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Darragh LB, Knitz MM, Hu J, Clambey ET, Backus J, Dumit A, Samedi V, Bubak A, Greene C, Waxweiler T, Mehrotra S, Bhatia S, Gadwa J, Bickett T, Piper M, Fakhoury K, Liu A, Petit J, Bowles D, Thaker A, Atiyeh K, Goddard J, Hoyer R, Van Bokhoven A, Jordan K, Jimeno A, D'Alessandro A, Raben D, McDermott JD, Karam SD. Publisher Correction: A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC. Nat Cancer 2024; 5:210. [PMID: 38200246 PMCID: PMC10824658 DOI: 10.1038/s43018-024-00724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
- Laurel B Darragh
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Michael M Knitz
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Junxiao Hu
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Eric T Clambey
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Backus
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Dumit
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Von Samedi
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Bubak
- Department of Neurology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Casey Greene
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Timothy Waxweiler
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Sanjana Mehrotra
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Shilpa Bhatia
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Gadwa
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas Bickett
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Miles Piper
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kareem Fakhoury
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado, Poudre Valley Hospital, Fort Collins, CO, USA
| | - Joshua Petit
- Department of Radiation Oncology, University of Colorado, Poudre Valley Hospital, Fort Collins, CO, USA
| | - Daniel Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ashesh Thaker
- Department of Radiology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberly Atiyeh
- Department of Otolaryngology Head and Neck Surgery, University of Colorado, Memorial South Hospital, Colorado Springs, CO, USA
| | - Julie Goddard
- Department of Otolaryngology Head and Neck Surgery, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Robert Hoyer
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adrie Van Bokhoven
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberly Jordan
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Antonio Jimeno
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - David Raben
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica D McDermott
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sana D Karam
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA.
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA.
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McDermott JD, Amini A, Molina E, Stokes WA, Karam SD. Treatment outcomes and cost comparisons for older adults with T4 laryngeal squamous cell cancer. Head Neck 2023; 45:664-674. [PMID: 36563300 PMCID: PMC10626713 DOI: 10.1002/hed.27284] [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: 05/12/2021] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate treatment modalities of T4 larynx cancer in older adults using SEER-Medicare. METHODS The database was queried for patients aged 66 and older with nonmetastatic T4 laryngeal squamous cell cancer from 2006 to 2015. Treatment modalities compared were surgery plus chemoradiation (SCR), surgery plus radiation (SR), chemoradiation (CR), surgery (S), and radiation (R). Multivariate analysis and Kaplan-Meier methods were used to explore the relationship of treatment modality and survival. Total cancer-related costs were calculated. RESULTS A total of 438 patients met inclusion criteria. Patients receiving CR or SR had similar CSS to SCR (HR 1.36 and HR 1.24, respectively). Those receiving S (HR 2.00) or R (HR 2.41) had significantly worse CSS. Similar findings were observed for OS. Cancer care-related costs were not significantly different but highest in SCR ($162215) and lowest in R ($121421). CONCLUSION Older patients with T4 larynx cancer had similar survival rates when treated with CR, SR, and SCR. Average total health care costs were not significantly different between modalities. Patients not eligible for triple-modality could consider these other treatment options.
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Affiliation(s)
- Jessica D McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Elizabeth Molina
- Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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Darragh LB, Knitz MM, Hu J, Clambey ET, Backus J, Dumit A, Samedi V, Bubak A, Greene C, Waxweiler T, Mehrotra S, Bhatia S, Gadwa J, Bickett T, Piper M, Fakhoury K, Liu A, Petit J, Bowles D, Thaker A, Atiyeh K, Goddard J, Hoyer R, Van Bokhoven A, Jordan K, Jimeno A, D'Alessandro A, Raben D, McDermott JD, Karam SD. Author Correction: A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC. Nat Cancer 2023; 4:148. [PMID: 36577897 PMCID: PMC9886545 DOI: 10.1038/s43018-022-00507-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Laurel B Darragh
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Michael M Knitz
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Junxiao Hu
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Eric T Clambey
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Backus
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Dumit
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Von Samedi
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Bubak
- Department of Neurology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Casey Greene
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Timothy Waxweiler
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Sanjana Mehrotra
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Shilpa Bhatia
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Gadwa
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas Bickett
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Miles Piper
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kareem Fakhoury
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado, Poudre Valley Hospital, Fort Collins, CO, USA
| | - Joshua Petit
- Department of Radiation Oncology, University of Colorado, Poudre Valley Hospital, Fort Collins, CO, USA
| | - Daniel Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ashesh Thaker
- Department of Radiology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberly Atiyeh
- Department of Otolaryngology Head and Neck Surgery, University of Colorado, Memorial South Hospital, Colorado Springs, CO, USA
| | - Julie Goddard
- Department of Otolaryngology Head and Neck Surgery, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Robert Hoyer
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adrie Van Bokhoven
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberly Jordan
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Antonio Jimeno
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - David Raben
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica D McDermott
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sana D Karam
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA.
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA.
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Darragh LB, Knitz MM, Hu J, Clambey ET, Backus J, Dumit A, Samedi V, Bubak A, Greene C, Waxweiler T, Mehrotra S, Bhatia S, Gadwa J, Bickett T, Piper M, Fakhoury K, Liu A, Petit J, Bowles D, Thaker A, Atiyeh K, Goddard J, Hoyer R, Van Bokhoven A, Jordan K, Jimeno A, D'Alessandro A, Raben D, McDermott JD, Karam SD. A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC. Nat Cancer 2022; 3:1300-1317. [PMID: 36434392 PMCID: PMC9701140 DOI: 10.1038/s43018-022-00450-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/21/2022] [Indexed: 11/27/2022]
Abstract
Five-year survival for human papilloma virus-unrelated head and neck squamous cell carcinomas remain below 50%. We assessed the safety of administering combination hypofractionated stereotactic body radiation therapy with single-dose durvalumab (anti-PD-L1) neoadjuvantly (n = 21) ( NCT03635164 ). The primary endpoint of the study was safety, which was met. Secondary endpoints included radiographic, pathologic and objective response; locoregional control; progression-free survival; and overall survival. Among evaluable patients at an early median follow-up of 16 months (448 d or 64 weeks), overall survival was 80.1% with 95% confidence interval (95% CI) (62.0%, 100.0%), locoregional control and progression-free survival were 75.8% with 95% CI (57.5%, 99.8%), and major pathological response or complete response was 75% with 95% exact CI (51.6%, 100.0%). For patients treated with 24 Gy, 89% with 95% CI (57.1%, 100.0%) had MPR or CR. Using high-dimensional multi-omics and spatial data as well as biological correlatives, we show that responders had: (1) an increase in effector T cells; (2) a decrease in immunosuppressive cells; and (3) an increase in antigen presentation post-treatment.
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Affiliation(s)
- Laurel B Darragh
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Michael M Knitz
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Junxiao Hu
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Eric T Clambey
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer Backus
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Dumit
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Von Samedi
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew Bubak
- Department of Neurology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Casey Greene
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Timothy Waxweiler
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Sanjana Mehrotra
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Shilpa Bhatia
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Gadwa
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Thomas Bickett
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Miles Piper
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kareem Fakhoury
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado, Poudre Valley Hospital, Fort Collins, CO, USA
| | - Joshua Petit
- Department of Radiation Oncology, University of Colorado, Poudre Valley Hospital, Fort Collins, CO, USA
| | - Daniel Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ashesh Thaker
- Department of Radiology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberly Atiyeh
- Department of Otolaryngology Head and Neck Surgery, University of Colorado, Memorial South Hospital, Colorado Springs, CO, USA
| | - Julie Goddard
- Department of Otolaryngology Head and Neck Surgery, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Robert Hoyer
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adrie Van Bokhoven
- Department of Pathology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberly Jordan
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Antonio Jimeno
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - David Raben
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA
| | - Jessica D McDermott
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sana D Karam
- Radiation Oncology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA.
- Department of Immunology, University of Colorado Denver at Anschutz Medical Campus, Aurora, CO, USA.
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Amini A, Morgan R, Meyer E, Fakhoury K, Ladbury C, Bickett T, McDermott JD, Stokes W, Karam SD. Outcomes between intensity-modulated radiation therapy versus 3D-conformal in early stage glottic cancer. Head Neck 2021; 43:3393-3403. [PMID: 34382714 DOI: 10.1002/hed.26841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/01/2021] [Accepted: 07/29/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The purpose of this study is to evaluate practice patterns and outcomes between intensity-modulated radiation therapy (IMRT) and 3D-conformal radiation (3D-CRT) in early stage glottic cancer. METHODS The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify and compare patient and disease profiles, mortality, and toxicity in patients with T1-2 larynx cancer undergoing definitive radiation (RT). RESULTS A total of 1520 patients underwent definitive radiation with 3D-CRT (n = 1309) or IMRT (n = 211). Non-white race, those with a Charlson Comorbidity Index ≥2, T2 disease, and those treated at community practices were more likely to undergo IMRT. Rates of IMRT increased from 2006 to 2015, while relative rates of 3D-CRT decreased. Two-year CSS was superior with 3D-CRT (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.22-0.65; p < 0.001). There was no difference in OS between 3D-CRT and IMRT (p = 0.119). CONCLUSIONS Patients receiving 3D-CRT had improved CSS compared to IMRT with no difference in OS.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California, USA
| | - Rustain Morgan
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elisabeth Meyer
- Department of Health Systems Management and Policy, Colorado Comprehensive Cancer Center, University of Colorado, Aurora, Colorado, USA
| | - Kareem Fakhoury
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Colton Ladbury
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California, USA
| | - Thomas Bickett
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jessica D McDermott
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - William Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Stokes WA, Molina E, McDermott JD, Morgan RL, Bickett T, Fakhoury KR, Amini A, Karam SD. Survival impact of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in head and neck cancer. Head Neck 2021; 43:3255-3275. [PMID: 34289190 DOI: 10.1002/hed.26809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Preclinical evidence suggests a link between the renin-angiotensin system and oncogenesis. We aimed to explore the impact of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in head and neck cancer (HNC). METHODS Over 5000 patients were identified from the Surveillance, Epidemiology, and End Results-Medicare linked dataset and categorized according to ACEi and ARB and diagnoses of chronic kidney disease (CKD) or hypertension (HTN). Overall survival (OS) and cancer-specific survival (CSS) were compared using Cox multivariable regression (MVA), expressed as hazard ratios (HR) with 95% confidence intervals (95%CI). RESULTS No significant MVA associations for OS or CSS were found for ACEi. Compared to patients with CKD/HTN taking ARB, those with CKD/HTN not taking ARB experienced worse OS (HR 1.28, 95%CI 1.09-1.51, p = 0.003) and CSS (HR 1.23, 95%CI 1.00-1.50, p = 0.050). CONCLUSIONS ARB usage is associated with improved OS and CSS among HNC patients with CKD or HTN.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Molina
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, Colorado, USA
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Rustain L Morgan
- Division of Nuclear Medicine, Department of Radiology, University of Colorado Denver, Aurora, Colorado, USA
| | - Thomas Bickett
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado, USA
| | - Kareem R Fakhoury
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado, USA
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McDermott JD, Eguchi M, Morgan R, Amini A, Goddard JA, Borrayo EA, Karam SD. Elderly Black Non-Hispanic Patients With Head and Neck Squamous Cell Cancer Have the Worst Survival Outcomes. J Natl Compr Canc Netw 2020; 19:57-67. [PMID: 32987364 DOI: 10.6004/jnccn.2020.7607] [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] [Received: 03/27/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this population study, we compared head and neck cancer (HNC) prognosis and risk factors in 2 underserved minority groups (Hispanic and Black non-Hispanic patients) with those in other racial/ethnicity groups. METHODS In this SEER-Medicare database study in patients with HNC diagnosed in 2006 through 2015, we evaluated cancer-specific survival (CSS) between different racial/ethnic cohorts as the main outcome. Patient demographics, tumor factors, socioeconomic status, and treatments were analyzed in relation to the primary outcomes between racial/ethnic groups. RESULTS Black non-Hispanic patients had significantly worse CSS than all other racial/ethnic groups, including Hispanic patients, in unadjusted univariate analysis (Black non-Hispanic patients: hazard ratio, 1.48; 95% CI, 1.33-1.65; Hispanic patients: hazard ratio, 1.12; 95% CI, 0.99-1.28). To investigate the association of several variables with CSS, data were stratified for multivariate analysis using forward Cox regression. This identified socioeconomic status, cancer stage, and receipt of treatment as predictive factors for the survival differences. Black non-Hispanic patients were most likely to present at a later stage (odds ratio, 1.62; 95% CI, 1.38-1.90) and to receive less treatment (odds ratio, 0.67; 95% CI, 0.55-0.81). Unmarried status, high poverty areas, increased emergency department visits, and receipt of healthcare at non-NCI/nonteaching hospitals also significantly impacted stage and treatment. CONCLUSIONS Black non-Hispanic patients have a worse HNC prognosis than patients in all other racial/ethnic groups, including Hispanic patients. Modifiable risk factors include access to nonemergent care and prevention measures, such as tobacco cessation; presence of social support; communication barriers; and access to tertiary centers for appropriate treatment of their cancers.
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Affiliation(s)
| | - Megan Eguchi
- Department of Health Systems, Management and Policy, and
| | - Rustain Morgan
- Department of Radiology, University of Colorado Anschutz School of Medicine, Aurora, Colorado
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California; and
| | | | | | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado
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Abstract
OPINION STATEMENT The epidemiology of head and neck squamous cell carcinoma (HNSCC) has shifted dramatically over the last 50 years, as smoking-related HNSCCs decrease in incidence while human papillomavirus (HPV)-related cancers rise. The shift in HNSCC risk factors has changed patient demographics, the distribution of affected anatomical subsites, and prognosis of this illness. As such, the medical community has responded by devising novel staging systems and prevention strategies. The medical community will require continued vigilance in reducing HNSCC traditional risks factors for HNSCC, such as cigarette use, and emerging risk like HPV infection.
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Affiliation(s)
- Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, 12801 18 E. 17th Ave, MS 8117, Aurora, CO, 80045, USA
- Hematology/Oncology Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, 12801 18 E. 17th Ave, MS 8117, Aurora, CO, 80045, USA.
- Hematology/Oncology Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
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McDermott JD, Eguchi M, Stokes WA, Amini A, Hararah M, Ding D, Valentine A, Bradley CJ, Karam SD. Short- and Long-term Opioid Use in Patients with Oral and Oropharynx Cancer. Otolaryngol Head Neck Surg 2019; 160:409-419. [PMID: 30396321 PMCID: PMC6886698 DOI: 10.1177/0194599818808513] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/02/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Opioid use and abuse is a national health care crisis, yet opioids remain the cornerstone of pain management in cancer. We sought to determine the risk of acute and chronic opioid use with head and neck squamous cell cancer (HNSCC) treatment. STUDY DESIGN Retrospective population-based study. SETTING Surveillance, Epidemiology and End Results (SEER)-Medicare database from 2008 to 2011. SUBJECTS AND METHODS In total, 976 nondistant metastatic oral cavity and oropharynx patients undergoing cancer-directed treatment enrolled in Medicare were included. Opiate use was the primary end point. Univariate and multivariable logistic analyses were completed to determine risk factors. RESULTS Of the patients, 811 (83.1%) received an opioid prescription during the treatment period, and 150 patients (15.4%) had continued opioid prescriptions at 3 months and 68 (7.0%) at 6 months. Opioid use during treatment was associated with prescriptions prior to treatment (odds ratio [OR], 3.28; 95% confidence interval [CI], 2.11-5.12) and was least likely to be associated with radiation treatment alone (OR, 0.35; 95% CI, 0.18-0.68). Risk factors for continued opioid use at both 3 and 6 months included tobacco use (OR, 2.23; 95% CI, 1.05-4.71 and OR, 3.84; 95% CI, 1.44-10.24) and opioids prescribed prior to treatment (OR, 3.84; 95% CI, 2.45-5.91 and OR, 3.56; 95% CI, 1.95-6.50). Oxycodone prescribed as the first opioid was the least likely to lead to ongoing use at 3 and 6 months (OR, 0.33; 95% CI, 0.17-0.62 and OR, 0.26; 95% CI, 0.10-0.67). CONCLUSION Patients with oral/oropharyngeal cancer are at a very high risk for receiving opioids as part of symptom management during treatment, and a significant portion continues use at 3 and 6 months after treatment completion.
