J, Hong MJ, Fukuhara S, Choi HS, Suzuki H. A prospective study on symptom generation according to spicy food intake and TRPV1 genotypes in functional dyspepsia patients. Neurogastroenterol Motil 2016; 28:1401-8. [PMID: 27094759 DOI: 10.1111/nmo.12841] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 12/22/2015] [Accepted: 03/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Capsaicin is an ingredient of red peppers that binds to transient receptor potential vanilloid subtype 1 (TRPV1), and Koreans eat more capsaicin-rich food than do Japanese. This study aimed to compare symptom generation according to TRPV1 genotypes and the intake of spicy foods. METHODS Consecutive functional dyspepsia (FD) patients who were evaluated at Konkuk University Medical Centre (Korea) and Keio University Hospital (Japan) were included. Questionnaires on spicy food intake, patient assessment of gastrointestinal symptoms (PAGI-SYM), patient assessment of quality of life, and hospital anxiety and depression scale were provided. Blood was sampled for the detection of TRPV1 polymorphisms, and upper gastrointestinal endoscopy was performed with biopsies. KEY RESULTS Of 121 included subjects, 35 and 28 carried the TRPV1 CC and GG genotypes, respectively, with the prevalence rates not differing between Japan and Korea. The prevalence of FD subtypes did not differ with the spicy food intake, TRPV1 genotypes, or Helicobacter pylori infection. Neither TRPV1 polymorphisms nor H. pylori infections were related to scores on the PAGI-SYM questionnaires, but spicy food intake was positively correlated with the scores for stomach fullness (p = 0.001) and retching (p = 0.001). Using the linear regression analysis, stomach fullness was associated with spicy food intake (p = 0.007), whereas retching was related to younger age (p < 0.001) and female gender (p = 0.014). CONCLUSIONS & INFERENCES Upper gastrointestinal symptoms are more common in subjects with a higher consumption of spicy foods, younger age and female gender, regardless of TRPV1 genotypes and the H. pylori infection status. Capsaicin-rich foods may induce stomach fullness.
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Affiliation(s)
- S-Y Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - T Masaoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - H S Han
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - J Matsuzaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - M J Hong
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - S Fukuhara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - H S Choi
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - H Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Medical Education Center, Keio University School of Medicine, Tokyo, Japan
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27
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Swierczewska M, Han HS, Kim K, Park JH, Lee S. Polysaccharide-based nanoparticles for theranostic nanomedicine. Adv Drug Deliv Rev 2016; 99:70-84. [PMID: 26639578 PMCID: PMC4798864 DOI: 10.1016/j.addr.2015.11.015] [Citation(s) in RCA: 259] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 11/30/2022]
Abstract
Polysaccharides are natural biological molecules that have numerous advantages for theranostics, the integrated approach of therapeutics and diagnostics. Their derivable reactive groups can be leveraged for functionalization with a nanoparticle-enabling conjugate, therapeutics (small molecules, proteins, peptides, photosensitizers) and/or diagnostic agents (imaging agents, sensors). In addition, polysaccharides are diverse in size and charge, biodegradable and abundant and show low toxicity in vivo. Polysaccharide-based nanoparticles are increasingly being used as platforms for simultaneous drug delivery and imaging and are therefore becoming popular theranostic nanoparticles. The review focuses on the method of nanoparticle formation (self-assembled, physical or chemical cross-linked) when engineering polysaccharide-based nanoparticles for theranostic nanomedicine. We highlight recent examples of polysaccharide-based theranostic systems from literature and their potential for use in the clinic, particularly chitosan- and hyaluronic acid-based NPs.
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Affiliation(s)
- M Swierczewska
- Russell H. Morgan Department of Radiology and Radiological Science, Center for Cancer Nanotechnology Excellence, Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University, 400 North Broadway, Baltimore, MD 21231, United States
| | - H S Han
- School of Chemical Engineering, College of Engineering, Sungkyunkwan University, Suwon 440-746, Republic of Korea
| | - K Kim
- Center for Theragnosis, Biomedical Research Institute, Korea Institute of Science and Technology, Seoul 136-791, Republic of Korea
| | - J H Park
- School of Chemical Engineering, College of Engineering, Sungkyunkwan University, Suwon 440-746, Republic of Korea
| | - S Lee
- Russell H. Morgan Department of Radiology and Radiological Science, Center for Cancer Nanotechnology Excellence, Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University, 400 North Broadway, Baltimore, MD 21231, United States
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28
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Park SJ, Kim BG, Oh AH, Han SH, Han HS, Ryu JH. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc 2016; 30:4598-606. [PMID: 26895920 DOI: 10.1007/s00464-016-4797-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 11/24/2015] [Accepted: 02/03/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Respiratory functions are usually impaired during pneumoperitoneum for laparoscopic surgery. This randomized, controlled and single-blinded study was performed to evaluate whether intraoperative protective lung ventilation influences postoperative pulmonary complications after laparoscopic hepatobiliary surgery. METHODS Sixty-two patients were randomized to receive either conventional ventilation with alveolar recruitment maneuver (tidal volume of 10 ml/kg with inspiratory pressure of 40 cmH2O for 30 s after the end of pneumoperitoneum, group R), or protective lung ventilation (low tidal volume of 6 ml/kg with positive end-expiratory pressure [PEEP] of 5 cmH2O, group P). Induction and maintenance of anesthesia were done with balanced anesthesia. Respiratory complications such as atelectasis, pneumonia or desaturation were observed postoperatively. The length of hospital stay, arterial blood gas analysis, peak inspiratory pressure and hemodynamic variables were also recorded. Results are presented as mean ± SD or number of patients (%). RESULTS Postoperative pulmonary complications (P = 0.023) and desaturation below 90 % (P = 0.016) occurred less frequently in group P than in group R. Eight patients of group R and 3 patients of group P showed atelectasis. Pneumonia was diagnosed in 1 patient of group R. No differences were observed in the length of hospital stay, arterial blood gas analysis (pH, PaO2, PaCO2 and PAO2) and hemodynamic variables except PAO2, AaDO2 and peak inspiratory pressure between the two groups. CONCLUSION Protective lung ventilation (low tidal volume with PEEP) during pneumoperitoneum was associated with less incidences of pulmonary complications than conventional ventilation with alveolar recruitment maneuver after laparoscopic hepatobiliary surgery.
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Affiliation(s)
- S J Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - B G Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - A H Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - S H Han
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - H S Han
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - J H Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea.
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Yin YJ, Nie CY, Liu WS, Zou Q, Zhai JC, Han HS, Li HP. Non-invasive determination of the immune physiological state of reindeer (Rangifer tarandus) in the Greater Khingan Mountains, China. Genet Mol Res 2015; 14:6664-73. [PMID: 26125874 DOI: 10.4238/2015.june.18.9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Immunoglobulin and cortisol levels are good indicators of well-being and living status in animals. In this study, the concentrations of fecal immunoglobulins A ([IgAF]), G ([IgGF]), and M ([IgMF]), and cortisol ([cortisolF]) were examined by enzyme-linked immunosorbent assay in reindeer of the Greater Khingan Mountains of Inner Mongolia, China. [IgAF] was significantly higher than [IgGF] and [IgMF], and [IgGF] was significantly higher than [IgMF] (P < 0.05). Both [IgAF] and [IgGF] were higher in the Adult group than in Aged or Infant groups, and higher in the Young than Infant group (P < 0.05). The four age group [IgMF]s were not significantly different (P > 0.05). [IgAF], [IgGF], and [IgMF] in each age group were higher in females than in males, with a significant difference in the Young group (P < 0.05). The Infant group had the highest [cortisolF], and the Adult group the lowest; [cortisolF] was significantly higher in the Infant group than in other age groups (P < 0.05). In each age group, [cortisolF] was higher in females than males, and there were significant differences among the Infant, Young, and Aged groups (P < 0.05). A significant negative correlation was observed between [cortisolF] and [IgAF] and [IgGF] (P > 0.05). Overall physical condition was better in the Adult and Young groups than in the Aged and Infant groups as determined by the comprehensive analysis of fecal Ig levels in the four age groups, with the Infant group the worst.
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Affiliation(s)
- Y J Yin
- College of Wildlife Resources, Northeast Forestry University, Harbin, China
| | - C Y Nie
- College of Wildlife Resources, Northeast Forestry University, Harbin, China
| | - W S Liu
- College of Wildlife Resources, Northeast Forestry University, Harbin, China
| | - Q Zou
- College of Wildlife Resources, Northeast Forestry University, Harbin, China
| | - J C Zhai
- College of Wildlife Resources, Northeast Forestry University, Harbin, China
| | - H S Han
- College of Animal Medicine, Northeast Agricultural University, Harbin, China
| | - H P Li
- College of Wildlife Resources, Northeast Forestry University, Harbin, China
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Min KW, Lee SJ, Jung HY, Han HS, Lee SY, Seong MK, Sung IK, Kim WY. Squamous cell carcinoma arising in a mature cystic teratoma exposed through a colo-ovarian fistula. J OBSTET GYNAECOL 2015; 35:763-4. [PMID: 25692501 DOI: 10.3109/01443615.2015.1007339] [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: 11/13/2022]
Affiliation(s)
- K-W Min
- a Department of Pathology , Hallym University Sacred Heart Hospital, Hallym University College of Medicine , Anyang, Gyeonggi-do , Republic of Korea
| | - S-J Lee
- b Department of Obstetrics and Gynecology , KonKuk University School of Medicine , Seoul , Republic of Korea
| | - H Y Jung
- c Department of Pathology , KonKuk University School of Medicine , Seoul , Republic of Korea
| | - H S Han
- c Department of Pathology , KonKuk University School of Medicine , Seoul , Republic of Korea
| | - S-Y Lee
- c Department of Pathology , KonKuk University School of Medicine , Seoul , Republic of Korea
| | - M-K Seong
- d Department of Colorectal Surgery , KonKuk University School of Medicine , Seoul , Republic of Korea
| | - I-K Sung
- e Department of Internal Medicine , KonKuk University School of Medicine , Seoul , Republic of Korea
| | - W Y Kim
- c Department of Pathology , KonKuk University School of Medicine , Seoul , Republic of Korea
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An HS, Kang HW, Han HS, Park JY, Hong CG, Park J, Myeong JI, An CM. Genetic differences between the wild and hatchery-produced populations of Korean short barbeled grunter (Hapalogenys nitens) determined with microsatellite markers. Genet Mol Res 2014; 13:8901-12. [PMID: 25366781 DOI: 10.4238/2014.october.31.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Short barbeled grunter, Hapalogenys nitens, is an economically important fishery resource. In Korea, this fish is in the early stage of domestication, and it has been regarded as the candidate marine fish species for prospective aquaculture diversification. This study presents a preliminary investigation of the future viability of sustainable fry production from short barbeled grunter. We used 12 polymorphic nuclear microsatellite DNA loci to analyze the possible genetic variability between the wild and hatchery-produced populations of short barbeled grunter from Korea and identified 91 alleles. Compared to the wild population, significant genetic changes including reduced genetic diversity (average allele number: 7.42 vs 3.75; average expected heterozygosity: 0.713 vs 0.598, Wilcoxon signed-rank test; P < 0.05) and differentiation [overall fixation index (FST) = 0.088, P < 0.01] occurred in the hatchery-produced population, as indicated by the observation of allele richness, unique allele, heterozygosity, FST, and results of molecular analysis of variance. These findings indicate that genetic drift may have promoted the differentiation between these 2 populations, which may have negative effects on sustainable fry production. Therefore, genetic variations of the wild and hatchery-produced populations should be monitored and subjected to control inbreeding through a commercial breeding program. The information presented by this paper would provide a useful genetic basis for future sustainable culturing planning and management of H. nitens.
