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Hitchcock KE, Miller ED, Shi Q, Dixon JG, Gholami S, White SB, Wu C, Goulet CC, George M, Jee KW, Wright CL, Yaeger R, Shergill A, Hong TS, George TJ, O'Reilly EM, Meyerhardt JA, Romesser PB. Alliance for clinical trials in Oncology (Alliance) trial A022101/NRG-GI009: a pragmatic randomized phase III trial evaluating total ablative therapy for patients with limited metastatic colorectal cancer: evaluating radiation, ablation, and surgery (ERASur). BMC Cancer 2024; 24:201. [PMID: 38350888 PMCID: PMC10863118 DOI: 10.1186/s12885-024-11899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND For patients with liver-confined metastatic colorectal cancer (mCRC), local therapy of isolated metastases has been associated with long-term progression-free and overall survival (OS). However, for patients with more advanced mCRC, including those with extrahepatic disease, the efficacy of local therapy is less clear although increasingly being used in clinical practice. Prospective studies to clarify the role of metastatic-directed therapies in patients with mCRC are needed. METHODS The Evaluating Radiation, Ablation, and Surgery (ERASur) A022101/NRG-GI009 trial is a randomized, National Cancer Institute-sponsored phase III study evaluating if the addition of metastatic-directed therapy to standard of care systemic therapy improves OS in patients with newly diagnosed limited mCRC. Eligible patients require a pathologic diagnosis of CRC, have BRAF wild-type and microsatellite stable disease, and have 4 or fewer sites of metastatic disease identified on baseline imaging. Liver-only metastatic disease is not permitted. All metastatic lesions must be amenable to total ablative therapy (TAT), which includes surgical resection, microwave ablation, and/or stereotactic ablative body radiotherapy (SABR) with SABR required for at least one lesion. Patients without overt disease progression after 16-26 weeks of first-line systemic therapy will be randomized 1:1 to continuation of systemic therapy with or without TAT. The trial activated through the Cancer Trials Support Unit on January 10, 2023. The primary endpoint is OS. Secondary endpoints include event-free survival, adverse events profile, and time to local recurrence with exploratory biomarker analyses. This study requires a total of 346 evaluable patients to provide 80% power with a one-sided alpha of 0.05 to detect an improvement in OS from a median of 26 months in the control arm to 37 months in the experimental arm with a hazard ratio of 0.7. The trial uses a group sequential design with two interim analyses for futility. DISCUSSION The ERASur trial employs a pragmatic interventional design to test the efficacy and safety of adding multimodality TAT to standard of care systemic therapy in patients with limited mCRC. TRIAL REGISTRATION ClinicalTrials.gov: NCT05673148, registered December 21, 2022.
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Affiliation(s)
| | | | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Jesse G Dixon
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Manju George
- COLONTOWN/PALTOWN Development Foundation, Crownsville, MD, USA
| | | | | | - Rona Yaeger
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box #22, 10065, New York, NY, USA
| | - Ardaman Shergill
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL, USA
| | | | | | - Eileen M O'Reilly
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box #22, 10065, New York, NY, USA
| | | | - Paul B Romesser
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box #22, 10065, New York, NY, USA.
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Hitchcock KE, Miller ED, Shi Q, Dixon JG, Gholami S, White SB, Wu C, Goulet CC, George M, Jee KW, Wright CL, Yaeger R, Shergill A, Hong TS, George TJ, O'Reilly EM, Meyerhardt JA, Romesser PB. Alliance for Clinical Trials in Oncology (Alliance) trial A022101/NRG-GI009: A pragmatic randomized phase III trial evaluating total ablative therapy for patients with limited metastatic colorectal cancer: evaluating radiation, ablation, and surgery (ERASur). Res Sq 2023:rs.3.rs-3773522. [PMID: 38196590 PMCID: PMC10775493 DOI: 10.21203/rs.3.rs-3773522/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background For patients with liver-confined metastatic colorectal cancer (mCRC), local therapy of isolated metastases has been associated with long-term progression-free and overall survival (OS). However, for patients with more advanced mCRC, including those with extrahepatic disease, the efficacy of local therapy is less clear although increasingly being used in clinical practice. Prospective studies to clarify the role of metastatic-directed therapies in patients with mCRC are needed. Methods The Evaluating Radiation, Ablation, and Surgery (ERASur) A022101/NRG-GI009 trial is a randomized, National Cancer Institute-sponsored phase III study evaluating if the addition of metastatic-directed therapy to standard of care systemic therapy improves OS in patients with newly diagnosed limited mCRC. Eligible patients require a pathologic diagnosis of CRC, have BRAF wild-type and microsatellite stable disease, and have 4 or fewer sites of metastatic disease identified on baseline imaging. Liver-only metastatic disease is not permitted. All metastatic lesions must be amenable to total ablative therapy (TAT), which includes surgical resection, microwave ablation, and/or stereotactic ablative body radiotherapy (SABR) with SABR required for at least one lesion. Patients without overt disease progression after 16-26 weeks of first-line systemic therapy will be randomized 1:1 to continuation of systemic therapy with or without TAT. The trial activated through the Cancer Trials Support Unit on January 10, 2023. The primary endpoint is OS. Secondary endpoints include event-free survival, adverse events profile, and time to local recurrence with exploratory biomarker analyses. This study requires a total of 346 evaluable patients to provide 80% power with a one-sided alpha of 0.05 to detect an improvement in OS from a median of 26 months in the control arm to 37 months in the experimental arm with a hazard ratio of 0.7. The trial uses a group sequential design with two interim analyses for futility. Discussion The ERASur trial employs a pragmatic interventional design to test the efficacy and safety of adding multimodality TAT to standard of care systemic therapy in patients with limited mCRC.
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Affiliation(s)
| | | | - Qian Shi
- Alliance for Clinical Trials in Oncology
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Romesser PB, Miller ED, Shi Q, Dixon JG, Gholami S, White S, Wu C, Goulet CC, Jee KW, Wright CL, Yaeger R, Shergill A, Hong TS, George TJ, O'Reilly E, Meyerhardt J, Hitchcock KE. Alliance A022101: A Pragmatic Randomized Phase III Trial Evaluating Total Ablative Therapy for Patients with Limited Metastatic Colorectal Cancer - Evaluating Radiation, Ablation and Surgery (ERASur). Int J Radiat Oncol Biol Phys 2023; 117:e335. [PMID: 37785178 DOI: 10.1016/j.ijrobp.2023.06.2391] [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) For patients with oligometastatic colorectal cancer (CRC), aggressive local therapy of isolated metastases, particularly in the liver, has been associated with long-term progression-free survival and overall survival (OS) primarily based on retrospective evidence. However, in patients with limited metastatic CRC that is deemed inoperable or those with additional disease outside of the liver or lungs, the role of local ablative therapies, including microwave ablation (MWA) and stereotactic body radiation therapy (SBRT), to render patients disease free is less clear. Further, despite the long history of treating oligometastatic CRC with local therapy, which is provider biased and not evidence based, questions remain regarding the benefit of extending the paradigm of metastatic directed therapy to patients with more extensive disease. This trial seeks to use a pragmatic multimodality approach that mirrors the current clinical dilemma. This study is designed to evaluate the safety and efficacy of adding total ablative therapy (TAT) of all sites of disease to standard of care systemic treatment in those with limited metastatic CRC. MATERIALS/METHODS A022101 is a National Clinical Trials Network randomized phase III study planned to enroll 364 patients with newly diagnosed metastatic CRC (BRAF wild-type, microsatellite stable) with 4 or fewer sites of metastatic disease on baseline imaging. Liver-only metastatic disease is not permitted, and lesions must be amenable to any combination of surgical resection, MWA, and/or SBRT with SBRT required for at least one lesion. Patients receive first-line systemic therapy for 4-6 months and are then randomized 1:1, stratified by number of metastatic organ sites (1-2 vs. 3-4), timing of metastatic disease diagnosis (de novo vs. secondary), and presence of metastatic disease outside the liver and lungs in at least one site. Patients in Arm 1 will receive TAT which consists of treatment of all metastatic sites with SBRT ± MWA ± surgical resection followed by standard of care systemic therapy. Patients in Arm 2 will continue with standard of care systemic therapy alone. The primary endpoint is OS. Secondary endpoints include event-free survival, treatment-related toxicities, and local recurrence with exploratory biomarker analyses. The study needs 346 evaluable patients combined in the 2 arms to demonstrate an improvement in OS with a hazard ratio of 0.7 to provide 80% power with a one-sided alpha of 5%. The trial utilizes a group sequential design with two interim analyses (25% and 50% of events) for futility. RESULTS The trial activated in January 2023. CONCLUSION Recruitment is ongoing.
