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Tolaney SM, Guarneri V, Seo JH, Cruz J, Abreu MH, Takahashi M, Barrios C, McIntyre K, Wei R, Munoz M, Antonio BS, Liepa AM, Martin M, Johnston SRD, Kellokumpu-Lehtinen PL, Harbeck N. Long-term patient-reported outcomes from monarchE: Abemaciclib plus endocrine therapy as adjuvant therapy for HR+, HER2-, node-positive, high-risk, early breast cancer. Eur J Cancer 2024; 199:113555. [PMID: 38244363 DOI: 10.1016/j.ejca.2024.113555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND In monarchE, abemaciclib demonstrated a sustained benefit in invasive disease-free survival and a tolerable safety profile at 42-months median follow-up. With no expected disease-related symptoms, therapies in the adjuvant setting should preserve quality of life (QoL). With all patients off abemaciclib, we report updated patient-reported outcomes (PROs) for the full 2-year treatment period and follow-up. METHODS Patients completed PROs including FACT-B, FACT-ES, and FACIT-Fatigue at baseline, 3, 6, 12, 18, and 24 months during treatment, and 1, 6, and 12 months after treatment discontinuation. Mixed effects repeated measures model estimated changes from baseline within and between arms for QoL scales and individual items. Meaningful changes were prespecified and no statistical testing was performed. Frequencies of responses to items associated with relevant adverse events and treatment bother were summarized. RESULTS At baseline, completion rates for PRO instruments were >96 %. Mean changes from baseline for all QoL scales were numerically similar within and between arms (ie, less than prespecified thresholds). The same was observed for all individual items, except diarrhea. Within abemaciclib arm, meaningful differences for diarrhea were observed at 3 and 6 months (mean increases of 1.19 and 1.03 points on 5-point scale, respectively). During treatment, most patients in both arms (69-78 %) reported being bothered "a little bit" or "not at all" by side effects. Overall, patterns for fatigue were similar between arms. During post-treatment follow-up, PROs in both arms were similar to baseline. CONCLUSION PRO findings confirm a tolerable and reversible toxicity profile for abemaciclib. QoL was preserved with the addition of adjuvant abemaciclib to endocrine therapy, supporting its use in patients with HR+, HER2-, high-risk early breast cancer.
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Affiliation(s)
| | | | - Jae Hong Seo
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Josefina Cruz
- Hospital Universitario de Canarias, Canary Islands, Spain
| | - Miguel Henriques Abreu
- Department of Medical Oncology, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Masato Takahashi
- Department of Breast Surgery, Hokkaido University Hospital, Hokkaido, Japan
| | - Carlos Barrios
- Latin American Cooperative Oncology Group (LACOG), Oncoclínicas, