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Cracchiolo JR, Arafat W, Atreja A, Bruckner L, Emamekhoo H, Heinrichs T, Raldow AC, Smerage J, Stetson P, Sugalski J, Tevaarwerk AJ. Getting ready for real-world use of electronic patient-reported outcomes (ePROs) for patients with cancer: A National Comprehensive Cancer Network ePRO Workgroup paper. Cancer 2023; 129:2441-2449. [PMID: 37224181 DOI: 10.1002/cncr.34844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Electronic patient‐reported outcome (ePRO) programs may offer advantages for patients with cancer, clinicians, health care systems, payors, and society in general; but developing and maintaining an ePRO program will require cancer centers to navigate defining meaningful problems, collecting ePROs, implementing action when those ePROs require intervention without over‐burdening clinicians, and monitoring the successes and failures of their ePRO programs. Physician informaticists from the National Comprehensive Cancer Network Electronic Health Record Advisory Group offer 10 guiding principles to consider when contemplating, building, or refining an ePRO program for patients with cancer.
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Affiliation(s)
| | - Waddah Arafat
- Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ashish Atreja
- University of California-Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Lauren Bruckner
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Hamid Emamekhoo
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Tricia Heinrichs
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
| | - Ann C Raldow
- University of California-Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Jeffrey Smerage
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Peter Stetson
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jessica Sugalski
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania, USA
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Tevaarwerk AJ, Chandereng T, Osterman T, Arafat W, Smerage J, Polubriaginof FCG, Heinrichs T, Sugalski J, Martin DB. Oncologist Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network Survey. JCO Oncol Pract 2021; 17:e1318-e1326. [PMID: 34264741 PMCID: PMC9810123 DOI: 10.1200/op.21.00195] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The use of telemedicine expanded dramatically in March 2020 following the COVID-19 pandemic. We sought to assess oncologist perspectives on telemedicine's present and future roles (both phone and video) for patients with cancer. METHODS The National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group formed a Workgroup to assess the state of oncology telemedicine and created a 20-question survey. NCCN EHR Oncology Advisory Group members e-mailed the survey to providers (surgical, hematology, gynecologic, medical, and radiation oncology physicians and clinicians) at their home institution. RESULTS Providers (N = 1,038) from 26 institutions responded in Summer 2020. Telemedicine (phone and video) was compared with in-person visits across clinical scenarios (n = 766). For reviewing benign follow-up data, 88% reported video and 80% reported telephone were the same as or better than office visits. For establishing a personal connection with patients, 24% and 7% indicated video and telephone, respectively, were the same as or better than office visits. Ninety-three percent reported adverse outcomes attributable to telemedicine visits never or rarely occurred, whereas 6% indicated they occasionally occurred (n = 801). Respondents (n = 796) estimated 46% of postpandemic visits could be virtual, but challenges included (1) lack of patient access to technology, (2) inadequate clinical workflows to support telemedicine, and (3) insurance coverage uncertainty postpandemic. CONCLUSION Telemedicine appears effective across a variety of clinical scenarios. Based on provider assessment, a substantial fraction of visits for patients with cancer could be effectively and safely conducted using telemedicine. These findings should influence regulatory and infrastructural decisions regarding telemedicine postpandemic for patients with cancer.
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Affiliation(s)
| | | | | | - Waddah Arafat
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Smerage
- Rogel Comprehensive Cancer Center, University of Michigan; Ann Arbor, MI
| | | | - Tricia Heinrichs
- National Comprehensive Cancer Network, Plymouth Meeting, PA,Tricia Heinrichs, BS, National Comprehensive Cancer Network, 3025 Chemical Rd, Suite 100, Plymouth Meeting, PA 19462; Twitter: @AmyeTevaarwerkMD, @NCCN; e-mail:
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Tevaarwerk A, Osterman T, Arafat W, Smerage J, Polubriaginof FC, Heinrichs T, Sugalski J, Martin D. BIO21-011: Oncology Provider Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network (NCCN®) Survey. J Natl Compr Canc Netw 2021. [DOI: 10.6004/jnccn.2020.7728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Waddah Arafat
- 3Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Smerage
- 4Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI
| | | | | | | | - Daniel Martin
- 7University of Washington Medical Center, Seattle, WA
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Janni WJ, Yab TC, Hayes DF, Cristofanilli M, Bidard FC, Ignatiadis M, Regan MM, Alix-Panabières C, Barlow WE, Caldas C, Carey LA, Dirix L, Fehm T, Garcia-Saenz JA, Gazzaniga P, Generali D, Gerratana L, Gisbert-Criado R, Jacot W, Jiang Z, Lianidou E, Magbanua MJ, Manso L, Mavroudis D, Müller V, Munzone E, Pantel K, Pierga JY, Rack B, Riethdorf S, Rugo HS, Sideras K, Sleijfer S, Smerage J, Stebbing J, Terstappen LW, Vidal-Martínez J, Zamarchi R, Giridhar K, Friedl TW, Liu MC. Abstract GS4-08: Clinical utility of repeated circulating tumor cell (CTC) enumeration as early treatment monitoring tool in metastatic breast cancer (MBC) - a global pooled analysis with individual patient data. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs4-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Several studies suggest clinical utility of serial circulating tumor cell (CTC) enumeration as a means of assessing response status in metastatic breast cancer (MBC). The aim of this study is to conduct a comprehensive pooled analysis comprising globally available data to further define and explore the role of CTC enumeration as a tool for early treatment monitoring in patients with MBC with a focus on the predictive power in different breast cancer subtypes and clinical settings.