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Affiliation(s)
- P B Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - E D Miller
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Q Shi
- Mayo Clinic, Rochester, MN
| | | | - S Gholami
- University of California, Davis, Davis, CA
| | - S White
- Medical College of Wisconsin, Milwaukee, WI
| | - C Wu
- Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - K W Jee
- Massachusetts General Hospital, Boston, MA
| | | | - R Yaeger
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Shergill
- The University of Chicago, Chicago, IL, United States
| | - T S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - T J George
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | - E O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - K E Hitchcock
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
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Ou FS, Ahn DH, Dixon JG, Grothey A, Lou Y, Kasi PM, Hubbard JM, Van Cutsem E, Saltz LB, Schmoll HJ, Goldberg RM, Venook AP, Hoff P, Douillard JY, Hecht JR, Hurwitz H, Punt CJA, Koopman M, Bokemeyer C, Fuchs CS, Diaz-Rubio E, Tebbutt NC, Cremolini C, Kabbinavar FF, Bekaii-Saab T, Chibaudel B, Yoshino T, Zalcberg J, Adams RA, de Gramont A, Shi Q. Evaluation of Intratumoral Response Heterogeneity in Metastatic Colorectal Cancer and Its Impact on Patient Overall Survival: Findings from 10,551 Patients in the ARCAD Database. Cancers (Basel) 2023; 15:4117. [PMID: 37627145 PMCID: PMC10452983 DOI: 10.3390/cancers15164117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Metastatic colorectal cancer (mCRC) is a heterogeneous disease that can evoke discordant responses to therapy among different lesions in individual patients. The Response Evaluation Criteria in Solid Tumors (RECIST) criteria do not take into consideration response heterogeneity. We explored and developed lesion-based measurement response criteria to evaluate their prognostic effect on overall survival (OS). PATIENTS AND METHODS Patients enrolled in 17 first-line clinical trials, who had mCRC with ≥ 2 lesions at baseline, and a restaging scan by 12 weeks were included. For each patient, lesions were categorized as a progressing lesion (PL: > 20% increase in the longest diameter (LD)), responding lesion (RL: > 30% decrease in LD), or stable lesion (SL: neither PL nor RL) based on the 12-week scan. Lesion-based response criteria were defined for each patient as follows: PL only, SL only, RL only, and varied responses (mixture of RL, SL, and PL). Lesion-based response criteria and OS were correlated using stratified multivariable Cox models. The concordance between OS and classifications was measured using the C statistic. RESULTS Among 10,551 patients with mCRC from 17 first-line studies, varied responses were noted in 51.6% of patients, among whom, 3.3% had RL/PL at 12 weeks. Among patients with RL/SL, 52% had stable disease (SD) by RECIST 1.1, and they had a longer OS (median OS (mOS) = 19.9 months) than those with SL only (mOS = 16.8 months, HR (95% CI) = 0.81 (0.76, 0.85), p < 0.001), although a shorter OS than those with RL only (mOS = 25.8 months, HR (95% CI) = 1.42 (1.32, 1.53), p < 0.001). Among patients with SL/PL, 74% had SD by RECIST 1.1, and they had a longer OS (mOS = 9.0 months) than those with PL only (mOS = 8.0 months, HR (95% CI) = 0.75 (0.57, 0.98), p = 0.040), yet a shorter OS than those with SL only (mOS = 16.8 months, HR (95% CI) = 1.98 (1.80, 2.18), p < 0.001). These associations were consistent across treatment regimen subgroups. The lesion-based response criteria showed slightly higher concordance than RECIST 1.1, although it was not statistically significant. CONCLUSION Varied responses at first restaging are common among patients receiving first-line therapy for mCRC. Our lesion-based measurement criteria allowed for better mortality discrimination, which could potentially be informative for treatment decision-making and influence patient outcomes.
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Affiliation(s)
- Fang-Shu Ou
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel H Ahn
- Division of Medical Oncology, Mayo Clinic, Phoenix, AZ 85259, USA
| | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Axel Grothey
- West Cancer Center, University of Tennessee, Memphis, TN 38104, USA
| | - Yiyue Lou
- Vertex Pharmaceuticals, Boston, MA 02210, USA
| | - Pashtoon M Kasi
- Division of Hematology and Oncology, University of Iowa, Iowa City, IA 52242, USA
| | | | - Eric Van Cutsem
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, 3000 Leuven, Belgium
| | - Leonard B Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hans-Joachim Schmoll
- Department of Internal Medicine, Clinic for Internal Medicine IV, Martin-Luther-University Halle/Saale, 06120 Halle, Germany
| | - Richard M Goldberg
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Alan P Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA 94143, USA
| | - Paulo Hoff
- Department of Clinical Oncology, University of Sao Paulo, Sao Paulo 05508-010, Brazil
| | - Jean-Yves Douillard
- Department of Medical Oncology, University of Nantes Medical School, 44035 Nantes, France
| | | | - Herbert Hurwitz
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
| | - Cornelis J A Punt
- Julius Center, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | - Eduardo Diaz-Rubio
- Department of Oncology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Niall C Tebbutt
- Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Richard A Adams
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
- Velindre Cancer Center, Velindre NHS Trust, Cardiff CF14 2TL, UK
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
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5
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Dixon JG, Çağlayan Ç, Chihara D, Nielsen T, Dimier N, Zheng J, Wall AK, Salles G, Morschhauser F, Marcus R, Herold M, Kimby E, Blum KA, Ghielmini M, Shi Q, Flowers CR. Factors Affecting the Clinical Course of Follicular Lymphoma: A Multistate Survival Analysis Using Individual Patient Data from Eight Multicenter Randomized Clinical Trials. Clin Lymphoma Myeloma Leuk 2022; 22:e1009-e1018. [PMID: 36045021 DOI: 10.1016/j.clml.2022.07.015] [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] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION/BACKGROUND Leveraging the Follicular Lymphoma Analysis of Surrogacy Hypothesis database of individual patient data from first-line clinical trials, we studied the clinical course of follicular lymphoma (FL) and investigated clinical factors associated with FL outcomes. PATIENTS AND METHODS We examined 2428 patients from 8 randomized trials using multistate survival models with 4 states: induction treatment, progression, death from FL, and death from other causes. We utilized Aalen-Johansen estimator and Cox models to assess the likelihood of FL outcomes and quantify predictors' effects. RESULTS Two-year progression, FL-related death, and death from other causes estimates were 26.5%, 3.4% and 1.4%, respectively. FL-associated deaths were the primary cause of mortality within 10 years of follow-up. Male sex (hazard ratio: 1.25; 95% confidence interval: 1.05-1.47), > 4 involved nodal areas (1.51; 1.23-1.86), elevated LDH (1.20; 1.01-1.43), low hemoglobin (1.44; 1.15-1.81), and elevated β-2 levels (1.23; 1.02-1.47) increased risk of progression. CD20-targeting agents reduced risks for progression (0.29; 0.22-0.39), death from FL (0.05; 0.01-0.20), and death from other causes without progression (0.13; 0.05-0.33) and following progression (0.52; 0.30-0.92). Estimated 2-year progression rates were 22.3% and 43.5% with or without CD20-targeting agents, respectively. Two-year FL-associated mortality rate was 8.3% among patients without CD20-targeting agents, 5.4% with B-symptoms, 4.9% with elevated LDH, and 9.1% with low hemoglobin. CONCLUSION This study identified independent contributions of baseline clinical factors to distinct outcomes for patients with FL following first-line therapy on a clinical trial. Similar analytical approaches are needed to increase understanding of factors that influence FL outcomes in other settings.
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Affiliation(s)
- Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
| | - Çağlar Çağlayan
- Asymmetric Operations Sector, Johns Hopkins University Applied Physics Laboratory, Laurel, MD
| | - Dai Chihara
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Tina Nielsen
- Department of Biostatistics, Roche Products Ltd, Welwyn Garden City, Hertfordshire, United Kingdom
| | - Natalie Dimier
- Department of Biostatistics, Roche Products Ltd, Welwyn Garden City, Hertfordshire, United Kingdom
| | | | - Anna K Wall
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Gilles Salles
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Franck Morschhauser
- Department of Hematology, University of Lille, Lille, Hauts-de-France, France
| | - Robert Marcus
- Department of Haematology, Addenbrookes Hospital, Cambridge, Cambridgeshire, United Kingdom
| | - Michael Herold
- Helios Klinikum Erfurt, Onkologisches Zentrum, Erfurt, Thuringia, Germany
| | - Eva Kimby
- Unit for Hematology Karolinska University Hospital, Stockholm, Sweden
| | - Kristie A Blum
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - Michele Ghielmini
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Ticino, Switzerland
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Christopher R Flowers
- Department of Lymphoma/Myeloma, MD Anderson Cancer Center, University of Texas, Houston, TX
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Sarkaria JN, Ballman KV, Kizilbash SH, Sulman EP, Giannini C, Mashru SH, Piccioni DE, Friday BEB, Dixon JG, Kabat B, Laack NN, Hu L, Kumthekar P, Ellingson BM, Anderson SK, Galanis E. Randomized phase II/III trial of veliparib or placebo in combination with adjuvant temozolomide in newly diagnosed glioblastoma (GBM) patients with MGMT promoter hypermethylation (Alliance A071102). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2001 Background: PolyADP-ribose polymerase (PARP) is an important modulator of DNA repair following temozolomide (TMZ) therapy. Pre-clinical testing demonstrated significant survival benefit for the combination of TMZ and PARP inhibitor veliparib in a subset of GBM pt-derived xenografts with MGMT promoter hypermethylation. Methods: After central pathology review and MGMT testing, patients (pts) with newly diagnosed, MGMT promoter hypermethylated GBM who had completed concurrent radiation and TMZ were randomized to adjuvant therapy with TMZ (Days 1-5 q28 days) combined with either placebo or veliparib (Days 1-7 q28 days). Veliparib/placebo+TMZ treatment was continued for up to 6 cycles. Pts accrued on the phase II and III portions of the trial were included in the primary endpoint analysis of overall survival (OS), with 90% power to detect a hazard ratio of 0.71 using a one-sided log-rank test with type I error rate of 0.05. The planned phase III sample size was 400 pts with data maturity after 302 deaths. Results: The phase II and III portions of the trial were open to accrual from 12/15/2014 to 2/6/2017 and 11/8/2017 to 10/15/2018, respectively; 447 pts were accrued to the trial and used in this intention to treat analysis. The two treatment groups were well balanced for prognostic factors, 421 pts initiated treatment, median follow-up was 57.8 months (mos), 380 pts had disease progression and 335 pts have died. There was no difference in OS (p = 0.15; HR 0.89 (0.71-1.11), median OS 28.1 vs. 24.8 mo. for TMZ+veliparib vs. TMZ+placebo, respectively) and no difference in secondary endpoint progression free survival (PFS, p = 0.31; HR 1.05 (0.86-1.30), median 13.2 vs. 12.1 mo, respectively). There was a notable trend for extended OS with TMZ+veliparib treatment at intermediate time-points between 24 and 42 mos (3-year OS 36.6% vs. 28.9% with TMZ+placebo, p = 0.09). In an unplanned exploratory analysis, treatment with TMZ at the time of first recurrence was associated with extended post-recurrence OS (p = 0.03) for pts treated on the experimental arm; median post-recurrence OS with TMZ salvage was 17.0 mo in the TMZ+veliparib arm and 12.6 mo in the TMZ+placebo arm, as compared to 9.6 mo in either arm if TMZ salvage was not used. These data are consistent with a possible effect of veliparib limiting the emergence of TMZ resistance in a subset of GBM pts. Conclusions: Veliparib combined with adjuvant TMZ therapy was not associated with significant extension in OS or PFS in newly diagnosed, MGMT hypermethylated GBM pts. However, a subset of pts treated with TMZ+veliparib may have an extended survival following re-treatment with TMZ at first recurrence. Clinical trial information: NCT02152982.