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Affiliation(s)
- H S An
- Biotechnology Research Division, National Fisheries Research and Development Institute, Busan, Korea
| | - H W Kang
- Biotechnology Research Division, National Fisheries Research and Development Institute, Busan, Korea
| | - H S Han
- Biotechnology Research Division, National Fisheries Research and Development Institute, Busan, Korea
| | - J Y Park
- Aquaculture Industry Division, Nacional Fisheries Research and Development Institute, Yeosu, Korea
| | - C G Hong
- Aquaculture Industry Division, Nacional Fisheries Research and Development Institute, Yeosu, Korea
| | - J Park
- Biotechnology Research Division, National Fisheries Research and Development Institute, Busan, Korea
| | - J I Myeong
- Biotechnology Research Division, National Fisheries Research and Development Institute, Busan, Korea
| | - C M An
- Biotechnology Research Division, National Fisheries Research and Development Institute, Busan, Korea
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Abstract
The protective effect of therapeutic hypothermia in cerebral ischemia is well accepted in experimental models, and some clinical studies show that there is benefit in humans as well. Long-term observations in animal and clinical studies have documented recovery of neurological function following hypothermia treatment. Diminished damage by hypothermic protection should contribute to the recovery in many ways, but hypothermia appears to enhance regeneration of brain tissue as well. Since regeneration of the brain after damage initiates within hours and is active days and weeks after stroke, prolonged hypothermia might affect regenerative processes which have been documented to occur in these time frames. As there is a lack of data at the basic and clinical levels, the mechanism of neuroregeneration by hypothermia is unclear. Yet, we speculate that hypothermia enhances regeneration by positively influencing neurogenesis, angiogenesis, gliogenesis and synapse/circuit formation after stroke. In this chapter, we will provide up-to-date data from experimental studies and clinical reports on the effect of therapeutic hypothermia on neuroregeneration, with perspectives on future research.
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Affiliation(s)
- M A Yenari
- Department of Neurology, University of California, and San Francisco Veterans Affairs Medical Center, 4150 Clement St., San Francisco, CA 94121, USA.
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Choi SY, Yun J, Lee OJ, Han HS, Yeo MK, Lee MA, Suh KS. MicroRNA expression profiles in placenta with severe preeclampsia using a PNA-based microarray. Placenta 2013; 34:799-804. [PMID: 23830491 DOI: 10.1016/j.placenta.2013.06.006] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [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: 02/07/2013] [Revised: 05/24/2013] [Accepted: 06/10/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Preeclampsia (PE) is a leading cause of maternal and neonatal mortality and morbidity worldwide. However, the pathophysiology of this disease is not yet fully understood. MiRNA plays an important role in post-transcriptional gene regulation. Recent studies have suggested that dysregulation of miRNAs in placental tissue is involved in the pathogenesis of PE. Therefore, we investigated miRNA profiles in PE placenta to understand the miRNA function in PE pathogenesis. METHODS MiRNA profiling was performed in 20 formalin-fixed and paraffin-embedded samples (10 placentas from severe PE and 10 from a control group). We used a hybridization-based microarray with a PNA-probe comprised of 158 miRNAs. RESULTS Thirteen miRNAs (miR-92b, miR-197, miR-342-3p, miR-296-5p, miR-26b, miR-25, miR-296-3p, miR-26a, miR-198, miR-202, miR-191, miR-95, and miR-204) were significantly overexpressed and two miRNAs (miR-21 and miR-223) were underexpressed in PE compared with the control group. Among 15 differentially expressed miRNAs, miR-26b, miR-296-5p, and miR-223 were found to be consistent with results from previous studies. We identified 893 genes that were predicted by at least three of four computational algorithms. Target genes participated in several signaling pathways, adherens junction, focal adhesion, and regulation of the actin cytoskeleton. CONCLUSIONS Several miRNAs are found to be dysregulated in placentas of PE patients and they seem to be closely associated with the early pathogenesis of PE. Further study is necessary to develop tools for early detection and management.
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Affiliation(s)
- S-Y Choi
- Department of Pathology, Chungbuk National University Hospital, Cheongju, South Korea
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Park IH, Han HS, Lee H, Lee KS, Kang HS, Lee S, Kim SW, Jung S, Ro J. Resumption or persistence of menstruation after cytotoxic chemotherapy is a prognostic factor for poor disease-free survival in premenopausal patients with early breast cancer. Ann Oncol 2012; 23:2283-2289. [PMID: 22377562 DOI: 10.1093/annonc/mds006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [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: 11/13/2022] Open
Abstract
BACKGROUND We investigated the relationship between resumption or persistence of menstruation after cytotoxic chemotherapy (RM) and disease-free survival (DFS) in premenopausal patients with early breast cancer. METHODS Medical records from 872 patients who received cytotoxic chemotherapy for stage I to III breast cancer were retrospectively reviewed. RESULTS The median patient age was 41 years (range, 21-54) and the median follow-up duration was 6.2 years (range, 0.7-10.4). Six hundred ninety-two patients (79.4%) were hormone receptor (HR) positive and the majority of these received tamoxifen therapy after completing chemotherapy. The chemotherapy-induced amenorrhea (CIA) rate was 76.7% (n = 669), and 51.8% (n = 452) experienced RM during the follow-up period. One hundred twenty-one (13.9%) patients had persistent menstruation without CIA. DFS was significantly affected by younger age at diagnosis (≤35 years) (P = 0.013), tumor size > 2 cm (P < 0.001), node positivity (P < 0.001), HR negativity (P < 0.001), HER2 positivity (P = 0.010), and RM (P < 0.001). HR negativity [hazard ratio 1.7, 95% confidence interval (CI) 1.2-2.4, P = 0.006], tumor size > 2 cm (hazard ratio 2.1, 95% CI 1.4-3.0, P < 0.001), node positivity (hazard ratio 3.0, 95% CI 2.0-4.7, P < 0.001), and RM (hazard ratio 1.8, 95% CI 1.2-2.7, P = 0.004) remained significant factors for DFS on multivariate analysis. CONCLUSIONS A considerable proportion of premenopausal patients treated with chemotherapy experienced RM after CIA. RM was a poor prognostic factor for DFS in premenopausal patients with early breast cancer.