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Affiliation(s)
- Jessica D. McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Megan Eguchi
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A. Stokes
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Mohammad Hararah
- Department of Otolaryngology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Ding Ding
- University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Allison Valentine
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cathy J. Bradley
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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10
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Amini A, Eguchi M, Jones BL, Stokes WA, Gupta A, McDermott JD, Massarelli E, Bradley CJ, Karam SD. Comparing outcomes of concurrent chemotherapy regimens in patients 65 years old or older with locally advanced oropharyngeal carcinoma. Cancer 2018; 124:4322-4331. [PMID: 30291789 PMCID: PMC6892396 DOI: 10.1002/cncr.31740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The comparative efficacy of cisplatin (CDDP), carboplatin, and cetuximab (CTX) delivered concurrently with radiation for locally advanced oropharyngeal squamous cell carcinoma continues to be evaluated. METHODS The linked Surveillance, Epidemiology, and End Results-Medicare database was used to identify and compare patient and disease profiles, mortality, toxicity, and overall cost for patients with oropharynx cancer undergoing definitive concurrent chemoradiation with CDDP, carboplatin, or CTX between 2006 and 2011. The human papillomavirus status was unknown. The primary outcome was 2-year overall survival (OS). RESULTS Four hundred nine patients receiving concurrent CDDP (n = 167), carboplatin (n = 69), or CTX (n = 173) were included. Those who were older, those who were nonwhite, and those with a Charlson Comorbidity Index ≥ 2 were less likely to receive CDDP. Two-year OS was inferior with CTX (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.08-2.60; P = .020) and no different with carboplatin (HR, 1.31; 95% CI, 0.73-2.35; P = .362) in a Cox proportional hazards model (reference CDDP). There was no statistically significant difference between carboplatin and CTX (HR, 1.28; 95% CI, 0.77-2.14; P = .891). Rates of antiemetic use and hospital visits for nausea/emesis/diarrhea or dehydration were statistically higher with CDDP. Pneumonia rates were higher with carboplatin. In the multivariate model, the corrected mean per-patient spending was significantly higher for CTX and carboplatin than CDDP ($61,133 and $65,721 vs $48,709). CONCLUSIONS Patients who received CDDP had improved OS. CDDP was also associated with slightly lower overall costs and higher antiemetic usage and hospital visit rates, although a strong selection bias was observed because those receiving CTX and carboplatin were older and had higher comorbidity scores.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California
| | - Megan Eguchi
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L. Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - William A. Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Abhinav Gupta
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D. McDermott
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Erminia Massarelli
- Department of Radiation Oncology, City of Hope Cancer Center, Duarte, California
| | - Cathy J. Bradley
- Department of Health Systems Management and Policy, Colorado Comprehensive Cancer Center, University of Colorado, Aurora, Colorado
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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11
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Stokes WA, Eguchi M, Amini A, Hararah MK, Ding D, McDermott JD, Bradley CJ, Karam SD. Survival impact and toxicity of metformin in head and neck cancer: An analysis of the SEER-Medicare dataset. Oral Oncol 2018; 84:12-19. [PMID: 30115470 DOI: 10.1016/j.oraloncology.2018.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Recent preclinical research has renewed interest in the interplay between glucose dysregulation and cancer. Metformin holds promise as an adjunctive antineoplastic agent in head and neck cancer (HNC). We aimed to explore the impact of metformin in HNC patients from a population-based dataset. PATIENTS & METHODS Patients diagnosed with HNC from 2008 to 2011 were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset and categorized into three groups: non-diabetics (nD), diabetics not taking metformin (DnM), and diabetics taking metformin (D + M). Overall survival (OS) and cancer-specific survival (CSS) were compared between groups using Kaplan-Meier and Cox regression controlling for sociodemographic, clinical, and treatment covariates. The incidence of toxicities associated with HNC therapy was compared among groups using χ2 analysis. RESULTS Among 1646 patients, there were 1144 nD, 378 DnM, and 124 D + M. 2-year OS rates was 65.6% for nD, 57.7% for DnM, and 73.4% for D + M by Kaplan-Meier (p < 0.01), and corresponding rates of 2-year CSS were 73.7%, 66.1%, and 88.8% (p < 0.01), respectively. On Cox multivariable analysis, OS among the three groups did not significantly differ; however, CSS was significantly worse among both nD versus DnM as compared to D + M. Toxicity rates were not significantly increased among D + M. CONCLUSION HNC patients with diabetes taking metformin experience improved CSS. Prospective investigation of the addition of metformin to standard-of-care HNC therapy is warranted.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado Denver, USA
| | - Megan Eguchi
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope Cancer Center, USA
| | | | - Ding Ding
- Department of Radiation Oncology, University of Colorado Denver, USA
| | | | - Cathy J Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Denver, USA.
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12
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Zerr J, McDermott JD, Beckmann NM, Fullick RK, Chhabra A. Case study: failure of superior capsular reconstruction using dermal allograft. Skeletal Radiol 2017; 46:1585-1589. [PMID: 28748362 DOI: 10.1007/s00256-017-2716-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Received: 05/11/2017] [Revised: 06/27/2017] [Accepted: 07/03/2017] [Indexed: 02/02/2023]
Abstract
Superior capsular reconstruction (SCR) is a novel technique for treating irreparable rotator cuff tears in younger patients in whom a reverse total shoulder arthroplasty is not the optimal treatment choice. This case study describes a middle-aged male with a recurrent, massive, irreparable rotator cuff tear treated with SCR that subsequently failed at the glenoid attachment. The patient underwent successful arthroscopic revision of the SCR. The case illustrates the MRI and arthroscopic correlations of the failed dermal allograft reconstruction, which to our knowledge has not been previously shown in the radiology literature.
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Affiliation(s)
- J Zerr
- Department of Radiology, UTSW, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | | | - N M Beckmann
- Department of Diagnostic and Interventional Imaging, Houston, TX, USA
| | - R K Fullick
- Department of Orthopedic Surgery, Houston, TX, USA
| | - A Chhabra
- Department of Radiology, UTSW, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.
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13
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Sumner WA, Stokes WA, Oweida A, Berggren KL, McDermott JD, Raben D, Abbott D, Jones B, Gan G, Karam SD. Survival impact of pre-treatment neutrophils on oropharyngeal and laryngeal cancer patients undergoing definitive radiotherapy. J Transl Med 2017; 15:168. [PMID: 28764811 PMCID: PMC5539641 DOI: 10.1186/s12967-017-1268-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/19/2017] [Indexed: 11/12/2022] Open
Abstract
Background Squamous cell carcinoma of the head and neck (HNSCC) represents an array of disease processes with a generally unfavorable prognosis. Inflammation plays an important role in tumor development and response to therapy. We performed a retrospective analysis of HNSCC patients to explore the relationship of the lymphocyte and neutrophil counts, the neutrophil-to-lymphocyte ratio (NLR) overall survival (OS), cancer-specific survival (CSS), local control (LC) and distant control (DC). Materials/methods All patients received definitive treatment for cancers of the oropharynx or larynx between 2006–2015. Neutrophil and lymphocyte counts were collected pre-, during-, and post-treatment. The correlations of patient, tumor, and biological factors to OS, CSS, LC and DC were assessed. Results 196 patients met our inclusion criteria; 171 patients were Stage III or IV. Median follow-up was 2.7 years. A higher neutrophil count at all treatment time points was predictive of poor OS with the pre-treatment neutrophil count and overall neutrophil nadir additionally predictive of DC. Higher pre-treatment and overall NLR correlated to worse OS and DC, respectively. Conclusion A higher pre-treatment neutrophil count correlates to poor OS, CSS and DC. Lymphocyte counts were not found to impact survival or tumor control. Higher pre-treatment NLR is prognostic of poor OS. Electronic supplementary material The online version of this article (doi:10.1186/s12967-017-1268-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Whitney A Sumner
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ayman Oweida
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kiersten L Berggren
- Department of Internal Medicine, Section of Radiation Oncology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, USA
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diana Abbott
- Department of Biostatistics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bernard Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory Gan
- Department of Internal Medicine, Section of Radiation Oncology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
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14
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Rusthoven CG, Lanning RM, Jones BL, Amini A, Koshy M, Sher DJ, Bowles DW, McDermott JD, Jimeno A, Karam SD. Metastatic nasopharyngeal carcinoma: Patterns of care and survival for patients receiving chemotherapy with and without local radiotherapy. Radiother Oncol 2017; 124:139-146. [DOI: 10.1016/j.radonc.2017.03.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/20/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
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15
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Wang K, McDermott JD, Schrock AB, Elvin JA, Gay L, Karam SD, Raben D, Somerset H, Ali SM, Ross JS, Bowles DW. Comprehensive genomic profiling of salivary mucoepidermoid carcinomas reveals frequent BAP1, PIK3CA, and other actionable genomic alterations. Ann Oncol 2017; 28:748-753. [PMID: 28327999 DOI: 10.1093/annonc/mdw689] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Indexed: 12/15/2022] Open
Abstract
Background We sought to identify genomic alterations (GAs) in salivary mucoepidermoid carcinomas. Patients and methods DNA was extracted from 48 mucoepidermoid carcinomas. Comprehensive genomic profiling (CGP) including the calculation to tumor mutational burden (TMB) was performed on hybridization-captured adaptor ligation-based libraries of 315 cancer-related genes plus introns from 28 genes frequently rearranged for cancer and evaluated for all classes of GAs. Results A total of 183 GAs were found in 80 unique genes. High-grade tumors had more GAs (mean 5 ± 3.8) compared with low (2.3 ± 1.4) or intermediate (2.6 ± 1.5) (P = 0.019). TP53 GAs were seen in all tumor grades (41.7%) but were most common in high-grade malignancies (56%) (P = 0.047). CDKN2A GAs were seen in 41.6% of tumors. PI3K/mTOR pathway activation, including PI3KCA mutations, were more common in high grade (52%) than in low- and intermediate-grade tumors (4.3%) (P = 0.007). BAP1 GAs were observed in 20.8% of tumors and BRCA1/2 GAs present in 10.5% of specimens. ERBB2 amplifications were seen in only 8.3% of tumors. The TMB for this patient group was relatively low with only 5 (10%) of cases having greater than 10 mutations/megabase of sequenced DNA. Conclusion CGP of salivary mucoepidermoid carcinomas revealed diverse GAs that may lead to customized treatment options for patients with these rare tumors.
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Affiliation(s)
- K Wang
- Foundation Medicine, Inc., Cambridge, USA
- Center for Precision Medicine, Zhejiang University International Hospital, Hangzhou, Zhejiang, China
| | - J D McDermott
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - J A Elvin
- Foundation Medicine, Inc., Cambridge, USA
| | - L Gay
- Foundation Medicine, Inc., Cambridge, USA
| | - S D Karam
- Departments of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - D Raben
- Departments of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - H Somerset
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - S M Ali
- Foundation Medicine, Inc., Cambridge, USA
| | - J S Ross
- Foundation Medicine, Inc., Cambridge, USA
- Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, USA
| | - D W Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
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16
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Robin TP, Jones BL, Gordon OM, Phan A, Abbott D, McDermott JD, Goddard JA, Raben D, Lanning RM, Karam SD. A comprehensive comparative analysis of treatment modalities for sinonasal malignancies. Cancer 2017; 123:3040-3049. [PMID: 28369832 DOI: 10.1002/cncr.30686] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sinonasal malignancies are a rare and heterogeneous group of tumors for which there is a paucity of robust data with which to guide management decisions. The authors used the National Cancer Data Base to better understand the presenting characteristics of these tumors and to compare outcomes by treatment modality. METHODS The National Cancer Data Base was queried for sinonasal malignancies diagnosed between 2004 and 2012. Overall survival was assessed using multivariate analyses and propensity score matching. RESULTS A total of 11,160 patients were identified for the initial analysis. The majority were male, aged 40 to 69 years, with tumors of the nasal cavity or maxillary sinus. Squamous cell histology was most common. The majority of patients presented with advanced tumor stage but without locoregional lymph node or distant metastases. Treatment modalities were compared for squamous cell carcinomas. In multivariate analysis, compared with surgery alone, patients who received adjuvant radiotherapy (hazard ratio [HR], 0.658 [P<.001]), adjuvant chemoradiotherapy (HR, 0.696 [P = .002]), or neoadjuvant therapy (HR, 0.656 [P = .007]) had improved overall survival. Patients who received radiotherapy alone (HR, 1.294 [P = .001]) or chemotherapy alone (HR, 1.834 [P<.001]) had worse outcomes. These findings were validated in propensity score matching. It is important to note that neoadjuvant chemoradiotherapy was associated with achieving a negative surgical margin (odds ratio, 2.641 [P = .045]). CONCLUSIONS Surgery is the mainstay of therapy for patients with sinonasal malignancies, but multimodality therapy is associated with improved overall survival. Cancer 2017;123:3040-49. © 2017 American Cancer Society.