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Affiliation(s)
| | - Karla V. Ballman
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
| | | | - Erik P. Sulman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - David Eric Piccioni
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, UCSD Moores Cancer Center, San Diego, CA
| | | | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Priya Kumthekar
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | - Benjamin M. Ellingson
- Department of Radiology, Radiology, Brain Research Institute, University of California, Los Angeles, Los Angeles, CA
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7
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Jin Z, Dixon JG, Hubbard JM, Eng C, Lieu CH, Douillard JY, Adams R, Maughan TS, Van Cutsem E, Venook AP, Lenz HJ, Heinemann V, Stintzing S, Kaplan RS, Bokemeyer C, Chibaudel B, Zalcberg JR, Yoshino T, De Gramont A, Shi Q. Response to epithelial growth factor receptor inhibitor (EGFRi) treatment in patients with early-onset, treatment-naïve metastatic colorectal cancer (mCRC): An ARCAD database analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3572 Background: Early onset colorectal cancer (eoCRC: disease diagnosed < 50) has been increasing over the past 2 decades. Currently, standard treatment recommendations for eoCRC patients (pts) with metastatic disease does not differ from late-onset CRC (loCRC) pts although outcomes data in eoCRC pts is limited. Methods: Individual patient data on 5,761 treatment-naive metastatic eoCRC pts was pooled from 8 phase II and III randomized EGFRi studies (2000 - 2012) from the ARCAD mCRC database. The distribution of demographics, clinicopathological features, and biomarkers were summarized by age groups. Progression-free survival (PFS) was compared between age groups by stratified Cox models, adjusting for potential confounders. Predictive value of age group was evaluated by testing interaction effect between treatment and age variables based on a subset of trials with concurrent randomizations between regimens with and without EGFRi Results: eoCRC (n=756) were more evenly distributed between gender, had improved performance status (PS), increased likelihood of metastatic resection, and distant lymph node metastasis, but were less likely to have lung metastasis or KRAS mutation compared to loCRC (n=5,005, table 1). eoCRC and loCRC patients had similar distribution of primary tumor sidedness, primary resection, liver and/or peritoneal involvement, number of metastatic sites involved, and BRAF mutations (MT). No difference in PFS for eoCRC versus loCRC pts was noted (7.8 vs. 7.9 months [M], adjusted hazard ratio [HRadj], 1.02, 95% confidence interval [CI], 0.93-1.11). Among pts with KRAS wild type (WT) and left sided primary tumors, univariable analysis of EGFRi demonstrated improved mPFS in loCRC (9.9 vs 8.5M, HR = 0.74, p<0.001), but this benefit was not seen in eoCRC (8.3 vs 8.9 months, HR 1.20, p=0.36). The same pattern was observed upon multivariable analysis (Table). Conclusions: In our pooled analysis, EGFRi + chemotherapy significantly improved PFS in treatment-naïve loCRC patients but not in left sided, KRAS WT, eoCRC patients. Further validation in an independent cohort is warranted. [Table: see text]
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Affiliation(s)
| | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | - Jean-Yves Douillard
- University of Nantes, and Integrated Centers of Oncology ICO René Gauducheau Cancer, Nantes, France
| | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
| | - Timothy S. Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | | | | | - Heinz-Josef Lenz
- Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Volker Heinemann
- University Hospital, LMU Munich, Department of Medicine III, and Comprehensive Cancer Center Munich, Munich, Germany
| | - Sebastian Stintzing
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Hematology, Oncology, and Cancer Immunology (CCM), Berlin, Germany
| | - Richard S. Kaplan
- Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - John Raymond Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Hospital, Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
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Dixon JG, Dimier N, Nielsen T, Zheng J, Marcus R, Morschhauser F, Evens AM, Federico M, Blum KA, Shi Q. End of induction positron emission tomography complete response (PET-CR) as a surrogate for progression-free survival in previously untreated follicular lymphoma. Br J Haematol 2022; 198:333-337. [PMID: 35491747 DOI: 10.1111/bjh.18217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
Progression-free survival (PFS) has been the regulatory primary end-point for recent phase III trials in first-line follicular lymphoma (FL), but requires prolonged follow-up. Complete response (CR) at 30 months after initiation of induction treatment was validated as surrogate end-point for PFS. Our objective was to further evaluate surrogacy of CR measured by [18 F] fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging at the end of induction (EoI). Individual patient data were analysed from 1505 patients from five randomized trials. Trial-level surrogacy examining the association between treatment effects on EoI-PET-CR and PFS was evaluated using linear regression ( R WLS 2 $$ {R}_{\mathrm{WLS}}^2 $$ ) and bivariate Copula ( R Copula 2 $$ {R}_{\mathrm{Copula}}^2 $$ ) models. Although EoI-PET-CR strongly predicted PFS at a prognostic level, the trial-level assessment did not show strong correlation ( R WLS 2 = 0.56 $$ {R}_{\mathrm{WLS}}^2=0.56 $$ , confidence interval [CI]: 0.20-0.88; R Copula 2 = 0.35 $$ {R}_{\mathrm{Copula}}^2=0.35 $$ , CI: 0.0-0.82). The high uncertainty in estimation was possibly due to the small number of trials and the population of patients with available PET data. Maintenance therapy affecting PFS beyond induction treatment, but not EoI-PET-CR end-point, may have distorted the association between treatment effects. However, there will probably be a number of additional trials approaching completion with available PET response data. Refined evaluation of PET-CR based surrogate end-points is still warranted.
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Affiliation(s)
- Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Natalie Dimier
- Biostatistics, Roche Products Ltd, Welwyn Garden City, UK
| | - Tina Nielsen
- Biostatistics, Roche Products Ltd, Welwyn Garden City, UK
| | - Jamie Zheng
- Worldwide Medical Affairs Hematology/Lymphoma/CLL, Bristol-Myers Squibb, Plainsboro, New Jersey, USA
| | - Robert Marcus
- Department of Haematology, King's College Hospital, London, UK
| | - Franck Morschhauser
- Groupe de Recherche sur les formes Injectables et les Technologies Associees, University of Lille, CHU Lille, Lille, France
| | - Andrew M Evens
- Department of Biomedical and Health Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Massimo Federico
- Dipartimento di Oncologia ed Ematologia, Centro Oncologico Modenese, Universita di Modena e Reggio Emilia, Modena, Italy
| | - Kristie A Blum
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia, USA
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
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9
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Jin Z, Dixon JG, Hubbard JM, Eng C, Lieu CH, Fiskum J, Saltz LB, Hurwitz HI, Venook AP, Schmoll HJ, Fuchs CS, Hecht JRR, Cremolini C, Diaz-Rubio E, Punt CJA, Tebbutt NC, Heinemann V, Yoshino T, De Gramont A, Shi Q. Efficacy of bevacizumab-based treatment in early-onset treatment-naïve metastatic colorectal cancer patients: An ARCAD database analysis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
101 Background: Colorectal cancer (CRC) incidence and mortality have decreased since the 1970s, but the incidence in young adults (20-49 years, named early-onset CRC, eoCRC) has been increasing. eoCRC patients with metastatic disease are treated with the same standard regimens as late-onset CRC (loCRC, age ≥ 50 years) although detailed response data for eoCRC are largely missing. Methods: Individual patient data on 7,604 subjects with metastatic eoCRC from 11 first line randomized bevacizumab studies between 2000 and 2012 in the ARCAD advanced colorectal cancer database were pooled. The distributions of demographics, clinicopathological features, biomarkers, and outcome data were summarized by age groups. Progression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier curves and Cox models stratified by treatment arms within studies, adjusting for potential confounders. Predictive value of age group was evaluated by testing interaction effect between treatment and age variables. Results: Female eoCRC are more commonly seen compared to loCRC (46.8% vs. 38.7%, p<0.0001). Patients with eoCRC (n=1,289) were significantly more likely to have had prior metastasectomy (17.5% vs. 13.5%, p=0.043) and lung metastatic disease (67% vs. 59.8%, p<0.001), but less likely to have distant lymph node metastatic disease (58.8 vs. 62.9%, p=0.036) or KRAS mutation (29.2% vs. 34.4%, p=0.042) compared to those with loCRC (n=6,315). eoCRC and loCRC patients had similar distributions according to PS, primary tumor sidedness, prior primary tumor resection, liver involvement, peritoneal involvement, number of metastatic sites, NRAS and BRAF. Age of disease onset was not a statistically significant prognostic factor for PFS in univariate and multivariate analysis (seen in table). Bevacizumab in addition to chemo improved PFS in eoCRC population (9.9 vs. 6.8 months, HR = 0.66, p<0.001), which was similar to the findings in loCRC population (9.4 vs. 7.3 months, HR= 0.73, p<0.001, interaction p=0.54). By multivariate analysis, a greater improvement in PFS was noted for the addition of bevacizumab in eoCRC relative to LoCRC patients (HR = 0.62 vs. HR = 0.82). Conclusions: Treatment naive eoCRC patients with metastatic disease derive similar benefit from bevacizumab relative to their average age counterparts.[Table: see text]
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Affiliation(s)
| | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | - Cathy Eng
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | | | - Jack Fiskum
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alan P. Venook
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Chiara Cremolini
- Azienda Ospedaliero Universitaria Pisana-Ospedale Santa Chiara, Pisa, Italy
| | | | - Cornelis J. A. Punt
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Niall C. Tebbutt
- Olivia Newton-John Cancer, Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
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10
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Jin Z, Dixon JG, Fiskum JM, Parekh HD, Sinicrope FA, Yothers G, Allegra CJ, Wolmark N, Haller D, Schmoll HJ, de Gramont A, Kerr R, Taieb J, Van Cutsem E, Tweleves C, O’Connell M, Saltz LB, Sadahiro S, Blanke CD, Tomita N, Seitz JF, Erlichman C, Yoshino T, Yamanaka T, Marsoni S, Andre T, Mahipal A, Goldberg RM, George TJ, Shi Q. Clinicopathological and Molecular Characteristics of Early-Onset Stage III Colon Adenocarcinoma: An Analysis of the ACCENT Database. J Natl Cancer Inst 2021; 113:1693-1704. [PMID: 34405233 PMCID: PMC8634466 DOI: 10.1093/jnci/djab123] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/23/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Colon cancer (CC) incidence in young adults (age 20-49 years), termed early-onset CC (EO-CC), is increasing. METHODS Individual patient data on 35 713 subjects with stage III colon cancer from 25 randomized studies in the Adjuvant Colon Cancer ENdpoint database were pooled. The distributions of demographics, clinicopathological features, biomarker status, and outcome data were summarized by age group. Overall survival, disease-free survival, time to recurrence, and survival after recurrence were assessed by Kaplan-Meier curves and Cox models stratified by treatment arms within studies, adjusting for sex, race, body mass index, performance status, disease stage, grade, risk group, number of lymph nodes examined, disease sidedness, and molecular markers. All statistical tests were 2-sided. RESULTS Using a 5% difference between age groups as the clinically meaningful cutoff, patients with stage III EO-CC had similar sex, race, performance status, risk group, tumor sidedness, and T stage compared with patients with late-onset CC (age 50 years and older). EO-CC patients were less likely to be overweight (30.2% vs 36.2%) and more commonly had 12 or more lymph nodes resected (69.5% vs 58.7%). EO-CC tumors were more frequently mismatch repair deficient (16.4% vs 11.5%) and less likely to have BRAFV600E (5.6% vs 14.0%), suggesting a higher rate of Lynch syndrome in EO-CC. Patients with EO-CC had statistically significantly better overall survival (hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.74 to 0.89; P < .001), disease-free survival (HR = 0.91, 95% CI = 0.84 to 0.98; P = .01), and survival after recurrence (HR = 0.88, 95% CI = 0.80 to 0.97; P = .008) in the analysis without molecular markers; however, age at onset of CC lost its prognostic value when outcome was adjusted for molecular markers. CONCLUSION Tumor biology was found to be a more important prognostic factor than age of onset among stage III colon cancer patients in the Adjuvant Colon Cancer ENdpoint database.
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Affiliation(s)
- Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jack M Fiskum
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Hiral D Parekh
- Cancer Specialists of North Florida, Jacksonville, FL, USA
| | | | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carmen J Allegra
- Department of Medicine, Shands Cancer Center, University of Florida, Gainesville, FL, USA
| | | | - Daniel Haller
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hans-Joachim Schmoll
- Department of Internal Medicine IV-Hematology-Oncology, University Clinic Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Julien Taieb
- Sorbonne Paris Cité, Paris Descartes University Georges Pompidou European Hospital, Paris, France
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - Christopher Tweleves
- University of Leeds and St. James’s Institute of Oncology, Tom Connors Cancer Research Center, University of Bradford, Bradford, UK
| | | | | | | | | | - Naohiro Tomita
- Cancer Treatment Center, Toyonaka Municipal Hospital, Toyonaka, Japan
| | | | | | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Kanagawa, Japan
| | | | - Thierry Andre
- Medical Oncology Department in St. Antoine Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Amit Mahipal
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Richard M Goldberg
- West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Thomas J George
- University of Florida, Health Cancer Center, Gainesville, FL, USA
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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11
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Yin J, Salem ME, Dixon JG, Jin Z, Cohen R, DeGramont A, Van Cutsem E, Taieb J, Alberts SR, Wolmark N, Schmoll HJ, Saltz LB, George TJ, Goldberg RRM, Kerr R, Lonardi S, Yoshino T, Yothers G, Grothey A, Andre T, Shi Q. Reevaluating Disease-Free Survival as an Endpoint vs Overall Survival in Stage III Adjuvant Colon Cancer Trials. J Natl Cancer Inst 2021; 114:60-67. [PMID: 34505880 PMCID: PMC8755492 DOI: 10.1093/jnci/djab187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/17/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Disease-free survival (DFS) with a 3-year median follow-up (3-year DFS) was validated as a surrogate for overall survival (OS) with a 5-year median follow-up (5-year OS) in adjuvant chemotherapy colon cancer (CC) trials. Recent data show further improvements in OS and survival after recurrence in patients who received adjuvant FOLFOX. Hence, reevaluation of the association between DFS and OS and determination of the optimal follow-up duration of OS to aid its utility in future adjuvant trials are needed. METHODS Individual patient data from 9 randomized studies conducted between 1998 and 2009 were included; 3 trials tested biologics. Trial-level surrogacy examining the correlation of treatment effect estimates of 3-year DFS with 5 to 6.5-year OS was evaluated using both linear regression (RWLS2) and Copula bivariate (RCopula2) models and reported with 95% confidence intervals (CIs). For R2, a value closer to 1 indicates a stronger correlation. RESULTS Data from a total of 18 396 patients were analyzed (median age = 59 years; 54.0% male), with 54.1% having low-risk tumors (T1-3 and N1), 31.6% KRAS mutated, 12.3% BRAF mutated, and 12.4% microsatellite instability high or deficient mismatch repair tumors. Trial-level correlation between 3-year DFS and 5-year OS remained strong (RWLS2 = 0.82, 95% CI = 0.67 to 0.98; RCopula2 = 0.92, 95% CI = 0.83 to 1.00) and increased as the median follow-up of OS extended. Analyses limited to trials that tested biologics showed consistent results. CONCLUSIONS Three-year DFS remains a validated surrogate endpoint for 5-year OS in adjuvant CC trials. The correlation was likely strengthened with 6 years of follow-up for OS.
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Affiliation(s)
- Jun Yin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Zhaohui Jin
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Romain Cohen
- Department of Medical Oncology, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Aimery DeGramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and University of Leuven, Leuven, Belgium
| | - Julien Taieb
- Sorbonne Paris Cité, Paris Descartes University Georges Pompidou European Hospital, Paris, France
| | | | - Norman Wolmark
- Department of Clinical Trials, Alleghany Health Network, Pittsburgh, PA, USA
| | | | | | - Thomas J George
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Richard R M Goldberg
- West Virginia University Cancer Institute, the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Rachel Kerr
- Adjuvant Colorectal Cancer Group, University of Oxford, Oxford, UK
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology IRCCS, Padova PD, Italy
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center, Tokyo, Japan
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Thierry Andre
- Department of Medical Oncology, Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA,Correspondence to: Qian Shi, PhD, Department of Quantitative Health Sciences, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA (e-mail: )
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12
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Jin Z, Dixon JG, Parekh H, Sinicrope FA, Yothers G, Haller DG, Schmoll H, De Gramont A, Kerr R, Taieb J, Van Cutsem E, Twelves C, Saltz LB, Tomita N, Yoshino T, Andre T, Mahipal A, Goldberg RM, George TJ, Shi Q. Clinicopathological and molecular characteristics of early-onset stage III colon adenocarcinoma: An analysis of 25 studies with 35,713 patients in the Adjuvant Colon Cancer End Points (ACCENT) database. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3597 Background: Colon cancer (CC) incidence and mortality have decreased since the 1970s, but the incidence in young adults (20-49 years) is increasing. There are limited data suggesting that, as a group, patients with early onset CRC (eoCC) may have different phenotypic characteristics compared to those with late onset CRC (loCC, age ≥ 50 years). Methods: Individual patient data on 35,713 subjects with stage III CC from 25 randomized studies (recruiting between 1987 and 2009) in the ACCENT database were pooled. The distributions of demographics, clinicopathological features, biomarkers, and outcome data were summarized by age group. Overall survival (OS), disease-free survival (DFS), recurrence free rate (RFR), and survival after recurrence (SAR) were assessed by Kaplan-Meier curves and Cox models stratified by treatment arms within studies, adjusting for gender, race, body mass index, performance status, disease stage, grade, risk group, number of lymph nodes examined, disease sidedness and molecular markers. Results: Using a 5% difference between age groups as the clinically meaningful cutoff, patients with stage III eoCC (n = 6246) had similar distributions according to gender, race, PS, risk group, tumor sidedness and T/N stage compared to those with loCC (n = 29467). Patients with eoCC were significantly less likely to be overweight (30.2% vs 36.2%) but more commonly had ≥ 12 lymph nodes resected (69.5% vs 58.7%). The eoCC tumors were more frequently mismatch repair deficient (16.4% vs 11.5%), and less likely to have BRAFV600E (5.6% vs 14.0%), suggesting a higher frequency of Lynch syndrome in eoCC. In univariate analysis, patients with stage III eoCC had significantly better OS, DFS, and SAR; the difference between 3-year DFS and RFR strongly suggests the OS/DFS difference between these the eoCC and loCC may be due to increased competing risks and comorbidities in patients with loCC. In multivariate analysis, age at onset lost its prognostic value when outcome was adjusted for molecular markers. The clear relation between age of onset and KRAS/BRAF status was confirmed in the interaction analysis. Conclusions: Tumor biology was an important determinant of prognosis regardless of patient age. In multivariate analysis age of onset was not a statistically significant determinant of outcome.[Table: see text]
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Affiliation(s)
- Zhaohui Jin
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Hiral Parekh
- Cancer Specialist of North Florida, Jacksonville, FL
| | | | - Greg Yothers
- University of Pittsburgh Department of Biostatistics, and NRG Oncology Statistics and Data Management Center, Pittsburgh, PA
| | - Daniel G. Haller
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | | | | | - Rachel Kerr
- University of Oxford, Oxford, United Kingdom
| | - Julien Taieb
- Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Chris Twelves
- St. James's Hospital and The University of Leeds, Leeds, United Kingdom
| | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Naohiro Tomita
- Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | | | - Thierry Andre
- Sorbonne Université and Hôpital-Saint Antoine, Paris, France
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13
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Jaeckle KA, Ballman KV, van den Bent M, Giannini C, Galanis E, Brown PD, Jenkins RB, Cairncross JG, Wick W, Weller M, Aldape KD, Dixon JG, Anderson SK, Cerhan JH, Wefel JS, Klein M, Grossman SA, Schiff D, Raizer JJ, Dhermain F, Nordstrom DG, Flynn PJ, Vogelbaum MA. CODEL: phase III study of RT, RT + TMZ, or TMZ for newly diagnosed 1p/19q codeleted oligodendroglioma. Analysis from the initial study design. Neuro Oncol 2021; 23:457-467. [PMID: 32678879 DOI: 10.1093/neuonc/noaa168] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We report the analysis involving patients treated on the initial CODEL design. METHODS Adults (>18) with newly diagnosed 1p/19q World Health Organization (WHO) grade III oligodendroglioma were randomized to radiotherapy (RT; 5940 centigray ) alone (arm A); RT with concomitant and adjuvant temozolomide (TMZ) (arm B); or TMZ alone (arm C). Primary endpoint was overall survival (OS), arm A versus B. Secondary comparisons were performed for OS and progression-free survival (PFS), comparing pooled RT arms versus TMZ-alone arm. RESULTS Thirty-six patients were randomized equally. At median follow-up of 7.5 years, 83.3% (10/12) TMZ-alone patients progressed, versus 37.5% (9/24) on the RT arms. PFS was significantly shorter in TMZ-alone patients compared with RT patients (hazard ratio [HR] = 3.12; 95% CI: 1.26, 7.69; P = 0.014). Death from disease progression occurred in 3/12 (25%) of TMZ-alone patients and 4/24 (16.7%) on the RT arms. OS did not statistically differ between arms (comparison underpowered). After adjustment for isocitrate dehydrogenase (IDH) status (mutated/wildtype) in a Cox regression model utilizing IDH and RT treatment status as covariables (arm C vs pooled arms A + B), PFS remained shorter for patients not receiving RT (HR = 3.33; 95% CI: 1.31, 8.45; P = 0.011), but not OS ((HR = 2.78; 95% CI: 0.58, 13.22, P = 0.20). Grade 3+ adverse events occurred in 25%, 42%, and 33% of patients (arms A, B, and C). There were no differences between arms in neurocognitive decline comparing baseline to 3 months. CONCLUSIONS TMZ-alone patients experienced significantly shorter PFS than patients treated on the RT arms. The ongoing CODEL trial has been redesigned to compare RT + PCV versus RT + TMZ.