Methods:
In a global effort, peer-reviewed published studies with data on repeated CTC assessments (CellSearch® technology; Menarini Silicon Biosystems; Bologna, Italy) in MBC patients were screened and investigators were asked to provide individual patient data for this pooled analysis. 2761 cases from 32 data sets with data on both baseline and one follow up CTC assessments were included in the analysis (median time interval between the two CTC assessments 35 days). Data were analyzed using log rank tests and Cox regressions to evaluate the association between serial CTC enumeration results and overall survival (OS) in the full patient cohort and defined subgroups.
Results:
588 (21.3%) patients had no CTCs at both time points (neg/neg), 236 (8.5%) patients were CTC negative at baseline and CTC positive at follow up (neg/pos), 712 (25.8%) patients converted from CTC positive at baseline to CTC negative (pos/neg), and 1225 (44.4%) patients had at least one CTC at both time points (pos/pos). Log rank tests showed significant differences in OS between these four CTC change groups (p < 0.0001 for all pairwise comparisons except for the comparison between neg/pos and pos/neg, p = 0.015). Median OS for the neg/neg, neg/pos, pos/neg and pos/pos group was 45.6, 26.1, 34.6, and 17.6 months, respectively. Hazard ratios (HR) (reference group neg/neg) were 1.38 (95% CI 1.16 - 1.64) for the pos/neg group, 1.78 (95% CI 1.43 - 2.22) for the neg/pos group, and 3.06 (95% CI 2.63 - 3.56) for the pos/pos group. Results were similar if a cutoff of 5 CTCs was used for CTC positivity (pos/neg group: HR 1.43, 95% CI 1.25 - 1.63; neg/pos group: HR 2.39, 95% CI 1.91 - 2.99; pos/pos group: HR 3.54, 95% CI 3.12 - 4.02).
In total, 2586 patients could be assigned to different tumor subtypes based on known hormone receptor (ER) and HER2 status of the primary tumor: 1513 (58.5%) patients had a luminal-like tumor (ER positive, HER2 negative), 682 (26.4%) patients had a HER2-positive tumor, and 391 (15.1%) patients had a triple-negative tumor. In patients with luminal-like tumors, the hazard ratios were 1.67 (95% CI 1.29 - 2.17), 2.01 (95% CI 1.45 - 2.77), and 3.87 (95% CI 3.09 - 4.83) for the pos/neg, neg/pos, and pos/pos group, respectively. In patients with HER2-positive tumors, the neg/pos group (HR 1.68, 95% CI 1.12 - 2.53) and the pos/pos group (HR 2.11, 95% CI 1.58 - 2.83) showed significantly worse OS compared to the neg/neg group, while in triple-negative patients, the pos/pos group had a significantly shorter OS compared to the neg/neg group (HR 2.99, 95% CI 2.11 - 4.24).
The results will be up-dated by inclusion of additional large data sets (CALGB 40502, CALGB 40503, COMET, SWOG S0500, TBCRC 001) for the analysis to be presented at SABCS 2020.
Conclusion:
This large pooled analysis confirms that at a median of 35 days after treatment initiation, follow-up CTC assessments strongly predict overall survival. These results suggest potential clinical utility of CTC monitoring as early response marker in MBC, especially in luminal-like tumors.
Citation Format: Wolfgang J Janni, Tracy C. Yab, Daniel F. Hayes, Massimo Cristofanilli, Francois-Clement Bidard, Michail Ignatiadis, Meredith M. Regan, Catherine Alix-Panabières, William E. Barlow, Carlos Caldas, Lisa A. Carey, Luc Dirix, Tanja Fehm, Jose A. Garcia-Saenz, Paola Gazzaniga, Daniele Generali, Lorenzo Gerratana, Rafael Gisbert-Criado, William Jacot, Zefei Jiang, Evi Lianidou, Mark J.M. Magbanua, Luis Manso, Dimitrios Mavroudis, Volkmar Müller, Elisabetta Munzone, Klaus Pantel, Jean-Yves Pierga, Brigitte Rack, Sabine Riethdorf, Hope S. Rugo, Kostandinos Sideras, Stefan Sleijfer, Jeffrey Smerage, Justin Stebbing, Leon W.M.M. Terstappen, José Vidal-Martínez, Rita Zamarchi, Karthik Giridhar, Thomas W.P. Friedl, Minetta C. Liu. Clinical utility of repeated circulating tumor cell (CTC) enumeration as early treatment monitoring tool in metastatic breast cancer (MBC) - a global pooled analysis with individual patient data [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS4-08.