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Affiliation(s)
- I H Park
- Center for Breast Cancer, National Cancer Center, Goyang
| | - H S Han
- Department of Internal medicine, Chungbuk College of Medicine, Chungbuk
| | - H Lee
- Center for Clinical Trial, National Cancer Center, Goyang, Korea
| | - K S Lee
- Center for Breast Cancer, National Cancer Center, Goyang
| | - H S Kang
- Center for Breast Cancer, National Cancer Center, Goyang
| | - S Lee
- Center for Breast Cancer, National Cancer Center, Goyang
| | - S W Kim
- Center for Breast Cancer, National Cancer Center, Goyang
| | - S Jung
- Center for Breast Cancer, National Cancer Center, Goyang
| | - J Ro
- Center for Breast Cancer, National Cancer Center, Goyang.
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Lim SD, Youn JI, Kim WS, Kim IH, Hwang TS, Han HS, Yeo UC. Comprehensive histologic analysis of interstitial lipolysis with the 1444 nm wavelength during a 3-month follow-up. Histol Histopathol 2011; 26:1375-82. [PMID: 21938674 DOI: 10.14670/hh-26.1375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A number of near-infrared wavelengths have been proposed and studied for laser lipolysis, but the histologic evaluation of tissue response to laser lipolysis during long-term follow-up has been lacking. A 1444 nm Nd:YAG laser with better absorption in both fat and water has recently attracted attention. The present study was designed to investigate the comprehensive histopathology of 1444 nm Nd:YAG laser-assisted lipolysis at different energy levels during a 3-month follow-up. Laser lipolysis was performed on porcine fat tissue in vivo using a 1444 nm Nd:YAG laser (AccuSculpt®, Lutronic Corporation, Ilsan, Republic of Korea) and the total energies delivered interstitially to 10x10 cm² areas were 750 J, 1500 J, 2250 J, 3000 J, 3750 J, 4500 J, and 5250 J. Biopsy samples were taken and histologically analyzed immediately after biopsy and at 1, 2, 4, and 12 weeks postoperatively. With a fluence setting above 3000J/100 cm², inflammation was severe and remained by the 3-month follow-up, resulting in severe scarring of the fat tissue. Below this energy level, mild lobular inflammation in the early phase biopsy had resolved with no scarring by the 3-month follow-up. No histologic changes in the epidermis or dermal connective tissue were present. This study suggested that controlling the energy level is important for clinical applications of laser lipolysis with no significant complications.
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Affiliation(s)
- S D Lim
- Department of Pathology, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Republic of Korea
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Kim JW, Im SA, Kim JH, Ham HS, Han HS, Kim JS, Kim TM, Han SW, Oh DY, Lee SH, Kim DW, Cho N, Moon WK, Kim TY, Park IA, Heo DS, Bang YJ. Abstract P2-09-36: Role of ABCB1 Polymorphisms as Predictive Markers in Patients with HER-2 FISH Positive Metastatic Breast Cancer Who Were Treated with Taxane Plus Trastuzumab First Line Chemotherapy. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-09-36] [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: ABCB1 polymorphisms could predict treatment results of taxane therapy in several malignancies. FCGR2A and FCGR3A polymorphisms were associated with clinical outcomes in several diseases after treatment with monoclonal antibody drugs which had antibody-dependent cell-mediated cytotoxicity activity. These polymorphisms could be possible predictive markers after taxane plus trastuzumab (TH) chemotherapy in patients with HER-2-positive metastatic breast cancer (MBC).
Methods: Fifty-seven patients with HER-2 FISH positive MBC who received TH chemotherapy as the 1st-line treatment were enrolled. We analyzed 5 polymorphisms using DNA from peripheral blood mononuclear cells: ABCB1 1236C>T (rs1128503), ABCB1 2677G>T/A (rs2032582), ABCB1 3435C>T (rs1045642), FCGR2A 131H/R (rs1801274), and FCGR3A 158V/F (rs396991), then correlated them to treatment results of patients.
Results: Among 57 patients, 22 patients (38.6%) received weekly paclitaxel plus trastuzumab, 26 patients (45.6%) tri-weekly paclitaxel plus trastuzumab, and 9 patients (15.8%) tri-weekly docetaxel plus trastuzumab. After a median follow-up of 30.6 (range, 0.6-75.9) months, median progression-free survival (PFS) was 15.1 (95% confidence interval (CI), 10.3-19.8) months. ABCB1 2677T allele carriers had longer PFS than the others (42.1 (95% CI, 12.7-71.4) months vs. 13.0 (95% CI, 10.6-15.4) months; p=0.037) along with a tendency toward higher response rate (RR) (86.4% vs. 76.0%; p=0.470) and longer overall survival (OS) (54.7 (95% CI, 43.0-66.4) months vs. 38.9 (95% CI, 18.1-59.7) months; p=0.057). In addition, ABCB1 3435CC genotype carriers had shorter PFS than the others (13.0 (95% CI, 10.8-15.2) months vs. 19.1 (95% CI, 0.0-38.5) months; p=0.039) along with a tendency toward lower RR (78.6% vs. 100%; p=0.567) and shorter OS (38.9 (95% CI, 19.7-58.1) months vs. 54.7 (95% CI, 43.0-66.4) months; p=0.093). ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F were not significantly associated with RR, PFS, and OS. None of these polymorphisms were associated with any grades of hematologic or cardiac toxicities.
Conclusions: Our results support that ABCB1 2677G>T/A and 3435C>T may have predictive roles after the 1st-line TH chemotherapy in patients with HER-2-positive MBC. In contrast, ABCB1 1236C>T, FCGR2A 131H/R, and FCGR3A 158V/F could not predict response after TH treatment.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-36.
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Affiliation(s)
- J-W Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - S-A Im
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - JH Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - HS Ham
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - H-S Han
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - J-S Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - T-M Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - S-W Han
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - D-Y Oh
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - S-H Lee
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - D-W Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - N Cho
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - WK Moon
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - T-Y Kim
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - IA Park
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - DS Heo
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
| | - Y-J. Bang
- Seoul National University College of Medicine, Republic of Korea; Seoul National University, Republic of Korea; Public Healthcare Center of Yangyang County, Yangyang, Republic of Korea
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Han HS, Cho JY, Yoon YS, Ahn KS, Kim H. Preoperative inflammation is a prognostic factor for gallbladder carcinoma. Br J Surg 2010; 98:111-6. [PMID: 21136565 DOI: 10.1002/bjs.7265] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammation frequently accompanies gallbladder carcinoma (GBC), but its impact on outcome is unclear. The present study investigated the impact of concomitant inflammation on survival of patients with GBC. METHODS All patients undergoing surgery for GBC between October 2003 and May 2009 were identified retrospectively from a prospectively collected database. Patients were classified according to whether preoperative inflammation was present (65 patients) or not (23). RESULTS A total of 88 patients were enrolled. There were no differences in sex, mean age, tumour node metastasis (TNM) stage and radicality of resection between the two groups. The overall 3-year survival rate was lower in patients with preoperative inflammation than in those without (33 versus 73 per cent; P = 0·001). In univariable analysis, preoperative inflammation, T, N and M category, TNM stage, radicality of surgery and tumour differentiation were significant prognostic factors. The presence of preoperative inflammation (hazard ratio (HR) 2·38, 95 per cent confidence interval 1·04 to 5·43), lymph node metastases (HR 5·23, 1·05 to 26·09) and R1 or R2 resection (HR 3·77, 1·47 to 9·72) were independent prognostic factors for poor survival. CONCLUSION The presence of preoperative inflammation is an independent prognostic factor for poor survival in patients with GBC.
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Affiliation(s)
- H-S Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kim WJ, Kim KK, Han HS, Nam BH, Kim YO, Kong HJ, Noh JK, Yoon M. Population structure of the olive flounder (Paralichthys olivaceus) in Korea inferred from microsatellite marker analysis. J Fish Biol 2010; 76:1958-1971. [PMID: 20557649 DOI: 10.1111/j.1095-8649.2010.02638.x] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The population structure of olive flounder Paralichthys olivaceus was estimated using nine polymorphic microsatellite (MS) loci in 459 individuals collected from eight populations, including five wild and three hatchery populations in Korea. Genetic variation in hatchery (mean number of alleles per locus, A = 10.2-12.1; allelic richness, A(R) = 9.3-10.1; observed heterozygosity, H(O) = 0.766-0.805) and wild (mean number of alleles per locus, A = 11.8-19.6; allelic richness, A(R) = 10.9-16.1; observed heterozygosity, H(O) = 0.820-0.888) samples did not differ significantly, suggesting a sufficient level of genetic variation in these well-managed hatchery populations, which have not lost a substantial amount of genetic diversity. Neighbour-joining tree and principal component analyses showed that genetic separation between eastern and pooled western and southern wild populations in Korea was probably influenced by restricted gene flow between regional populations due to the barrier effects of sea currents. The pooled western and southern populations are genetically close, perhaps because larval dispersal may depend on warm currents. One wild population (sample from Wando) was genetically divergent from the main distribution, but it was genetically close to hatchery populations, indicating that the genetic composition of the studied populations may be affected by hydrographic conditions and the release of fish stocks. The estimated genetic population structure and potential applications of MS markers may aid in the proper management of P. olivaceus populations.
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Affiliation(s)
- W-J Kim
- Biotechnology Research Institute, National Fisheries Research & Development Institute (NFRDI), Busan 619-705, South Korea
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Yoon YS, Lee KH, Han HS, Cho JY, Ahn KS. Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy. Br J Surg 2009; 96:633-40. [DOI: 10.1002/bjs.6609] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Background
This study evaluated the short- and long-term patency of preserved splenic vessels after laparoscopic spleen-preserving distal pancreatectomy (SPDP) with preservation of the splenic vessels.
Methods
This single-centre retrospective study included all patients who had undergone splenic vessel-preserving laparoscopic SPDP between 2004 and 2007. The patency of the splenic vessels was assessed by abdominal computed tomography and classified into three grades according to the degree of stenosis.
Results
Twenty-two patients were included. The preoperative patency of the splenic artery and vein was normal in 20 and 19 patients respectively. Normal patency of the splenic artery and vein was observed in 16 and five patients respectively within 1 month of surgery, and in 19 and nine patients 6 months or more after operation. Nine of ten patients with complete splenic vein occlusion developed a collateral circulation in the late postoperative phase. Splenic perfusion was well preserved in all patients.