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Affiliation(s)
- Kurt A Jaeckle
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Karla V Ballman
- Alliance Statistics and Data Center, Weill Cornell Medicine, New York, New York, USA
| | - Martin van den Bent
- Brain Tumor Center, Erasmus MC Cancer Center, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Caterina Giannini
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Evanthia Galanis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert B Jenkins
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - J Gregory Cairncross
- Department of Clinical Neurosciences, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada
| | - Wolfgang Wick
- Neurologische Klinik, University of Heidelberg, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Kenneth D Aldape
- Department of Neuropathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jesse G Dixon
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota, USA
| | - S Keith Anderson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Jane H Cerhan
- Departments of Psychiatry and Psychology, Houston, Texas, USA
| | - Jeffrey S Wefel
- Departments of Neuro-Oncology and Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Martin Klein
- Department of Medical Psychology, VU University Medical Center, Amsterdam, Netherlands
| | - Stuart A Grossman
- Department of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - David Schiff
- Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Jeffrey J Raizer
- Department of Neurology, Northwestern University, Chicago, Illinois, USA
| | - Frederick Dhermain
- Department of Radiation Therapy, Gustave Roussy Cancer Institute, Villejuif, France
| | | | - Patrick J Flynn
- Medical Oncology, Minnesota Oncology, Northfield, Minnesota, USA
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14
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Jaeckle KA, Dixon JG, Anderson SK, Moreno-Aspitia A, Colon-Otero G, Hebenstreit K, Patel TA, Reddy SL, Perez EA. Intra-CSF topotecan in treatment of breast cancer patients with leptomeningeal metastases. Cancer Med 2020; 9:7935-7942. [PMID: 32885617 PMCID: PMC7643683 DOI: 10.1002/cam4.3422] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Background There are few treatment options for patients with leptomeningeal metastases (LM). Methods We report a case series of patients with breast cancer and LM treated with intra‐CSF topotecan (TOPO). Outcome was assessed by clinical exam and MRI at baseline, at end of induction (4‐5 weeks), then every 3 months; CSF cytology was determined at baseline and with each treatment. Results Thirty‐one women [median age, 58 (37‐81); median KPS 60 (40‐100)] received treatment. At baseline, 68% had positive CSF cytology, and 90%, leptomeningeal enhancement on MRI. 84% of patients also received focal RT (not during TOPO) and 77% received concomitant systemic hormonal or chemotherapy. Median number of TOPO treatments was 14.5 (range, 3‐71); median duration of treatment, 11 weeks (1‐176); and median OS, 6.9 months (range, 0.9‐48.8). Patients remaining progression‐free during 4‐6 weeks of induction (81%) had a median OS of 11.5 months (range, 1.8‐48.8). Overall neurologic PFS at 6, 12, and 24 months was 39%, 26%, and 6%, respectively. Clearing of CSF malignant cells for >3 consecutive samples occurred in 10/21 (48%) patients with positive CSF cytology at baseline, remaining clear for a median duration of 15.9 months (range, 1.4‐34.5). Grade 3 adverse events included headache or vomiting (3pts), T2 hyperintensity surrounding the ventricular catheter (2 pts), and meningitis (2 pts). Conclusions Intra‐CSF TOPO, with focal RT as needed for symptomatic areas of enhancement produced durable clearing of CSF malignant cells in 48% of patients positive at baseline, with promising median PFS and OS.
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Affiliation(s)
| | | | | | | | | | | | - Tejal A Patel
- Houston Methodist Hospital Cancer Center, Houston, TX, USA
| | - Samarth L Reddy
- Hematology Oncology Associates of Boca Raton, Boca Raton, FL, USA
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15
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Wagner AD, Grothey A, Andre T, Dixon JG, Wolmark N, Haller DG, Allegra CJ, de Gramont A, VanCutsem E, Alberts SR, George TJ, O'Connell MJ, Twelves C, Taieb J, Saltz LB, Blanke CD, Francini E, Kerr R, Yothers G, Seitz JF, Marsoni S, Goldberg RM, Shi Q. Sex and Adverse Events of Adjuvant Chemotherapy in Colon Cancer: An Analysis of 34 640 Patients in the ACCENT Database. J Natl Cancer Inst 2020; 113:400-407. [PMID: 32835356 DOI: 10.1093/jnci/djaa124] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/22/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adjuvant chemotherapy is a standard treatment option for patients with stage III and high-risk stage II colon cancer. Sex is one of several factors responsible for the wide inter-patient variability in drug responses. Amalgamated data on the effect of sex on the toxicity of current standard adjuvant treatment for colorectal cancer are missing. METHODS The objective of our study was to compare incidence and severity of major toxicities of fluoropyrimidine- (5FU or capecitabine) based adjuvant chemotherapy, with or without oxaliplatin, between male and female patients after curative surgery for colon cancer. Adult patients enrolled in 27 relevant randomized trials included in the ACCENT (Adjuvant Colon Cancer End Points) database, a large, multi-group, international data repository containing individual patient data, were included. Comparisons were conducted using logistic regression models (stratified by study and treatment arm) within each type of adjuvant chemotherapy (5FU, FOLFOX, capecitabine, CAPOX, and FOLFIRI). The following major toxicities were compared (grade III or IV and grade I-IV, according to National Cancer Institute Common Terminology Criteria [NCI-CTC] criteria, regardless of attribution): nausea, vomiting, nausea or vomiting, stomatitis, diarrhea, leukopenia, neutropenia, thrombocytopenia, anemia, and neuropathy (in patients treated with oxaliplatin). RESULTS Data from 34 640 patients were analyzed. Statistically significant and clinically relevant differences in the occurrence of grade III or IV nonhematological {especially nausea (5FU: odds ratio [OR] = 2.33, 95% confidence interval [CI] = 1.90 to 2.87, P < .001; FOLFOX: OR = 2.34, 95% CI = 1.76 to 3.11, P < .001), vomiting (5FU: OR = 2.38, 95% CI = 1.86 to 3.04, P < .001; FOLFOX: OR = 2.00, 95% CI = 1.50 to 2.66, P < .001; CAPOX: OR = 2.32, 95% CI = 1.55 to 3.46, P < .001), and diarrhea (5FU: OR = 1.35, 95% CI = 1.21 to 1.51, P < .001; FOLFOX: OR = 1.60, 95% CI = 1.35 to 1.90, P < .001; FOLFIRI: OR = 1.57, 95% CI = 1.25 to 1.97, P < .001)} as well as hematological toxicities (neutropenia [5FU: OR = 1.55, 95% CI = 1.37 to 1.76, P < .001; FOLFOX: OR = 1.96, 95% CI = 1.71 to 2.25, P < .001; FOLFIRI: OR = 2.01, 95% CI = 1.66 to 2.43, P < .001; capecitabine: OR = 4.07, 95% CI = 1.84 to 8.99, P < .001] and leukopenia [5FU: OR = 1.74, 95% CI = 1.40 to 2.17, P < .001; FOLFIRI: OR = 1.75, 95% CI = 1.28 to 2.40, P < .001]) were observed, with women being consistently at increased risk. CONCLUSIONS Our analysis confirms that women with colon cancer receiving adjuvant fluoropyrimidine-based chemotherapy are at increased risk of toxicity. Given the known sex differences in fluoropyrimidine pharmacokinetics, sex-specific dosing of fluoropyrimidines warrants further investigation.