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Affiliation(s)
- Tyler P Robin
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Oren M Gordon
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Andy Phan
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Diana Abbott
- Department of Biostatistics and Informatics, Colorado Biostatistics Consortium, Colorado School of Public Health, Aurora, Colorado
| | - Jessica D McDermott
- Department of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado Cancer Center, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Ryan M Lanning
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado
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17
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Stokes WA, Amini A, Jones BL, McDermott JD, Raben D, Ghosh D, Goddard JA, Bowles DW, Karam SD. Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis. Head Neck 2017; 39:1113-1121. [PMID: 28301079 DOI: 10.1002/hed.24739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/20/2016] [Accepted: 12/29/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis. METHODS 8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose. RESULTS On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88-1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort (p < .01). CONCLUSION Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1113-1121, 2017.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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18
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Amini A, Waxweiler TV, Brower JV, Jones BL, McDermott JD, Raben D, Ghosh D, Bowles DW, Karam SD. Association of Adjuvant Chemoradiotherapy vs Radiotherapy Alone With Survival in Patients With Resected Major Salivary Gland Carcinoma. JAMA Otolaryngol Head Neck Surg 2016; 142:1100-1110. [DOI: 10.1001/jamaoto.2016.2168] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora
| | - Timothy V. Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora
| | - Jeffrey V. Brower
- Department of Human Oncology, Carbone Cancer Center, School of Medicine, University of Wisconsin, Madison
| | - Bernard L. Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora
| | - Jessica D. McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora4Division of Medical Oncology, Department of Medicine, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora
| | - Debashis Ghosh
- Department of Biostatistics, University of Colorado School of Medicine, Aurora
| | - Daniel W. Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora4Division of Medical Oncology, Department of Medicine, Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora
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19
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Stokes WA, Jones BL, Bhatia S, Oweida AJ, Bowles DW, Raben D, Goddard JA, McDermott JD, Karam SD. A comparison of overall survival for patients with T4 larynx cancer treated with surgical versus organ-preservation approaches: A National Cancer Data Base analysis. Cancer 2016; 123:600-608. [PMID: 27727461 DOI: 10.1002/cncr.30382] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/18/2016] [Accepted: 09/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although laryngectomy is the treatment of choice for patients with T4 larynx cancer, many patients are unable or unwilling to undergo laryngectomy and instead pursue larynx-preservation strategies combining radiotherapy (RT) and chemotherapy. Herein, the authors analyzed the National Cancer Data Base to evaluate overall survival (OS) between patients treated with surgical and organ-preserving modalities. METHODS The National Cancer Data Base was queried for patients diagnosed from 2004 through 2012 with T4M0 laryngeal cancer who underwent either laryngectomy (surgery) with adjuvant RT (SRT), chemotherapy starting concurrently within 7 days of RT (CCRT), or multiagent induction chemotherapy starting 43 to 98 days before RT (ICRT). Multivariate analysis and propensity score matching were used to explore the association between the intervention and OS. Recursive partitioning analysis was performed to identify groups benefiting from particular modalities. RESULTS A total of 1559 patients who underwent SRT, 1597 patients who underwent CCRT, and 386 patients who underwent ICRT were included. Adjusting for covariates, CCRT was found to be associated with inferior OS compared with SRT (hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.41-1.70 [P<.01]) and with ICRT (HR, 1.25; 95% CI, 1.07-1.45 [P<.01]). OS among the patients treated with SRT did not appear to differ significantly from that of the ICRT cohort (HR, 0.87; 95% CI, 0.73-1.03 [P = 0.10]), a finding confirmed with propensity score matching. Recursive partitioning analysis identified no subset of patients that derived an OS benefit from either approach over the other. CONCLUSIONS OS among patients undergoing SRT was found to be superior to that of patients treated with CCRT but did not significantly differ from that of those undergoing ICRT. Because these intriguing findings require validation, SRT should remain the standard of care for patients with this disease. However, organ preservation with ICRT may be a reasonable alternative in certain patients. Cancer 2017;123:600-608. © 2016 American Cancer Society.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ayman J Oweida
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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20
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Wang K, Russell JS, McDermott JD, Elvin JA, Khaira D, Johnson A, Jennings TA, Ali SM, Murray M, Marshall C, Oldham DS, Washburn D, Wong SJ, Chmielecki J, Yelensky R, Lipson D, Miller VA, Stephens PJ, Serracino HS, Ross JS, Bowles DW. Profiling of 149 Salivary Duct Carcinomas, Carcinoma Ex Pleomorphic Adenomas, and Adenocarcinomas, Not Otherwise Specified Reveals Actionable Genomic Alterations. Clin Cancer Res 2016; 22:6061-6068. [DOI: 10.1158/1078-0432.ccr-15-2568] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 05/10/2016] [Accepted: 05/23/2016] [Indexed: 11/16/2022]
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21