Conclusion
Splenic vessel-preserving laparoscopic SPDP has the short-term benefit of good perfusion to the spleen. In the long term, there is a risk of left-sided portal hypertension if the splenic vein becomes occluded after surgery.
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Affiliation(s)
- Y-S Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - K H Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - H-S Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - J Y Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - K S Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
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Suh KS, Yi NJ, Kim J, Shin WY, Lee HW, Han HS, Lee KU. Laparoscopic hepatectomy for a modified right graft in adult-to-adult living donor liver transplantation. Transplant Proc 2009; 40:3529-31. [PMID: 19100430 DOI: 10.1016/j.transproceed.2008.07.134] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 07/22/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND We performed a modified right hepatectomy completely by laparoscopic techniques preserving the middle hepatic vein (MHV) branches in adult-to-adult living donor liver transplantation (LDLT). PATIENTS AND METHODS Two young women (24 and 25 years old) volunteered to be live donors for their parents who had hepatocellular carcinomas. As the donors expressed concerns about scarring, we performed a laparoscopic procedure using a hand port device. Mobilization of the right liver and the hepatic parenchymal transection were performed under pneumoperitoneum. Parenchymal transection was performed using a laparoscopic ultrasonic aspirator without the Pringle maneuver. During parenchymal transection, major MHV branches >5 mm were preserved using Hem-o-lock clips. The graft was extracted through the hand port site. On the back table, the 3 MHV branches were reconstructed using an artificial vascular graft. The livers were transplanted without complications. RESULTS The operative times for the donors were 765 and 898 minutes. The donors did not require transfusions or reoperation; they were discharged on postoperative days 10 and 14 with normal liver functions. CONCLUSION A hepatectomy performed completely by laparoscopic techniques for a right graft with preservation of the MHV branches was technically feasible.
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Affiliation(s)
- K S Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Han HS, Escalón MP, Hsiao B, Serafini A, Lossos IS. High incidence of false-positive PET scans in patients with aggressive non-Hodgkin's lymphoma treated with rituximab-containing regimens. Ann Oncol 2008; 20:309-18. [PMID: 18842613 DOI: 10.1093/annonc/mdn629] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) is a powerful predictor of relapse and survival in non-Hodgkin's lymphomas (NHLs) based on studies carried out in the prerituximab era. Little is known about the predictive power of PET in rituximab-treated patients. PATIENTS AND METHODS Patients with aggressive B-cell NHL with baseline and follow-up PET studies were included. Clinical characteristics, PET and computed tomography scans, biopsy results, and outcomes were reviewed. PET was defined as positive if higher than mediastinal or background activity was observed. RESULTS In all, 51 patients (diffuse large B cell-38; mantle cell lymphoma-13) treated with rituximab-containing regimens were included. For 13 of 40 patients (32.5%), mid-therapy PET studies were positive and 9 of 48 patients (18.7%) had positive posttherapy PET. The positive predictive value (PPV), negative predictive value (NPV), sensitivity (Se), and specificity (Sp) of the mid-therapy PET for predicting relapse were 33% [95% confidence interval (CI) 19% to 49%], 68% (95% CI 51% to 81%), 33% (95% CI 6% to 76%), and 68% (95% CI 49% to 82%), respectively. For posttherapy PET, the relapse PPV, NPV, Se and Sp were 19% (95% CI 9% to 33%), 81% (95% CI 67% to 91%), 13% (95% CI 0.6% to 53%), and 80%(95% CI 64% to 90%), respectively. CONCLUSIONS Compared with previous reports in prerituximab era, addition of rituximab resulted in reduced PPV and sensitivity of mid- and posttherapy PET in patients with aggressive B-cell NHL.
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Affiliation(s)
- H S Han
- Division of Hematology and Oncology, The Sylvester Comprehensive Cancer Center, Miami, FL 33136, USA
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Han HS, Kang SB, Yoon KS. High incidence of loosening of the femoral component in legacy posterior stabilised-flex total knee replacement. ACTA ACUST UNITED AC 2008; 89:1457-61. [PMID: 17998181 DOI: 10.1302/0301-620x.89b11.19840] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have examined the results obtained with 72 NexGen legacy posterior stabilised-flex fixed total knee replacements in 47 patients implanted by a single surgeon between March 2003 and September 2004. Aseptic loosening of the femoral component was found in 27 (38%) of the replacements at a mean follow-up of 32 months (30 to 48) and 15 knees (21%) required revision at a mean of 23 months (11 to 45). We compared the radiologically-loose and revised knees with those which had remained well-fixed to identify the factors which had contributed to this high rate of aseptic loosening. Post-operatively, the mean maximum flexion was 136 degrees (110 degrees to 140 degrees) in the loosened group and 125 degrees (95 degrees to 140 degrees) in the well-fixed group (independent t-test, p = 0.022). Squatting, kneeling, or sitting cross-legged could be achieved by 23 (85%) of the loosened knees, but only 22 (49%) of the well-fixed knees (chi-squared test, p = 0.001). The loosened femoral components were found to migrate into a more flexed position, but no migration was detected in the well-fixed group. These implants allowed a high degree of flexion, but showed a marked rate of early loosening of the femoral component, which was associated with weight-bearing in maximum flexion.
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Affiliation(s)
- H S Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Dongjak-gu, 156-707 Seoul, Korea
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Jo JY, Han HS, Yoon JG, Song TK, Kim SH, Noh TW. Domain switching kinetics in disordered ferroelectric thin films. Phys Rev Lett 2007; 99:267602. [PMID: 18233604 DOI: 10.1103/physrevlett.99.267602] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Indexed: 05/25/2023]
Abstract
We investigated domain kinetics by measuring the polarization switching behaviors of (111)-preferred polycrystalline Pb(Zr,Ti)O3 films, which are widely used in ferroelectric memories. Their switching behaviors at various electric fields and temperatures could be explained by assuming the Lorentzian distribution of logarithmic domain-switching times. We suggested that the local field variation due to dipole defects at domain pinning sites could explain the Lorentzian distribution.