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Affiliation(s)
- Wolfgang J Janni
- 1Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Tracy C. Yab
- 2Department of Oncology, Mayo Clinic, Rochester, MN
| | - Daniel F. Hayes
- 3Breast Oncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Massimo Cristofanilli
- 4Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Michail Ignatiadis
- 6Department of Medical Oncology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Meredith M. Regan
- 7Division of Biostatistics, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Catherine Alix-Panabières
- 8Laboratory of Rare Human Circulating Cells (LCCRH), University Medical Centre of Montpellier, Montpellier, France
| | | | - Carlos Caldas
- 10Department of Oncology, Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Lisa A. Carey
- 11Division of Hematology-Oncology, University of North Carolina, Chapel Hill, NC
| | - Luc Dirix
- 12University of Antwerp and GZA Sint-Augustinus, Antwerp, Belgium
| | - Tanja Fehm
- 13Department of Gynecology and Obstetrics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Paola Gazzaniga
- 15Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Generali
- 16Women Cancer Center, Azienda Socio Sanitaria Territoriale di Cremona, University of Trieste, Trieste, Italy
| | - Lorenzo Gerratana
- 17Department of Medicine (DAME) - The University of Udine, Udine, Italy
| | | | - William Jacot
- 19Department of Medical Oncology, Institut du Cancer de Montpellier (ICM), IRCM, INSERM U1194, Université de Montpellier, Montpellier, France
| | - Zefei Jiang
- 20Department of Breast Cancer, The 307th Hospital of Chinese People’s Liberation Army, Beijing, China
| | - Evi Lianidou
- 21Laboratory of Analytical Chemistry, Analysis of Circulating Tumor Cells (ACTC) Lab, Department of Chemistry, University of Athens, Athens, Greece
| | - Mark J.M. Magbanua
- 22University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Luis Manso
- 23Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Dimitrios Mavroudis
- 24Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | - Volkmar Müller
- 25Department of Gynecology and Obstetrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabetta Munzone
- 26Division of Medical Senology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Klaus Pantel
- 27Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jean-Yves Pierga
- 28Department of Medical Oncology, Institute Curie, Paris & St Cloud, Paris University, Paris, France
| | - Brigitte Rack
- 1Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
| | - Sabine Riethdorf
- 27Department of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hope S. Rugo
- 22University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | - Stefan Sleijfer
- 30Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Jeffrey Smerage
- 3Breast Oncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Justin Stebbing
- 31Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Leon W.M.M. Terstappen
- 32Medical Cell BioPhysics Group, MIRA Institute, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | | | - Rita Zamarchi
- 33Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Thomas W.P. Friedl
- 1Department of Obstetrics and Gynecology, University Hospital Ulm, Ulm, Germany
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Bidard FC, Michiels S, Riethdorf S, Mueller V, Esserman LJ, Lucci A, Naume B, Horiguchi J, Gisbert-Criado R, Sleijfer S, Toi M, Garcia-Saenz JA, Hartkopf A, Generali D, Rothé F, Smerage J, Muinelo-Romay L, Stebbing J, Viens P, Magbanua MJM, Hall CS, Engebraaten O, Takata D, Vidal-Martínez J, Onstenk W, Fujisawa N, Diaz-Rubio E, Taran FA, Cappelletti MR, Ignatiadis M, Proudhon C, Wolf DM, Bauldry JB, Borgen E, Nagaoka R, Carañana V, Kraan J, Maestro M, Brucker SY, Weber K, Reyal F, Amara D, Karhade MG, Mathiesen RR, Tokiniwa H, Llombart-Cussac A, Meddis A, Blanche P, d'Hollander K, Cottu P, Park JW, Loibl S, Latouche A, Pierga JY, Pantel K. Circulating Tumor Cells in Breast Cancer Patients Treated by Neoadjuvant Chemotherapy: A Meta-analysis. J Natl Cancer Inst 2019; 110:560-567. [PMID: 29659933 DOI: 10.1093/jnci/djy018] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/24/2018] [Indexed: 11/13/2022] Open
Abstract
Background We conducted a meta-analysis in nonmetastatic breast cancer patients treated by neoadjuvant chemotherapy (NCT) to assess the clinical validity of circulating tumor cell (CTC) detection as a prognostic marker. Methods We collected individual patient data from 21 studies in which CTC detection by CellSearch was performed in early breast cancer patients treated with NCT. The primary end point was overall survival, analyzed according to CTC detection, using Cox regression models stratified by study. Secondary end points included distant disease-free survival, locoregional relapse-free interval, and pathological complete response. All statistical tests were two-sided. Results Data from patients were collected before NCT (n = 1574) and before surgery (n = 1200). CTC detection revealed one or more CTCs in 25.2% of patients before NCT; this was associated with tumor size (P < .001). The number of CTCs detected had a detrimental and decremental impact on overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P < .001), but not on pathological complete response. Patients with one, two, three to four, and five or more CTCs before NCT displayed hazard ratios of death of 1.09 (95% confidence interval [CI] = 0.65 to 1.69), 2.63 (95% CI = 1.42 to 4.54), 3.83 (95% CI = 2.08 to 6.66), and 6.25 (95% CI = 4.34 to 9.09), respectively. In 861 patients with full data available, adding CTC detection before NCT increased the prognostic ability of multivariable prognostic models for overall survival (P < .001), distant disease-free survival (P < .001), and locoregional relapse-free interval (P = .008). Conclusions CTC count is an independent and quantitative prognostic factor in early breast cancer patients treated by NCT. It complements current prognostic models based on tumor characteristics and response to therapy.