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Affiliation(s)
- Anna D Wagner
- Division of Medical Oncology, Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Axel Grothey
- West Cancer Center and Research Institute, Germantown, TN, USA
| | - Thierry Andre
- Sorbonne University and Saint-Antoine Hospital, Paris, France
| | - Jesse G Dixon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Norman Wolmark
- NRG Oncology and the University of Pittsburgh , Pittsburgh, PA, USA
| | | | | | | | | | | | - Thomas J George
- Department of Medicine and University of Florida Health Cancer Center, Gainesville, FL, USA
| | | | | | - Julien Taieb
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP, Sorbonne Paris Cité, Université de Paris, Paris, France
| | | | | | | | - Rachel Kerr
- Adjuvant Colorectal Cancer Group, University of Oxford, Oxford, UK
| | - Greg Yothers
- NRG Oncology and the University of Pittsburgh, Pittsburgh, PA, USA
| | - Jean F Seitz
- Timone Hospital, Aix-Marseille-University, Marseille, France
| | - Silvia Marsoni
- Precision Oncology, The FIRC Institute Of Molecular Oncology, Milan, Italy
| | | | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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16
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Jin Z, Dixon JG, Parekh HD, Alberts SR, Yothers G, Allegra CJ, Kerr R, Haller DG, De Gramont A, Yoshino T, Van Cutsem E, Twelves C, Taieb J, Saltz LB, Seitz JF, Andre T, Mahipal A, Goldberg RM, Shi Q, George TJ. Clinicopathological and molecular biological characteristics of early-onset stage II/III colorectal adenocarcinoma: An analysis of 25 studies with 47,184 patients (pts) in the adjuvant colon cancer end points (ACCENT) database. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4099] [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: 11/20/2022] Open
Abstract
4099 Background: Colorectal cancer (CRC) incidence and mortality has decreased since the 1970s but the incidence is increasing in young adults (age 20-49). The incidence of early onset CRC (eoCRC) will keep increasing significantly based on the trends of the SEER CRC registry data. There is limited data suggesting eoCRC may have different behaviors compared to traditional CRC (tCRC, age ≥ 50). Methods: Individual pt data of 47184 stage II/III CRC pts from 25 randomized studies in the ACCENT database were pooled. The distributions of demographics, clinicopathological features, biomarker status, and treatment-related data were summarized by age group. Overall survival (OS), disease-free survival (DFS), recurrence-free rate (RFR), and survival after recurrence (SAR) were assessed by Kaplan-Meier curves and Cox models stratified by treatment arms within studies, adjusting for stage, performance status (PS), BMI and grade. Results: Using 5% difference between age groups as clinically meaningful cutoff, eoCRC had similar gender, race, ethnicity, PS, risk group, disease sidedness and T stage as tCRC. eoCRC were less likely overweight (30 vs 36%) and more pts had ≥ 12 lymph nodes resected (63 vs 51%). eoCRC had more frequent dMMR status (18 vs 12%), less BRAF mutations (5 vs 13%), and more dMMR/BRAF wild type (WT) status (17 vs 7%). Overall, eoCRC had better OS, DFS, and SAR, with the most significant differences between the < 30 and > = 70 age groups. Similar results were observed within pMMR pts. eoCRC experienced less hematological side effects, diarrhea, and stomatitis, but had more nausea and/or vomiting. Conclusions: eoCRC have unique characteristics; although statistically significant, the clinical differences in outcomes between eoCRC and tCRC are potentially due to the difference seen in extremely young and old pts. eoCRC have a different adverse events panel compared to tCRC. [Table: see text]
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Affiliation(s)
| | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | | | - Greg Yothers
- NRG Oncology, and The University of Pittsburgh, Pittsburgh, PA
| | | | - Rachel Kerr
- University of Oxford, Oxford, United Kingdom
| | - Daniel G. Haller
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | | | | | - Eric Van Cutsem
- University Hospitals Gasthuisberg Leuven, KU Leuven, Leuven, Belgium
| | - Chris Twelves
- St. James's Hospital and The University of Leeds, Leeds, United Kingdom
| | - Julien Taieb
- Georges Pompidou European Hospital, Paris, France
| | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Thierry Andre
- Sorbonne University and Saint-Antoine Hospital, Paris, France
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17
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Galanis E, Anderson SK, Twohy EL, Carrero XW, Dixon JG, Tran DD, Jeyapalan SA, Anderson DM, Kaufmann TJ, Feathers RW, Giannini C, Buckner JC, Anastasiadis PZ, Schiff D. A phase 1 and randomized, placebo-controlled phase 2 trial of bevacizumab plus dasatinib in patients with recurrent glioblastoma: Alliance/North Central Cancer Treatment Group N0872. Cancer 2019; 125:3790-3800. [PMID: 31290996 DOI: 10.1002/cncr.32340] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 02/05/2019] [Revised: 04/23/2019] [Accepted: 05/04/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Src signaling is markedly upregulated in patients with invasive glioblastoma (GBM) after the administration of bevacizumab. The Src family kinase inhibitor dasatinib has been found to effectively block bevacizumab-induced glioma invasion in preclinical models, which led to the hypothesis that combining bevacizumab with dasatinib could increase bevacizumab efficacy in patients with recurrent GBM. METHODS After the completion of the phase 1 component, the phase 2 trial (ClinicalTrials.gov identifier NCT00892177) randomized patients with recurrent GBM 2:1 to receive 100 mg of oral dasatinib twice daily (arm A) or placebo (arm B) on days 1 to 14 of each 14-day cycle combined with 10 mg/kg of intravenous bevacizumab on day 1 of each 14-day cycle. The primary endpoint was 6-month progression-free survival (PFS6). RESULTS In the 121 evaluable patients, the PFS6 rate was numerically, but not statistically, higher in arm A versus arm B (28.9% [95% CI, 19.5%-40.0%] vs 18.4% [95% CI, 7.7%-34.4%]; P = .22). Similarly, there was no significant difference in the median overall survival noted between the treatment arms (7.3 months and 7.7 months, respectively; P = .93). The objective response rate was 15.7% in arm A and 26.3% in arm B (P = .52), but with a significantly longer duration in patients treated on arm A (16.3 months vs 2 months). The incidence of grade ≥3 toxicity was comparable between treatment arms, with hematologic toxicities occurring more frequently in arm A versus arm B (15.7% vs 7.9%) (adverse events were assessed as per the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). Correlative tissue analysis demonstrated an association between pSRC/LYN signaling in patient tumors and outcome. CONCLUSIONS Despite upregulation of Src signaling in patients with GBM, the combination of bevacizumab with dasatinib did not appear to significantly improve the outcomes of patients with recurrent GBM compared with bevacizumab alone.
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Affiliation(s)
| | - S Keith Anderson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Erin L Twohy
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Xiomara W Carrero
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jesse G Dixon
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - David Dinh Tran
- Oncology Division, Washington University School of Medicine, St. Louis, Missouri
| | | | - Daniel M Anderson
- Department of Hematology/Oncology, Regions Hospital, St Paul, Minnesota
| | | | - Ryan W Feathers
- Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida
| | | | - Jan C Buckner
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - David Schiff
- Department of Neurology, University of Virginia Medical Center, Charlottesville, Virginia
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18
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Dixon JG, Jones MV, Turner MJ. The benefits of a challenge approach on match day: Investigating cardiovascular reactivity in professional academy soccer players. Eur J Sport Sci 2019; 20:375-385. [PMID: 31167615 DOI: 10.1080/17461391.2019.1629179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study assessed physiological (cardiovascular) and psychological (confidence, control, and approach focus) data in professional academy soccer players prior to performance in competitive matches. A challenge state is characterised by an increase in cardiac output (CO), and a decrease in total peripheral vascular resistance (TPR). Data were collected from 37 participants, with 19 of these providing data on two separate occasions. Performance was measured using coach and player self-ratings. Challenge reactivity was positively, and significantly, associated with performance. Participants who demonstrated blunted cardiovascular (CV) responses performed significantly worse than participants who displayed either challenge or threat reactivity. There was mixed consistency in CV reactivity for those participants whose data were collected on more than one occasion, suggesting that some participants responded differently across the competitive matches. The association between self-report data and CV responses was weak. This study supports previous research demonstrating that challenge reactivity is associated with superior performance.
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Affiliation(s)
- J G Dixon
- Life Sciences and Education, Staffordshire University & Stoke City Football Club, Stoke on Trent, UK
| | - M V Jones
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - M J Turner
- Life Sciences and Education, Staffordshire University, Stoke on Trent, UK
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19
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Jaeckle KA, Anderson SK, Twohy EL, Dixon JG, Giannini C, Jenkins R, Egorin MJ, Sarkaria JN, Brown PD, Flynn PJ, Schwerkoske J, Buckner JC, Galanis E. Correction to: Phase I-II trial of imatinib mesylate (Gleevec; STI571) in treatment of recurrent oligodendroglioma and mixed oligoastrocytoma. North central cancer treatment group study N0272 (ALLIANCE/NCCTG). J Neurooncol 2019; 143:583. [PMID: 31165953 DOI: 10.1007/s11060-019-03201-3] [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: 11/24/2022]
Abstract
The last author's first name was truncated in the initial online publication. The original article has been corrected.
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Affiliation(s)
- Kurt A Jaeckle
- Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - S K Anderson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Erin L Twohy
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Jesse G Dixon
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - P J Flynn
- , Metro-Minnesota, St. Louis Park, MN, USA
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20
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Jaeckle KA, Anderson SK, Twohy EL, Dixon JG, Giannini C, Jenkins R, Egorin MJ, Sarkaria JN, Brown PD, Flynn PJ, Schwerkoske J, Buckner JC, Galanis E. Phase I-II trial of imatinib mesylate (Gleevec; STI571) in treatment of recurrent oligodendroglioma and mixed oligoastrocytoma. North central cancer treatment group study N0272 (ALLIANCE/NCCTG). J Neurooncol 2019; 143:573-581. [PMID: 31119479 DOI: 10.1007/s11060-019-03194-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/22/2019] [Revised: 05/09/2019] [Accepted: 05/11/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the pharmacokinetics and efficacy of imatinib in patients with recurrent oligodendroglial tumors. METHODS Patients with progressive WHO grade II-III recurrent tumors after prior RT and chemotherapy were eligible. A phase I dose-escalation study was conducted for patients on enzyme-inducing anticonvulsants (EIAC). A phase II study for non-EIAC patients utilized a fixed dose of 600 mg/D. Primary efficacy endpoint was 6-month progression-free survival (PFS6). A 2-stage design was utilized, with 90% power to detect PFS6 increase from 25 to 45%. RESULTS In the Phase I, maximum tolerated dose was not reached at 1200 mg/D. For phase II patients, overall PFS6 was 33% and median PFS 4.0 months (95% CI 2.1, 5.7). Median overall survival (OS) was longer in imatinib-treated patients compared with controls (16.6 vs. 8.0 months; HR = 0.64, 95% CI 0.41,1.0, p = 0.049), and longer in patients with 1p/19q-codeleted tumors (19.2 vs. 6.2 months, HR = 0.43, 95% CI 0.21,0.89, p = 0.019). Confirmed response rate was 3.9% (PR = 1; REGR = 1), with stable disease observed in 52.9%. At 600 mg/D, mean steady-state imatinib plasma concentration was 2513 ng/ml (95% CI 1831,3195). Grade 3-4 adverse events (hematologic, fatigue, GI, hypophosphatemia, or hemorrhage) occurred in 61%. CONCLUSIONS Although adequate plasma levels were achieved, the observed PFS6 of 33% did not reach our pre-defined threshold for success. Although OS was longer in imatinib-treated patients than controls, this finding would require forward validation in a larger cohort. Imatinib might show greater activity in a population enriched for PDGF-dependent pathway activation in tumor tissue.