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Affiliation(s)
- J Y Jo
- ReCOE&FPRD, Department of Physics and Astronomy, Seoul National University, Seoul 151-747, Korea
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Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc 2007; 22:1334-8. [PMID: 18027035 DOI: 10.1007/s00464-007-9660-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 09/26/2007] [Accepted: 10/09/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic surgery for pancreatic disease has gained increasing popularity. A laparoscopic distal pancreatectomy is technically simple and has been adopted as the preferred method in many centers. However, there is limited information on the outcomes of the laparoscopic surgery compared with open surgery. Therefore, this study aimed to investigate the clinical outcomes of laparoscopic distal pancreatectomy and to evaluate its efficacy compared with open distal pancreatectomy. METHODS From February 1995 to March 2006, 31 patients underwent laparoscopic distal pancreatectomy, and 167 patients underwent open distal pancreatectomy at Seoul National University Hospital and Bundang Seoul National University Hospital. A case-control design was used with 2:1 matching to compare laparoscopic surgery with open surgery. Among 167 patients who underwent open distal pancreatectomy, 62 patients whose age, gender, and pathology were similar to those of patients who underwent laparoscopic surgery were selected for this study. The operation time, intraoperative transfusion requirements, duration of postoperative hospitalization, complications, mortality, recurrence, and hospital charges were analyzed. RESULTS There were no significant differences in operation time, rate of intraoperative transfusions, complications, recurrence, or mortality between the two groups. Laparoscopic distal pancreatectomy was associated with a statistically significant shorter hospital stay (11.5 days vs 13.5 days; p = 0.049), but with more expensive hospital charges than open distal pancreatectomy (p < 0.01). CONCLUSION Laparoscopic distal pancreatectomy is a clinically safe and effective procedure for benign and borderline pancreatic tumors.
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Affiliation(s)
- B W Eom
- Department of Surgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul, 110-744, Korea
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Nakashima N, Shimizu S, Okamura K, Hahm JS, Kim YW, Han HS, Torata N, Antoku Y, Lee YS, Tanaka M. Development of a broadband telemedical network based on internet protocol in the Asia-Pacific region. Methods Inf Med 2007; 46:709-715. [PMID: 18066423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To promote the exchange of knowledge and standardization of medical procedures and medical systems in the Asia-Pacific region, we established a medical network with high-quality moving images over broadband Internet lines in February 2003. METHODS Real-time teleconferences and live demonstrations with medical-quality videos, broadcast via the Digital Video Transport System, have been used to teach surgical techniques and other medical procedures across national borders. The Asia-Pacific Advanced Network (APAN) committee in August 2005 formally approved our proposal to establish a medical working group within APAN. The network was expanded by the launch of the Trans-Eurasia Information Network 2 in 2006. By the end of 2006, we had conducted 82 events, in 10 countries in the Asia-Pacific region. The multi-station event has increased every year. RESULTS There have been no serious transmission problems or ethical conflicts so far. With these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific. CONCLUSION This system is a promising and very useful tool for the standardization of medical system and procedures across national borders. Drawing upon these experiences and current achievements, we hope to extend this advanced network system to the entire Asia-Pacific region.
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Affiliation(s)
- N Nakashima
- Department of Medical Informatics, Kyushu University Faculty of Medicine, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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Jung YJ, Ju SY, Yoo ES, Cho SJ, Cho KA, Woo SY, Seoh JY, Park JW, Han HS, Ryu KH. MSC–DC interactions: MSC inhibit maturation and migration of BM-derived DC. Cytotherapy 2007; 9:451-8. [PMID: 17786606 DOI: 10.1080/14653240701452057] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [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: 10/22/2022]
Abstract
BACKGROUND Mesenchymal stromal cells (MSC) comprise one of the BM stromal cells that are known to support hematopoiesis. It has also been suggested recently that MSC display immunosuppressive capacities through inhibiting the differentiation of monocyte-derived DC. DC travel to the lymph nodes (LN) to present Ag to T cells, and CCL21 is the chemokine that plays an important role in DC migration into the T-cell area of LN. We addressed the effect of MSC on this chemotactic activity of DC, one of the typical characteristics upon maturation. METHODS BM cells were isolated and then cultured for generation of myeloid DC in the presence of GM-CSF and/or lipopolysaccharide with or without MSC. MSC were identified by flow cytometry of the immunologic markers and by performing colony-forming unit fibroblast assay. Migration of DC was observed with a newly developed time-lapse video microscopic technique. RESULTS MSC co-culture inhibited the initial differentiation of DC, as well as their maturation. The matured DC actively migrated directionally in response to CCL21, a powerful DC-attracting chemokine, whereas the MSC co-cultured DC did not. DISCUSSION Collectively, the findings of these experiments raise the possibility that MSC suppress the migratory function of DC and so they may serve immunoregulatory activities through the modulation of the Ag-presenting function of DC.