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Affiliation(s)
| | | | | | | | | | | | - Bjørn Naume
- Oslo University Hospital, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Andreas Hartkopf
- Women's Health Center, University of Tuebingen, Tuebingen, Germany
| | - Daniele Generali
- Women Cancer Centre, University of Trieste, ASST of Cremona, Cremona, Italy
| | - Françoise Rothé
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jeffrey Smerage
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | | | - Patrice Viens
- Institut Paoli Calmettes, Aix Marseille University, CNRS, Inserm, Marseilles, France
| | | | | | - Olav Engebraaten
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | - Wendy Onstenk
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | | | | | | | | | | | - Denise M Wolf
- University of California at San Francisco, San Francisco, CA
| | | | | | | | | | - Jaco Kraan
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marisa Maestro
- Hospital Clinico San Carlos, Universidad Complutense, Madrid, Spain
| | | | | | - Fabien Reyal
- Institut Curie, PSL Research University, Paris, France
| | - Dominic Amara
- University of California at San Francisco, San Francisco, CA
| | | | | | | | | | | | - Paul Blanche
- LMBA, Université de Bretagne Sud, Vannes, France
| | | | - Paul Cottu
- Institut Curie, PSL Research University, Paris, France
| | - John W Park
- University of California at San Francisco, San Francisco, CA
| | | | | | | | - Klaus Pantel
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Morikawa A, Robinson DR, Soellner M, Wu YM, Lonigro R, Gilani R, Cheng X, Lachacz E, Thomas D, McMurray K, Smerage J, Henry NL, Heth J, Chinnaiyan A, Hayes DF, Merajver S. Abstract PD9-12: Integrative molecular profiling of breast cancer brain metastasis and patient-derived xenograft organoids from resected breast cancer brain metastases to interrogate and prioritize therapeutic personalized strategies. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd9-12] [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: Breast cancer brain metastasis (BM) is an area of unmet need in metastatic breast cancer patients. Novel therapeutic interventions to help prevent and treat BM are warranted. We conducted integrative molecular profiling of BM and matched primary tumors (PT) using next-generation DNA and RNA sequencing to examine the molecular landscape. In addition, we established patient-derived xenograft/organoid (PDX/PDO) to examine drug sensitivity according to the molecular and clinical features of the BM.
Methods: Archived, formalin fixed paraffin-embedded BM was collected retrospectively. BM were also collected prospectively at the time of clinically indicated surgical resection through the central nervous system tissue banking and the Michigan Oncology Sequencing Center (MI-ONCOSEQ) protocols. Matched archived PT tissues were collected when available. Integrative next-generation sequencing was conducted using the MI-ONCOSEQ platform. The prospectively collected BM were further used to establish PDXs/ PDOs. Successfully established PDXs/PDOs were used for ex vivo drug testing via MiDrugScreen, a novel drug sensitivity testing platform, where testing was performed in a dose-response format with drug selection prioritized by clinical scenario and molecular alterations if known a priori.
Results: 12 matched BM-PT pairs were analyzed: 6 triple negative, 5 HER2 positive, and 1 ER positive HER2 negative. All except one (11/12) had TP53 mutations. When present, TP53 mutations in BM were also found in PT (except for 1 unknwon case in PT due to low coverage). ER+HER2- was the only one without TP53 mutation but had hyper-mutation (APOBEC signature). Driver mutations and unique copy number alterations (CDKN2A loss in 1/12, mutations in PIK3CA in 1/12 and ESR1 in 1/12, CCNE1 amplification in 1/12) were noted in BMs. In 75% of cases, mutational burden was higher in BM vs. PT. 2 PDX/PDO were available for drug testing. PDO-BC9 was noted to have RB1 (splice acceptor) and LOH. As predicted by this alteration, PDO-BC9 was insensitive to CDK4/6 inhibitors (palbociclib, abemaciclib) tested on MiDrugScreen panel. PDX-BC4 was established from PIK3CA and ESR1 mutated BM from an ER+HER2- patient who had previously progressed on endocrine therapy with a CDK4/6 inhibitor. As predicted, the PDX-BC4 was resistant to CDK4/6 inhibitor but interestingly sensitive to PIK3CA, ERK, and MEK inhibitors.