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Amini A, Jasem J, Jones BL, Robin TP, McDermott JD, Bhatia S, Raben D, Jimeno A, Bowles DW, Karam SD. Predictors of overall survival in human papillomavirus-associated oropharyngeal cancer using the National Cancer Data Base. Oral Oncol 2016; 56:1-7. [PMID: 27086480 DOI: 10.1016/j.oraloncology.2016.02.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [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: 12/10/2015] [Revised: 01/25/2016] [Accepted: 02/23/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study identifies clinical characteristics associated with HPV-positive oropharynx squamous cell carcinoma (OPSCC) and evaluates predictors of overall survival (OS) in HPV-positive patients undergoing definitive treatment within the National Cancer Data Base (NCDB). MATERIAL AND METHODS The NCDB was queried for patients ⩾18years old with OPSCC and known HPV status who underwent definitive treatment: surgery, radiation (RT), chemotherapy-RT (CRT), surgery+RT, surgery+CRT (S-CRT). Cox proportional hazards model was used for multivariate analysis (MVA) to evaluate predictors of OS by HPV status. RESULTS 3952 patients were included: 2454 (62%) were HPV-positive. Median follow up was 23.7months (range, 1.0-54.5). Unadjusted 2-year OS rates for HPV-positive vs. negative were 93.1% vs. 77.8% (p<0.001) with an adjusted hazard ratio of 0.44 (95% CI, 0.36-0.53; p<0.001). MVA identified multimodality treatment including CRT (HR, 0.42; p=0.024) and S-RT (HR, 0.30; p=0.024), but not S-CRT (HR, 0.51; p=0.086), as predictors for improved OS in HPV-positive stage III-IVB disease. Multimodality treatment including S-CRT was associated with longer OS in HPV-negative OPSCC. Nodal stage was poorly associated with OS in HPV-positive cancers. The presence of positive margins and/or extracapsular extension was associated with worse OS in HPV-negative (HR, 2.11; p=0.008) but not HPV positive OPSCC (HR, 1.61; p=0.154). CONCLUSION The established demographic and clinical features of HPV-positive OPSCC were corroborated in the NCDB. Population analysis suggests that AJCC staging is poorly associated with OS in HPV-positive cancer, and traditional high-risk features may be less impactful. Bimodality therapy appears beneficial in HPV-positive HNSCC.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jagar Jasem
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tyler P Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica D McDermott
- Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA; Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel W Bowles
- Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA; Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
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22
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Amini A, Jones BL, McDermott JD, Serracino HS, Jimeno A, Raben D, Ghosh D, Bowles DW, Karam SD. Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base. Cancer 2016; 122:1533-43. [PMID: 26969811 DOI: 10.1002/cncr.29956] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 12/14/2015] [Revised: 01/19/2016] [Accepted: 01/27/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND The overall survival (OS) benefit of concurrent chemoradiotherapy (CRT) for head and neck squamous cell carcinoma patients older than 70 years is debated. This study examines the outcomes of elderly patients receiving CRT versus radiotherapy (RT) alone. METHODS The National Cancer Data Base was queried for patients older than 70 years with nonmetastatic oropharyngeal, laryngeal, or hypopharyngeal cancer (T3-4 or N(+)). CRT was defined as chemotherapy started within 14 days of the initiation of RT. Univariate analysis, multivariate analysis (MVA), propensity score matching (PSM), and recursive partitioning analysis (RPA) were performed. RESULTS The study included 4042 patients: 2538 (63%) received CRT. The median follow-up was 19 months. The unadjusted median OS was longer with the addition of CRT (P < .001). OS was superior with CRT in the MVA (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.58-0.68; P < .001) and PSM analyses (HR, 0.73; 95% CI, 0.66-0.80; P < .001) in comparison with RT alone. According to RPA, CRT was associated with longer OS for patients 81 years or younger with low comorbidity scores and either T1-2/N2-3 disease or T3-4/N0-3 disease. The survival benefit with CRT disappeared for 2 subgroups in the 71- to 81-year age range: those with T1-2, N1, and Charlson-Deyo 0-1 (CD0-1) disease and those with T3-4, N1+, and CD1+ disease. Patients who were older than 81 years did not have increased survival with CRT. The receipt of CRT was associated with a longer duration of RT (odds ratio, 1.74; 95% CI, 1.50-2.01; P < .001). CONCLUSIONS Patients older than 70 years should not be denied concurrent chemotherapy solely on the basis of age; additional factors, including the performance status and the tumor stage, should be taken into account. Cancer 2016;122:1533-43. © 2016 American Cancer Society.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, Colorado
| | - Hilary S Serracino
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Debashis Ghosh
- Department of Biostatistics, University of Colorado School of Public Health, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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Bowles DW, Keysar SB, Eagles JR, Wang G, Glogowska MJ, McDermott JD, Le PN, Gao D, Ray CE, Rochon PJ, Roop DR, Tan AC, Serracino HS, Jimeno A. A pilot study of cetuximab and the hedgehog inhibitor IPI-926 in recurrent/metastatic head and neck squamous cell carcinoma. Oral Oncol 2015; 53:74-9. [PMID: 26705064 DOI: 10.1016/j.oraloncology.2015.11.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND This phase 1, dose-finding study determined the safety, maximum tolerated dose (MTD)/recommended phase 2 dose (RP2D), antitumor activity, and molecular correlates of IPI-926, a Hedgehog pathway (HhP) inhibitor, combined with cetuximab in patients with relapsed/metastatic squamous cell carcinoma of the head and neck. PATIENTS AND METHODS Cetuximab was given with a 400mg/m(2) loading dose followed by 250mg/m(2) weekly. IPI-926 was given daily starting two weeks after cetuximab initiation. A "3+3" study design was used. Prior therapy with cetuximab was allowed. Tumor biopsies occurred prior to cetuximab initiation, prior to IPI-926 initiation, and after treatment with both drugs. RESULTS Nine patients were enrolled. The RP2D was 160mg, the same as the single-agent IPI-926 MTD. Among 9 treated, 8 evaluable patients, the best responses were 1 partial response (12.5%), 4 stable disease (50%), and 3 disease progressions (37.5%). The median progression free survival was 77days (95% confidence interval 39-156). Decreases in tumor size were seen in both cetuximab-naïve patients (one HPV-positive, one HPV-negative). The most frequent treatment-emergent adverse events were fatigue, muscle cramps, and rash. No DLTs were observed. Tumor shrinkage and progression free survival were associated with intra-tumoral ErbB and HhP gene expression down-regulation during therapy, supporting the preclinical hypothesis. CONCLUSION Treatment with IPI-926 and cetuximab yielded expected toxicities with signs of anti-tumor activity. Serial tumor biopsies were feasible and revealed proof-of-concept biomarkers.