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Affiliation(s)
- Kurt A Jaeckle
- Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| | - S K Anderson
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Erin L Twohy
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Jesse G Dixon
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - P J Flynn
- Minnesota Oncology, Minneapolis, MN, USA
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21
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Ruppert AS, Dixon JG, Salles GA, Wall AKM, Cunningham D, Poeschel V, Haioun C, Tilly H, Ghesquieres H, Ziepert M, Flament J, Flowers C, Shi Q, Shmitz N. Comparison of clinical scoring systems in aggressive B-cell lymphomas (BCL): An individual patient-level analysis across international trials (SEAL). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.7544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
7544 Background: Great heterogeneity in survival exists for patients (pts) newly diagnosed with aggressive BCL. Three scoring systems based on simple clinical parameters (age, lactate dehydrogenase, number/sites of involvement, stage, performance status) are widely used: the international prognostic index (IPI), revised-IPI (R-IPI), and National Comprehensive Cancer Network IPI (NCCN-IPI). We studied BCL pts treated with R-CHOP to determine which scoring systems best identifies subgroups with poor outcomes that might benefit from new approaches. Methods: Individual pt data from 7 multicenter trials (1998-2009) of pts with BCL (86% DLBCL) treated front-line with R-CHOP (or variant) were analyzed to determine whether IPI, R-IPI, or NCCN-IPI best discriminated overall survival (OS). The concordance index (c-index) from a proportional hazards model, stratifying on trial and induction therapy, quantified predictive accuracy of each scoring system. Results: 2561 pts (median age 63 yrs, 56% male) were classified into IPI, R-IPI, and NCCN-IPI risk groups (Table). With a median follow-up of 5 yrs, NCCN-IPI had the greatest absolute difference in OS estimates between the highest and lowest risk groups at 1, 3, and 5 yrs, and best discriminated OS (c-index = 0.631, Table). Conclusions: In an independent and large cohort of pts, NCCN-IPI performs best in risk-stratifying pts with aggressive BCL, readily distinguishing pts at high and low risk for treatment failure using clinical parameters (5-yr OS between 48 and 92%). Improvement over the simpler IPI appears incremental, and IPI may remain a valuable alternative. Work integrating molecular features of the tumor into the (NCCN-) IPI is in progress to define high risk groups where targeted novel approaches are needed most. [Table: see text]
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Affiliation(s)
- Amy S. Ruppert
- The Ohio State University, Department of Internal Medicine, Columbus, OH
| | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Gilles A. Salles
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Hématologie, Pierre Bénite, France
| | | | | | | | | | - Herve Tilly
- Department of Hematology, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Herve Ghesquieres
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Hématologie, Pierre Bénite, France
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics and Epidemology, Leipzig University, Leipzig, Germany
| | | | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN
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22
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Shi Q, De Gramont A, Dixon JG, Yin J, Van Cutsem E, Taieb J, Alberts SR, Wolmark N, Schmoll HJHJ, Saltz LB, Goldberg RM, Kerr R, Lonardi S, Yoshino T, Yothers G, Grothey A, Andre T, Salem ME. Re-evaluating disease-free survival (DFS) as an endpoint versus overall survival (OS) in adjuvant colon cancer (CC) trials with chemotherapy +/- biologics: An updated surrogacy analysis based on 18,886 patients (pts) from the Accent database. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3502 Background: DFS with 3 years median follow-up (3yDFS) was validated as a surrogate for OS with 5 years median follow-up (5yOS) in adjuvant chemotherapy CC trials prior. Recent data showed improved survival after recurrence and OS, over time, in pts who received adjuvant FOLFOX. Hence, re-evaluation of the association between DFS and OS, as well as the optimal follow-up of OS to aid its utility in future adjuvant trials is needed. Methods: Individual patient data from 8 randomized adjuvant studies conducted from 1998-2009 were included; 3 trials tested anti-VEGF or anti-EGFR agents. Trial-level surrogacy examining the correlation of treatment effect estimates (i.e. hazard ratios) of 3yDFS and 5y to 8yOS was evaluated using both linear regression (R2WLS) and Copula bivariate (R2Copula) models. For the R2, a value closer to 1 indicates a stronger correlation. Prespecified criteria for surrogacy required either R2WLS or R2Copula ≥ 0.80 and neither < 0.7, with lower-bound 95% Confidence Interval (CI) > 0.60. The rank correlation coefficient (ρ) quantified the individual-level surrogacy. Results: Total of 18,886 pts were analyzed, with median age 60, 54% male, 83% stage III, 59% > 12 nodes examined. Median follow-up for survival ranged from 5 to 10 years across trials. Trial level correlation between 3yDFS and OS remained strong (R2WLS ≥0.74; R2Copula ≥ 0.89) and increased as the median follow-up of OS extended longer (see table). Analyses limited to stage III pts and/or trials tested biologics showed consistent results. Conclusions: 3yDFS remains a validated surrogate endpoint for 5yOS in adjuvant trials in CC pts per prespecified criteria. The correlation was strengthened with more than 6 years of follow-up for OS. [Table: see text]
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Affiliation(s)
- Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Jesse G. Dixon
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Jun Yin
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Eric Van Cutsem
- University Hospitals Gasthuisberg, Leuven and KU Leuven, Leuven, Belgium
| | - Julien Taieb
- Hôpital Européen Georges-Pompidou, Sorbonne Paris Cite/Paris Descartes University, Paris, France
| | | | - Norman Wolmark
- NRG Oncology/NSABP, and Allegheny Health Network Cancer Institute at Allegheny General Hospital, Pittsburgh, PA
| | | | | | | | - Rachel Kerr
- University of Oxford, Oxford, United Kingdom
| | | | | | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Axel Grothey
- West Cancer Center, University of Tennessee, Germantown, TN
| | - Thierry Andre
- Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris and Sorbonne Université, Paris, France
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Shi Q, Schmitz N, Ou FS, Dixon JG, Cunningham D, Pfreundschuh M, Seymour JF, Jaeger U, Habermann TM, Haioun C, Tilly H, Ghesquieres H, Merli F, Ziepert M, Herbrecht R, Flament J, Fu T, Coiffier B, Flowers CR. Progression-Free Survival as a Surrogate End Point for Overall Survival in First-Line Diffuse Large B-Cell Lymphoma: An Individual Patient-Level Analysis of Multiple Randomized Trials (SEAL). J Clin Oncol 2018; 36:2593-2602. [PMID: 29975624 DOI: 10.1200/jco.2018.77.9124] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Overall survival (OS) is the definitive and best-established primary efficacy end point to evaluate diffuse large B-cell lymphoma (DLBCL) therapies, but it requires prolonged follow-up. An earlier end point assessed post-treatment would expedite clinical trial conduct and accelerate patient access to effective new therapies. Our objective was to formally evaluate progression-free survival (PFS) and PFS at 24 months (PFS24) as surrogate end points for OS in first-line DLBCL. Patients and Methods Individual patient data were analyzed from 7,507 patients from 13 multicenter randomized controlled trials of active treatment in previously untreated DLBCL, published after 2002, with sufficient PFS data to predict treatment effects on OS. Trial-level surrogacy examining the correlation of treatment effect estimates of PFS/PFS24 and OS was evaluated using both linear regression ( R2WLS) and Copula bivariable ( R2Copula) models. Prespecified criteria for surrogacy required either R2WLS or R2Copula ≥ 0.80 and neither < 0.7, with lower-bound 95% CI > 0.60. Results Trial-level surrogacy for PFS was strong ( R2WLS = 0.83; R2Copula = 0.85) and met the predefined criteria for surrogacy. At the patient level, PFS strongly correlated with OS. The surrogate threshold effect had a hazard ratio of 0.89. Surrogacy was consistent across comparisons with or without rituximab and with rituximab maintenance trials. Trial-level surrogacy for PFS24 was relatively strong ( R2WLS = 0.77; R2Copula = 0.78) but did not meet prespecified criteria. At the patient level, PFS24 significantly correlated with OS. The surrogate threshold effect had an odds ratio of 1.51. Conclusion This large pooled analysis of individual patient data supports PFS as a surrogate end point for OS in future randomized controlled trials evaluating chemoimmunotherapy in DLBCL. Use of this end point may expedite therapeutic development with the intent of bringing novel therapies to this patient population years before OS results are mature.
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Affiliation(s)
- Qian Shi
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Norbert Schmitz
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Fang-Shu Ou
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Jesse G Dixon
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - David Cunningham
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Michael Pfreundschuh
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - John F Seymour
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Ulrich Jaeger
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Thomas M Habermann
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Corinne Haioun
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Hervé Tilly
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Hervé Ghesquieres
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Francesco Merli
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Marita Ziepert
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Raoul Herbrecht
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Jocelyne Flament
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Tommy Fu
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Bertrand Coiffier
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
| | - Christopher R Flowers
- Qian Shi, Fang-Shu Ou, Jesse G. Dixon, and Thomas M. Habermann, Mayo Clinic, Rochester, MN; Norbert Schmitz, University of Muenster, Muenster; Michael Pfreundschuh, Universität des Saarlandes, Homburg; Marita Ziepert, University of Leipzig, Leipzig, Germany; David Cunningham, The Royal Marsden Hospital, Surrey, United Kingdom; John F. Seymour, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia; Ulrich Jaeger, Medical University of Vienna, Vienna, Austria; Corinne Haioun, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil; Hervé Tilly, Institut National de la Santé et de la Recherche Médicale U1245, Université de Rouen, Rouen; Hervé Ghesquieres and Bertrand Coiffier, Centre Hospitalier Lyon-Sud, Pierre-Benite; Raoul Herbrecht, Hôpital de Hautepierre, Strasbourg, France; Francesco Merli, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; Jocelyne Flament, Celgene, Boudry, Switzerland; Tommy Fu, Celgene, Summit, NJ; and Christopher R. Flowers, Emory University, Atlanta, GA
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Zhang BY, Jones JC, Briggler AM, Hubbard JM, Kipp BR, Sargent DJ, Dixon JG, Grothey A. Lack of Caudal-Type Homeobox Transcription Factor 2 Expression as a Prognostic Biomarker in Metastatic Colorectal Cancer. Clin Colorectal Cancer 2016; 16:124-128. [PMID: 27726953 DOI: 10.1016/j.clcc.2016.09.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 06/02/2016] [Accepted: 09/08/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although the lack of CDX2 expression has recently been proposed as a potential biomarker for a high risk of relapse in patients with stage II and III colon cancer after complete surgical resection, its prognostic role in metastatic colorectal cancer (CRC) remains unclear and warrants investigation. MATERIALS AND METHODS We identified 145 patients treated at our institution from 2006 to 2016, including 66 patients with CDX2-negative metastatic CRC and a comparison cohort of 79 patients with CDX2-positive metastatic CRC. Overall survival (OS) and progression-free survival (PFS) for first-line systemic therapy were estimated using the Kaplan-Meier method. The associations of CDX2 expression with survival were evaluated using Cox proportional hazards regression models. RESULTS The prevalence of absent CDX2 expression in our cohort was 5.6%. Patients with CDX2-negative metastatic CRC were significantly more likely to be female, and to have right-sided primary tumors, poorly differentiated histologic features, and distant lymph node metastasis. The median OS for patients with CDX2-negative and -positive metastatic CRC was 8 and 39 months, respectively (hazard ratio [HR], 4.04; 95% confidence interval [CI], 2.49-6.54; P < .0001). After adjusting for covariates in a multivariate model, the association of a lack of CDX2 expression and OS remained statistically significant (HR, 4.52; 95% CI, 2.50-8.17; P < .0001). In addition, the median PFS (3 vs. 10 months; HR, 2.23; 95% CI, 1.52-3.27; P < .0001) for first-line chemotherapy was significantly decreased in patients with CDX2-negative metastatic CRC. CONCLUSION The results of the present study show that a lack of CDX2 expression in metastatic CRC is an adverse prognostic feature and a potential negative predictor of the response to chemotherapy.