Conclusions: TP53 mutation was highly prevalent and may be a biomarker for increased risk of BM. Further study is warranted to see if specific TP53 mutations are associated with a risk of BM development and can be used in risk stratification for BM specific intervention. Unique molecular alterations in BM compared to matched PT may have a therapeutic implication as a target or resistance biomarker. Conducting drug testing in addition to molecular profiling has the strong potential of being informative in tailoring or prioritizing therapeutic agents in the era of precision medicine. Additional BM PDXs/PDOs from breast and other solid tumors are being examined using this novel therapeutic tailoring approach with the combination of MIONCOSEQ and MiDrugScreen.
Citation Format: Morikawa A, Robinson DR, Soellner M, Wu Y-M, Lonigro R, Gilani R, Cheng X, Lachacz E, Thomas D, McMurray K, Smerage J, Henry NL, Heth J, Chinnaiyan A, Hayes DF, Merajver S. Integrative molecular profiling of breast cancer brain metastasis and patient-derived xenograft organoids from resected breast cancer brain metastases to interrogate and prioritize therapeutic personalized strategies [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 PD9-12.
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Affiliation(s)
- A Morikawa
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - DR Robinson
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - M Soellner
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - Y-M Wu
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - R Lonigro
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - R Gilani
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - X Cheng
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - E Lachacz
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - D Thomas
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - K McMurray
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - J Smerage
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - NL Henry
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - J Heth
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - A Chinnaiyan
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - DF Hayes
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
| | - S Merajver
- University of Michigan, Ann Arbor, MI; University of Utah, Salt Lake City, UT
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Grivas PD, Devata S, Khoriaty R, Boonstra PS, Ruch J, McDonnell K, Hernandez-Aya L, Wilfong J, Smerage J, Ison MG, Eisenberg JNS, Silveira M, Cooney KA, Worden FP. Low-Cost Intervention to Increase Influenza Vaccination Rate at a Comprehensive Cancer Center. J Cancer Educ 2017; 32:871-877. [PMID: 27055536 DOI: 10.1007/s13187-016-1017-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Influenza morbidity and mortality can be severe and costly. Vaccination rates remain suboptimal in cancer patients due to provider- and patient-related factors. The objective of this study was to evaluate whether low-cost provider- and patient-focused interventions would increase influenza vaccination rates at the University of Michigan Comprehensive Cancer Center (UMCCC). This quality improvement project included all patients without documentation of influenza vaccination prior to their first outpatient appointment during the 2011-2012 and 2012-2013 influenza seasons. The multi-stepped intervention included provider and patient reminders. Influenza vaccination rates were compiled using CPT-4 codes. Same-day (with appointment) vaccination rates during the intervention seasons were compared to historical (2005-2011 seasons) controls; vaccination rates were also compared to contemporary control population at the University of Michigan Health System (UMHS). Reasons for non-adherence with vaccination were explored. The cumulative same-day vaccination rate in eligible adults was 10.1 % (2011-2012) and 9.4 % (2012-2013) compared to an average 6.9 % during influenza seasons 2005-2011. Based on logistic regression analysis, there was a 37.6 % (95 % CI 35-40.3 %) and 56.1 % (95 % CI 40.9-73 %) relative increase in the adult vaccination rate associated with the intervention, with 399 and 697 additional vaccinations, respectively, for each season. During the 2012-2013 season, the UMCCC adult vaccination rate was higher compared to the remainder of that of the UMHS. The intervention was well accepted by providers. Reasons for no vaccination were provider- and patient-related. Increasing provider and patient awareness with a simple, inexpensive intervention was associated with higher influenza vaccination rates at a large academic cancer center. The intervention is permanently implemented during influenza seasons.
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Affiliation(s)
- Petros D Grivas
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Desk R35, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Sumana Devata
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Rami Khoriaty
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Joshua Ruch
- Hematology/Oncology, Munson Medical Center, Traverse City, MI, USA
| | - Kevin McDonnell
- Division of Hematology/Oncology, University of Southern California, Los Angeles, CA, USA
| | - Leonel Hernandez-Aya
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua Wilfong
- Hospice and Palliative Medicine, Stanford University, Stanford, CA, USA
| | - Jeffrey Smerage
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Maria Silveira
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kathleen A Cooney
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Francis P Worden
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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Hertz DL, Caram MV, Kidwell KM, Thibert JN, Gersch C, Seewald NJ, Smerage J, Rubenfire M, Henry NL, Cooney KA, Leja M, Griggs JJ, Rae JM. Evidence for association of SNPs in ABCB1 and CBR3, but not RAC2, NCF4, SLC28A3 or TOP2B, with chronic cardiotoxicity in a cohort of breast cancer patients treated with anthracyclines. Pharmacogenomics 2016; 17:231-40. [PMID: 26799497 PMCID: PMC5558515 DOI: 10.2217/pgs.15.162] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 10/26/2015] [Indexed: 12/14/2022] Open
Abstract
AIMS Validation of associations for SNPs in RAC2, NCF4 and SLC28A3, identification of a novel association with a TOP2B SNP and screening 23 SNPs putatively relevant to anthracycline-induced cardiotoxicity. PATIENTS & METHODS A total of 166 breast cancer patients treated with doxorubicin underwent echocardiogram, including 19 cases with systolic dysfunction (ejection fraction <55%) and 147 controls. Four high priority SNPs were tested in the primary analysis, with appropriate statistical correction, and 23 additional SNPs were screened in an uncorrected secondary analysis. RESULTS Previously reported associations for RAC2, NCF4 and SLC28A3 could not be validated and a novel association with TOP2B was not discovered in this cohort (all p > 0.05), likely due to inadequate power. Two SNPs were identified in the uncorrected secondary analysis including a protective SNP in ABCB1 (3435C>T, p = 0.049) and a risk allele in CBR3 (V244M, p = 0.012). CONCLUSION The associations reported in prior publications and those discovered in this secondary analysis require further replication in independent cohorts.