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Affiliation(s)
- Y-J Jung
- Department of Microbiology, Gachon Medical School, Incheon, Korea
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Hwang TS, Choi HK, Han HS. Differential expression of manganese superoxide dismutase, copper/zinc superoxide dismutase, and catalase in gastric adenocarcinoma and normal gastric mucosa. Eur J Surg Oncol 2006; 33:474-9. [PMID: 17129702 DOI: 10.1016/j.ejso.2006.10.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [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: 04/17/2006] [Accepted: 10/11/2006] [Indexed: 10/23/2022] Open
Abstract
AIMS The biologic significance of antioxidant enzymes (AOEs) in gastric adenocarcinoma is still unclear. The aims of this study was to investigate the differential expression of AOEs in gastric carcinoma cells and non-cancerous counterparts and the relationship with the various clinicopathologic variables in gastric cancer patients. METHODS Expression status of MnSOD, Cu/ZnSOD, and catalase was evaluated immunohistochemically in 120 paired gastric cancer and adjacent non-cancerous tissue. The tissues were fixed in absolute methanol immediately after surgical resection and immunohistochemistry was performed by microprobe system using tissuemicroarray slides. RESULTS All AOEs revealed moderate to strong immunoreactivity in the parietal and intestinal metaplastic cells. Stromal cells in both cancer and non-cancerous tissue expressed MnSOD and catalase but Cu/ZnSOD. Immunoreactivity of MnSOD and catalase was increased in gastric carcinoma cells compared to their non-cancerous counterparts and revealed an association with intestinal type adenocarcinomas whereas immunoreactivity of Cu/ZnSOD did not reveal significant difference between cancer and non-cancerous mucosal cells. CONCLUSIONS Expression of MnSOD, Cu/ZnSOD, catalas in gastric cancer cells and non-cancerous counterparts was different and increased MnSOD and possibly catalase may in part be responsible for the increased risk of intestinal type adenocarcinoma of the stomach.
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Affiliation(s)
- T S Hwang
- Department of Pathology, Konkuk University Hospital, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea.
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Jang JY, Kim SW, Han HS, Yoon YS, Han SS, Park YH. Totally laparoscopic management of choledochal cysts using a four-hole method. Surg Endosc 2006; 20:1762-5. [PMID: 17001443 DOI: 10.1007/s00464-005-0565-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 08/11/2005] [Accepted: 12/12/2005] [Indexed: 12/18/2022]
Abstract
BACKGROUND Choledochal cyst is a rare benign disease of the biliary tract. However, once diagnosed, it must be excised with the gallbladder because of the risk for cancer developing in the biliary tree, including the gallbladder. This report introduces a new surgical technique for totally laparoscopic excision of choledochal cyst and hepaticojejunostomy using a four-hole method. METHODS Between October 2003 and May 2005, the authors performed totally laparoscopic choledochal cyst excision for 12 patients. All the patients except one were women, and the mean age was 37.3 years (range, 17-62 years). According to the Todani classification, there were five type Ia cases, four type Ic cases, and three type IV cases. Choledochal cyst excision and Roux-en-Y hepaticojejunostomy were performed laparoscopically using the four-port technique. RESULTS The mean operation time was 228 min (range, 150-330 min). No operative or postoperative transfusion was required. An oral diet was started on postoperative day 3. The average length of hospital stay was 5.8 days. There was no major complication associated with anastomosis leakage or obstruction. No patient had an adverse response, as determined by clinical or laboratory evaluation during a 2- to 19-month follow-up period. CONCLUSIONS Considering that choledochal cyst is common among young women, who are especially interested in cosmetic results in addition to complete resolution of medical problems, the laparoscopic management of choledochal cyst may be an attractive treatment option.
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Affiliation(s)
- J-Y Jang
- Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
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Shimizu S, Nakashima N, Okamura K, Hahm JS, Kim YW, Moon BI, Han HS, Tanaka M. International transmission of uncompressed endoscopic surgery images via superfast broadband Internet connections. Surg Endosc 2005; 20:167-70. [PMID: 16333545 DOI: 10.1007/s00464-005-0282-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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: 04/18/2005] [Accepted: 07/29/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although telecommunication is increasing in popularity, poor-quality images sent through a narrowband network limit its use in the medical field. METHODS Kyushu University Hospital in Japan and four hospitals in Korea were linked via superfast broadband Internet connection. The digital video transfer system, which can transmit digital videos without loss of image quality, was used, and the bandwidth was 30 Mbps per line. RESULTS Of the 16 teleconferences conducted, 6 demonstrated real-time endoscopic surgery. In addition to the surgical images, preoperative diagnostic images, images of the operating room, and images of the staff in the conference room were transmitted to facilitate discussion. The network remained stable, and the sound delay was restricted to less than 0.3 s. In the other 10 teleconferences, recorded video images were used for discussion. CONCLUSIONS The authors have established a high-quality, practical teleconference system that is economical and easy to use in clinical practice. This system shows promise for remote education beyond geographic borders.
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Affiliation(s)
- S Shimizu
- Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Hospital, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
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Han HS, Min SK, Lee HK, Kim SW, Park YH. Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign pancreas neoplasm. Surg Endosc 2005; 19:1367-9. [PMID: 16193376 DOI: 10.1007/s00464-004-8158-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 03/28/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic distal pancreatectomy to conserve the spleen is a beneficial operation for patients with benign and borderline malignancy in the pancreas. With this procedure, it is very desirable to preserve the splenic artery and vein as well. METHODS From May 2000 to July 2003, five laparoscopic distal pancreatectomies with preservation of the spleen and splenic vessels were performed for benign pancreas neoplasm at Ewha Womans University Mokdong Hospital in Seoul, Korea. RESULTS The postoperative pathologic diagnoses were two serous cystadenomas, two mucinous cystadenomas, and one solid and papillary epithelial tumor. The tumors ranged in size from 1.5 to 7 cm. Four trocars (10-15 mm) and a laparoscopic linear stapler were used for transection of the pancreas. The mean operation time was 348 min, and the mean length of the incision for extraction was 3.6 cm. The mean postoperative hospital stay was 10.4 days. There was no complication or mortality. CONCLUSION Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels is a relatively safe and feasible option for the management of benign tumor or borderline malignancy in the distal pancreas.
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Affiliation(s)
- H-S Han
- Department of Surgery, College of Medicine, Seoul National University, Seoul, 110-744, Korea
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