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Affiliation(s)
- Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Stephen B Keysar
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Justin R Eagles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Guoliang Wang
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Magdalena J Glogowska
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Phuong N Le
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Dexiang Gao
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Charles E Ray
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Paul J Rochon
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Dennis R Roop
- Charles C. Gates Center for Regenerative Medicine and Stem Cell Biology
| | - Aik-Choon Tan
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Hilary S Serracino
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States; Charles C. Gates Center for Regenerative Medicine and Stem Cell Biology.
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Bowles DW, McDermott JD, Jimeno A. Novel treatments for head and neck squamous cell carcinoma: preclinical identification and clinical investigation. Future Oncol 2015; 10:1065-80. [PMID: 24941990 DOI: 10.2217/fon.14.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 12/29/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a common cancer worldwide. Classically, it is a disease related to tobacco and alcohol use; an increasing number of patients are being diagnosed with HNSCC caused by infection with the human papillomavirus. New deep-sequencing techniques have confirmed the importance of p53 and EGF receptor in HNSCC development, and have identified pathways of critical importance, such as PI3K/mTOR and NOTCH. Increasing knowledge of key molecular features has lead to new therapeutic avenues for HNSCC. Novel therapies under investigation in HNSCC include antibody and small molecule inhibitors of EGF receptor and its family members, PI3K inhibitors, antiangiogenic agents, immunotherapies and agents interacting with early developmental pathways such as Hedgehog.
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Affiliation(s)
- Daniel W Bowles
- Division of Medical Oncology, University of Colorado School of Medicine, CO, USA
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25
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Amini A, McDermott JD, Gan G, Bhatia S, Sumner W, Fisher CM, Jimeno A, Bowles DW, Raben D, Karam SD. Stereotactic body radiotherapy as primary therapy for head and neck cancer in the elderly or patients with poor performance. Front Oncol 2014; 4:274. [PMID: 25340041 PMCID: PMC4189612 DOI: 10.3389/fonc.2014.00274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 08/05/2014] [Accepted: 09/21/2014] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Stereotactic body radiotherapy (SBRT) is increasingly used to treat a variety of tumors, including head and neck squamous cell carcinoma (HNSCC) in the recurrent setting. While there are published data for re-irradiation using SBRT for HNSCC, there are limited data supporting its use as upfront treatment for locally advanced disease. STUDY DESIGN/METHODS Here, we describe three patients who received SBRT as the primary treatment for their HNSCC along with a review of the current literature and discussion of future pathways. RESULTS The three cases discussed tolerated treatment well with manageable acute toxicities and had either a clinical or radiographic complete response to therapy. CONCLUSION Head and neck squamous cell carcinoma presents a unique challenge in the elderly, where medical comorbidities make it difficult to tolerate conventional radiation, often given with a systemic sensitizer. For these individuals, providing a shortened course using SBRT may offer an effective alternative.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, CO , USA
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine , Aurora, CO , USA
| | - Gregory Gan
- Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, CO , USA
| | - Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, CO , USA
| | - Whitney Sumner
- Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, CO , USA
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, CO , USA
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine , Aurora, CO , USA
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine , Aurora, CO , USA
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, CO , USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine , Aurora, CO , USA
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Le PN, McDermott JD, Jimeno A. Targeting the Wnt pathway in human cancers: therapeutic targeting with a focus on OMP-54F28. Pharmacol Ther 2014; 146:1-11. [PMID: 25172549 DOI: 10.1016/j.pharmthera.2014.08.005] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [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: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 12/15/2022]
Abstract
The Wnt signaling pathways are a group of signal transduction pathways that play an important role in cell fate specification, cell proliferation and cell migration. Aberrant signaling in these pathways has been implicated in the development and progression of multiple cancers by allowing increased proliferation, angiogenesis, survival and metastasis. Activation of the Wnt pathway also contributes to the tumorigenicity of cancer stem cells (CSCs). Therefore, inhibiting this pathway has been a recent focus of cancer research with multiple targetable candidates in development. OMP-54F28 is a fusion protein that combines the cysteine-rich domain of frizzled family receptor 8 (Fzd8) with the immunoglobulin Fc domain that competes with the native Fzd8 receptor for its ligands and antagonizes Wnt signaling. Preclinical models with OMP-54F28 have shown reduced tumor growth and decreased CSC frequency as a single agent and in combination with other chemotherapeutic agents. Due to these findings, a phase 1a study is nearing completion with OMP-54F28 in advanced solid tumors and 3 phase 1b studies have been opened with OMP-54F28 in combination with standard-of-care chemotherapy backbones in ovarian, pancreatic and hepatocellular cancers. This article will review the Wnt signaling pathway, preclinical data on OMP-54F28 and other Wnt pathway inhibitors and ongoing clinical trials.
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Affiliation(s)
- Phuong N Le
- University of Colorado School of Medicine, Division of Medical Oncology, United States
| | - Jessica D McDermott
- University of Colorado School of Medicine, Division of Medical Oncology, United States
| | - Antonio Jimeno
- University of Colorado School of Medicine, Division of Medical Oncology, United States.
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28
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McDermott JD. Litigation following vaccination of dogs. Aust Vet J 1969; 45:592. [PMID: 4314572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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