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Affiliation(s)
- Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, MI 48109, USA
| | - Megan V Caram
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Jacklyn N Thibert
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Christina Gersch
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Nicholas J Seewald
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Jeffrey Smerage
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Melvyn Rubenfire
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - N Lynn Henry
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Kathleen A Cooney
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Urology, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Monika Leja
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Jennifer J Griggs
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - James M Rae
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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9
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Caram MEV, Guo C, Leja M, Smerage J, Henry NL, Giacherio D, Rubenfire M, Schott A, Davis M, Hayes DF, Van Poznak C, Cooney KA, Hertz DL, Banerjee M, Griggs JJ. Doxorubicin-induced cardiac dysfunction in unselected patients with a history of early-stage breast cancer. Breast Cancer Res Treat 2015; 152:163-172. [PMID: 26050157 DOI: 10.1007/s10549-015-3454-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
Cardiomyopathy is a known complication of anthracycline-based adjuvant chemotherapy and is more commonly reported in population-based studies of breast cancer survivors than in clinical trials. This study prospectively evaluated the prevalence of elevated cardiac biomarkers in unselected patients who had been treated with doxorubicin for early-stage breast cancer and the prevalence of reduced LVEF in patients with an elevated biomarker. All participants underwent an examination, symptom inventory, medical record review, and biomarker analysis for BNP, troponin, and plasma and urine NT-proBNP. Patients who had one or more elevated biomarkers were referred for echocardiogram; systolic dysfunction was defined as LVEF less than 55 %. Multivariable logistic regression was used to determine the associations between age, BMI, cumulative dose of doxorubicin, diabetes, hypertension, and left-sided radiation therapy and the risk of reduced LVEF. Among the 269 patients who underwent lab testing (mean age 56 years, mean time since completion of doxorubicin-based chemotherapy 6 years), 192 (72 %) had one or more elevated biomarker. Among the 166 patients who completed an echocardiogram, 11.5 % had a LVEF < 55 %. After adjusting for covariates known to affect cardiac function, multivariable logistic regression revealed plasma NT-proBNP to be the only measured cardiac biomarker associated with systolic dysfunction. There is a relationship between NT-proBNP and the frequency of reduced LVEF in women treated with doxorubicin for curative intent; further study of NT-proBNP as a potential biomarker for subclinical cardiac dysfunction after exposure to anthracyclines is warranted.
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Affiliation(s)
- Megan E V Caram
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States.
| | - Cui Guo
- Department of Biostatistics, University of Michigan School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States
| | - Monika Leja
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive; Cardiovascular Center, Ann Arbor, MI, 48109, United States
| | - Jeffrey Smerage
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - N Lynn Henry
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Donald Giacherio
- Department of Pathology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Melvyn Rubenfire
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive; Cardiovascular Center, Ann Arbor, MI, 48109, United States
| | - Anne Schott
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Melinda Davis
- Department of Internal Medicine, Division of Cardiology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive; Cardiovascular Center, Ann Arbor, MI, 48109, United States
| | - Daniel F Hayes
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Catherine Van Poznak
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Kathleen A Cooney
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States.,Department of Urology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States
| | - Daniel L Hertz
- Department of Pharmacology, College of Pharmacy, University of Michigan , 428 Church Street, Ann Arbor, MI, 48104-1065, United States
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States
| | - Jennifer J Griggs
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan Medical School, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, United States.,Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109, United States
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10
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Lo SS, Mumby PB, Norton J, Rychlik K, Smerage J, Kash J, Chew HK, Gaynor ER, Hayes DF, Epstein A, Albain KS. Prospective multicenter study of the impact of the 21-gene recurrence score assay on medical oncologist and patient adjuvant breast cancer treatment selection. J Clin Oncol 2010; 28:1671-6. [PMID: 20065191 DOI: 10.1200/jco.2008.20.2119] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The 21-gene Recurrence Score (RS) assay has been validated to quantify the risk of distant recurrence in tamoxifen-treated patients with lymph node-negative, estrogen receptor-positive breast cancer and predict magnitude of chemotherapy benefit. This multicenter study was designed to prospectively examine whether RS affects physician and patient adjuvant treatment selection and satisfaction. PATIENTS AND METHODS Before and after obtaining the 21-gene RS assay, medical oncologists stated their adjuvant treatment recommendation and confidence in it. Patients also indicated their treatment choice pre- and post-RS assay. Patients completed measures for decisional conflict, anxiety, and quality of life. RESULTS Seventeen medical oncologists at one community and three academic practices consecutively enrolled 89 assessable patients. The medical oncologist treatment recommendation changed for 28 patients (31.%). Twenty-four patients (27%) changed their treatment decision. The largest change after the RS results was conversion from the medical oncologist's pretest recommendation for chemotherapy plus hormonal therapy (CHT) to post-test recommendation for hormone therapy (HT) in 20 cases (22.5%). Nine patients (10.1%) changed their treatment decision from CHT to HT. RS results increased medical oncologist confidence in their treatment recommendation in 68 cases (76%). Patient anxiety and decisional conflict were significantly lower after RS results. CONCLUSION The results of this study indicate that the RS assay impacts medical oncologist adjuvant treatment recommendations, patient treatment choice, and patient anxiety.