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Affiliation(s)
- Ben Y Zhang
- Department of Oncology, Mayo Clinic, Rochester, MN
| | | | | | | | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Daniel J Sargent
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jesse G Dixon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Axel Grothey
- Department of Oncology, Mayo Clinic, Rochester, MN.
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Wickstrom GC, Kelley DK, Keyserling TC, Kolar MM, Dixon JG, Xie SX, Lewis CL, Bognar BA, DuPre CT, Coxe DR, Hayden J, Williams MV. Confidence of academic general internists and family physicians to teach ambulatory procedures. J Gen Intern Med 2000; 15:353-60. [PMID: 10886468 PMCID: PMC1495470 DOI: 10.1046/j.1525-1497.2000.04109.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate and compare the readiness of academic general internal medicine physicians and academic family medicine physicians to perform and teach 13 common ambulatory procedures. DESIGN Mailed survey. SETTING Internal medicine and family medicine residency training programs associated with 35 medical schools in 9 eastern states. PARTICIPANTS Convenience sample of full-time teaching faculty. MEASUREMENTS AND MAIN RESULTS A total of 331 general internists and 271 family physicians returned completed questionnaires, with response rates of 57% and 65%, respectively. Academic generalists ranked most of the ambulatory procedures as important for primary care physicians to perform; however, they infrequently performed or taught many of the procedures. Overall, compared with family physicians, general internists performed and taught fewer procedures, received less training, and were less confident in their ability to teach these procedures. Physicians' confidence to teach a procedure was strongly associated with training to perform the procedure and performing or precepting a procedure at least 10 times per year. CONCLUSIONS Many academic general internists do not perform or precept common adult ambulatory procedures. To ensure that residents have the opportunity to learn routine ambulatory procedures, training programs may need to recruit qualified faculty, train current faculty, or arrange for academic specialists or community physicians to teach these skills.
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Affiliation(s)
- G C Wickstrom
- Department of Medicine, Summa Health System/Northeastern Ohio Universities College of Medicine, Akron, USA.
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Dixon JG, Barnes HV, Davies TC, Manser TG, Eng B. A combined residency in family medicine and internal medicine at Eastern Virginia Medical School. Acad Med 1999; 74:S121-S127. [PMID: 9934321 DOI: 10.1097/00001888-199901001-00043] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This paper describes the first operational four-year combined family medicine/internal medicine residency designed to qualify residents for board examination in both disciplines, which began at Eastern Virginia Medical School in 1995. The authors describe key program features, including their block rotation schedule, interdisciplinary ambulatory precepting, and plans for achieving 50% ambulatory training experience, as well as their difficulties in implementing a collaborative core didactic experience. The authors present faculty survey data indicating that internal medicine faculty members are more likely to view the combined residency as a resource, while family medicine faculty members would like to concentrate on the categorical residency. A recent survey of combined residents indicates that they are satisfied with their choice of combined training and optimistic about the opportunity of garnering additional skills relative to their internal medicine and family medicine counterparts. The authors suggest that successfully implementing this interdisciplinary effort requires an atmosphere of mutual respect and an effort to find opportunities to positively affect the training experiences of both combined residents and their resident partners in family medicine and internal medicine.
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Affiliation(s)
- J G Dixon
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk 23507-1912, USA
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Canham PB, Finlay HM, Dixon JG, Ferguson SE. Layered collagen fabric of cerebral aneurysms quantitatively assessed by the universal stage and polarized light microscopy. Anat Rec (Hoboken) 1991; 231:579-92. [PMID: 1793183 DOI: 10.1002/ar.1092310420] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We evaluated the effectiveness of the Universal stage, an instrument for measuring three-dimensional orientation of birefringent materials, for studying the collagen fabric in the wall of brain aneurysms. Vessels from autopsy were fixed at normal arterial distending pressure with 10% formalin, and prepared for polarized light microscopy, with paraffin embedding and staining with picrosirius red for birefringent enhancement. Quantitative data were obtained from tangential and oblique sections (7 microns thickness) of an intact 8 mm aneurysm, a 1.5 mm aneurysm, and a tangential section (3 microns thickness) of a cerebral artery. Sections of full-size aneurysms seen through the microscope, adjusted either for plane or circularly polarized light, revealed distinctive layers of collagen across the aneurysmal wall, which at higher magnification were further subdivided. Three-dimensional measurements, numbering 1,082, were made by use of the Universal stage attachment to the polarizing microscope. They were plotted by computer-controlled graphics on Lambert projections and analyzed by circular statistics. When assessed layer by layer, the collagen spanned a full range of orientations relative to the tangential plane. The circular standard deviation, a measure of the spread of alignment about the mean, was as low as 10 degrees for coherently organized collagen and as high as 40 degrees for the least coherently organized collagen, values characteristic of either the organized tunica media, or the least organized tunica adventitia of cerebral arteries. Although there was a marked thinning of the wall of one aneurysm, there was no evidence of structural weakness based only on the directional organization assessed by our measurements.
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Affiliation(s)
- P B Canham
- Department of Medical Biophysics, University of Western Ontario, London, Canada
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28
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Finlay HM, Dixon JG, Canham PB. Fabric organization of the subendothelium of the human brain artery by polarized-light microscopy. Arterioscler Thromb 1991; 11:681-90. [PMID: 2029506 DOI: 10.1161/01.atv.11.3.681] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The thickened subendothelium of brain arteries that is characteristic of atherosclerosis was assessed for the directional organization of the two main birefringent components, smooth muscle cells and collagen. Thirty-three arteries from 16 autopsy cases were pressure fixed at 30, 60, 110, and 200 mm Hg, sectioned at a thickness of 7 microns , and stained with silver impregnation to enhance tissue birefringence. The intended focus of the study was on muscle organization, but it also included the collagen among the cells because of the coalignment of the two tissues and their similar staining properties for polarized-light microscopy. The birefringent medial fabric at all pressures was circumferentially oriented, with a mean deviation of the 33 sections of 1.4 degrees from circumferential with an average circular standard deviation of 3.5 degrees, thereby showing remarkable coherence. In contrast, the subendothelium showed great variability both in thickness and in organization. Many arteries had no measurable subendothelium, and others had as much as 100%, with some atherosclerotic lesions as much as 300% of the medial width. Measurements from the subendothelium revealed a helical arrangement of tissue, often divided into separate regions, with a balance of left- and right-handed helical components and generally with lower pitch angles in the layers adjacent to the lumen. The average circular standard deviation within individual subendothelial layers was 14.5 degrees.
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Affiliation(s)
- H M Finlay
- Department of Medical Biophysics, University of Western Ontario, London, Canada
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29
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Abstract
The mechanical properties of collagen as a biopolymer ensures that collagen has a significant influence on the mechanical behavior of the host tissue. Structural organization is a key to that influence. We have assessed this relationship quantitatively in the tunica media of arteries from the heart and brain, using the polarizing light microscope and Universal stage. Arteries from 22 autopsies were isolated, cannulated and fixed with 10% buffered formalin, at a distending pressure spanning normal values in vivo. We prepared the tissue for light microscopy, with paraffin embedding, sectioning at 7 microns, and staining with picrosirius red to enhance the natural birefringence of medial collagen. Individual measurements, 30 to 50 per arterial section, referenced against the central axis of the vessel segment, revealed a coherent organization, with an average orientation which was within 1 to 2 degrees of being perfectly concentric for all artery segments. Analysis was done with Lambert projections and circular statistics. We calculated the circular standard deviation, which was 5.2 degrees for 27 brain arteries (S.D. 1.9 degrees) and 5.6 degrees (S.D. 2.1 degrees), for 5 coronary arteries sectioned at less than 15 degrees. Our interpretation is that medial collagen can be strained even though highly aligned, revealing a mechanical property which contrasts that of type I collagen.
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Affiliation(s)
- P B Canham
- Department of Medical Biophysics, University of Western Ontario, London, Canada
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30
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Canham PB, Finlay HM, Dixon JG, Boughner DR, Chen A. Measurements from light and polarised light microscopy of human coronary arteries fixed at distending pressure. Cardiovasc Res 1989; 23:973-82. [PMID: 2611805 DOI: 10.1093/cvr/23.11.973] [Citation(s) in RCA: 70] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
With the long term goal of improving our understanding of the mechanisms involved in coronary artery spasm, we have undertaken a two part study of the artery structure. We have made a comparison of the relative proportions of the different layers in proximal and distal regions of the main coronary arteries, and have quantitatively assessed their three dimensional structural fabric. Major coronary arteries from nine hearts were prepared for histological examination after fixation at a transmural pressure of 120 mm Hg. Measurements from 14 proximal and distal pairs of the cross sectioned arteries showed a dominant subendothelial layer, which diminished in thickness distally, with a small fraction of muscle cells interspersed with collagen. Three dimensional orientation measurements of the collagen and muscle components, which are birefringent, were obtained from one pair of segments from each of the left anterior descending, circumflex and right coronary arteries, using the polarising light microscope and Universal stage. Findings showed (1) a single circumferential order of adventitial collagen, with a mean circular standard deviation (CSD) of 22.3 degrees; (2) very highly ordered medial smooth muscle, mean CSD of 5.0 degrees (both findings are quantitatively similar between proximal and distal segments of artery, and between arteries); and (3) a multilayered fabric of collagen in the subendothelium in all vessel segments. The principal contributor to functional differences between proximal and distal regions may be the prominent and structurally varied subendothelial layer of the coronary arteries.
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Affiliation(s)
- P B Canham
- Department of Medical Biophysics, University of Western Ontario, London, Canada
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Flack RD, Thacker JG, Dixon JG. Moiré interferometry strain measurements in elastic thin membranes. Appl Opt 1979; 18:3841-3846. [PMID: 20216703 DOI: 10.1364/ao.18.003841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The strain in thin flexible membranes representing human skin has been studied using moiré interferometry. A method of using a flexible coating of photographic emulsion was developed. The equations for use in differential interferometry were also derived for very large deformations. The method was applied to two types of cases: rectangular membranes subjected to a uniform axial strain, and membranes containing strain concentrators that represent bandages placed on the surface of the skin. Results for the former case were within 3% of exact results, while results near the concentrator indicate strain concentration factors ranging from -1.25 to 1.75.
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