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Affiliation(s)
- Shelly S Lo
- Loyola University Medical Center, Cardinal Bernardin Cancer Center, 2160 S First Ave, Maywood, IL 60153, USA.
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Henry N, Jacobson J, Banerjee M, Hayden J, Smerage J, Stearns V, Hayes D. Association of Aromatase Inhibitor-Associated Musculoskeletal Symptoms with Ultrasonographic Changes at the Wrist. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-802] [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: About 40% of aromatase inhibitor (AI)-treated women develop AI-associated musculoskeletal symptoms (AIMSS) such as arthralgias, but the etiology is unclear. Tendon sheath fluid and tenosynovial changes have been demonstrated by imaging in symptomatic AI-treated patients. It is unclear if these changes correlate with development of AIMSS.Methods: Thirty consecutive patients (pts) initiating therapy with letrozole or exemestane on a prospective clinical trial were enrolled to this substudy. Pts with prior wrist trauma or who declined to provide informed consent were excluded. Pts underwent high resolution ultrasonography (US) of the wrists bilaterally and completed the Health Assessment Questionnaire (HAQ), pain Visual Analog Scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire at baseline (BL) and after 3 mo of AI. AIMSS was defined as increase in HAQ or pain VAS score during AI therapy that exceeded a predefined cutoff. Analysis of US images was performed in a blinded manner. Imaging abnormalities included the following: presence of fluid, synovitis, and/or hyperemia in the tendon sheath or joint recess. Statistical analysis was performed using univariate chi-square tests and logistic regression analyses.Results: Of the 30 enrolled subjects, 25 completed both BL and 3 mo assessments. Eight of 30 (27%) discontinued therapy because of AIMSS (2 before and 6 after the 3 mo timepoint), and 3 patients discontinued therapy for unrelated reasons. All patients have been followed for at least 6 mo. We observed a significant association between early treatment discontinuation and change in HAQ (Odds Ratio (OR) 1.525, p=0.0006) and VAS (OR 1.307, p=0.0096) but not DASH (OR 1.001, p=0.96) scores between BL and 3 mo. The proportion of pts with abnormalities on US at BL or that developed during therapy is given in tables 1 and 2, respectively. We did not observe a statistically significant correlation between objective abnormalities on US at BL or following initiation of AI therapy and the development of AIMSS or early treatment discontinuation because of AIMSS.Conclusions: Clinically relevant musculoskeletal symptoms develop in AI-treated women, leading to treatment discontinuation in a substantial percentage. However, patient-reported symptoms were not associated with inflammatory changes visible on wrist US in this pilot study.Proportion of pts with US abnormalities at BL # with abnl/total ptsof pts with AIMSS, # with US abnlof pts without AIMSS, # with US abnlof pts who d/c AI b/c AIMSS, # with US abnlof pts who continued AI, # with US abnlAny anatomic site27/30 (90%)9/10 (90%)18/20 (90%)7/8 (88%)20/22 (91%)--Tendon sheath14/30 (47%)7/10 (70%)7/20 (35%)5/8 (63%)9/22 (41%)--Joint recess24/30 (80%)6/10 (60%)18/20 (90%)6/8 (75%)18/22 (82%) Proportion of pts who developed new abnormalities on US during AI therapy # with abnl/total ptsof pts with AIMSS, # with US abnlof pts without AIMSS, # with US abnlof pts who d/c AI, # with US abnlof pts who continued AI, # with US abnlAny anatomic site13/25 (52%)5/9 (56%)7/16 (44%)4/6 (67%)7/19 (37%)--Tendon sheath5/25 (20%)2/9 (22%)3/16 (19%)0/6 (0%)5/19 (26%)--Joint recess12/25 (48%)5/9 (56%)6/16 (38%)4/6 (67%)6/19 (32%)
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 802.
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12
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Van Poznak C, Morris P, D'Andrea G, Schott A, Griggs J, Fornier M, Smerage J, Henry N, Hurria A, Drullinsky P, Mills N, Hayes D, Hudis C. Bone Mineral Density (BMD) Changes at 1 Year in Postmenopausal Women Who Are Not Receiving Adjuvant Endocrine Therapy for Breast Cancer (BCA). Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-1066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: Adjuvant therapy for breast cancer (BCA) may be associated with an increased risk for osteoporosis. This prospective, observational study evaluates BMD changes in postmenopausal women undergoing adjuvant chemotherapy (CTX) for early stage BCA, in the absence of endocrine therapy.Methods: Women who have been postmenopausal for at least 5 years, and who were recently diagnosed with Stage 0-III BCA were eligible to undergo serial BMD if adjuvant endocrine therapy was not recommended. Study BMDs were performed at baseline, 1 and 2 years. All patients (pts) were counseled on calcium, vitamin D and weight bearing exercise. This study was designed to assess serial changes in BMD in the individual and to compare changes in those treated with CTX to those who received no systemic therapy (observation). The study was closed prior to reaching target sample size due to slow accrual.Results: Sixteen pts enrolled. Eleven pts received CTX with a dose dense anthracycline and taxane containing regimen and 5 pts received no systemic adjuvant therapy. Twelve pts, median age 63 (range 52-80), have completed the 1 year assessment and are reported here. Two pts treated with CTX and 1 pt on observation were on bisphosphonates at study entry. Baseline BMD mean in gm/cm2 at the lumbar spine (LS) was 1.112 (range 0.807-1.389) and total hip (TH) was 0.989 (range 0.760-1.213). At 1 year, mean BMD at LS was 1.078 (range 0.767-1.347) and TH was 0.956 (range 0.753-1.210). For all 12 pts at 1 year, the individual BMD changes in LS & TH BMD ranged from 10% loss to 2% gain, with 8 of the 9 CTX treated pts losing 1-10% of BMD and the 3 pts on observation staying within 2% of baseline. The mean dosage of dexamethasone used during CTX by the 9 CTX pts was 230 mg (range 156-288mg). The 3 observation pts had no exposure to steroids during the parallel time period.Conclusions: This prospective, observational study supports the hypothesis that adjuvant CTX, and/or its supportive medications, may be associated with acute changes in BMD in postmenopausal women. Patient follow up continues.Funded by Susan G. Komen for the Cure POP0402593
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1066.
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Affiliation(s)
| | - P. Morris
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | - G. D'Andrea
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | | | | | - M. Fornier
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | | | | | | | | | - N. Mills
- 2Memorial Sloan-Kettering Cancer Center, NY,
| | | | - C. Hudis
- 2Memorial Sloan-Kettering Cancer Center, NY,
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14
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Haves D, Smerage J, Luker G, Eliane J, Doyle G. Circulating tumor cells and breast cancer. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Smerage J. PL4.3. Circulating Tumour cells and tumour DNA. Cancer Treat Rev 2008. [DOI: 10.1016/j.ctrv.2008.03.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Lo SS, Norton J, Mumby PB, Smerage J, Kash J, Chew HK, Hayes D, Epstein A, Albain KS. Prospective multicenter study of the impact of the 21-gene recurrence score (RS) assay on medical oncologist (MO) and patient (pt) adjuvant breast cancer (BC) treatment selection. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.577] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
577 Background: The 21-gene RS assay has been validated to quantify the risk of distant recurrence in tamoxifen treated pts in N-ER+BC and predict magnitude of chemotherapy benefit. Since there is little data regarding the impact of RS on MO and pt decision making, this multi-center study was designed to prospectively examine whether RS affects MO and pt adjuvant treatment selection. Methods: MOs stated their treatment recommendation and confidence in it while pts indicated treatment choice pre and post RS assay. RS were returned to MO and pt for routine clinical care. Frequency distributions and co-frequency tables are used to display categorical distributions of nominal variables; means and standard deviations are used to summarize continuous variables. Results: 15 MOs at 1 community and 3 academic practices consecutively enrolled 93 pts (89 evaluable) with N-ER+BC. The treatment plan changed in 31.5% of MOs and 27% of pts. The frequency of treatment changes are in the table below. The largest change induced by RS results was conversion from pre-test CHT to post-test HT (22.5% of MO, 10.1% of pts). MOs stated RS results increased confidence in 68 (76%). 90% of pts felt the RS assay influenced their treatment choice; 95% were glad they took the test. Conclusion: The results of this study indicate that the RS assay does impact MO adjuvant treatment recommendations, pt treatment choice, and confidence in the treatment plan. Investigator initiated trial supported by an unrestricted clinical trial grant from Genomic Health Inc. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- S. S. Lo
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - J. Norton
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - P. B. Mumby
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - J. Smerage
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - J. Kash
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - H. K. Chew
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - D. Hayes
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - A. Epstein
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
| | - K. S. Albain
- Loyola Univ, Maywood, IL; University of Michigan, Ann Arbor, MI; Edward Hospital, Naperville, IL; University of California at Davis, Sacramento, CA; Mount Sinai Medical Center, New York, NY
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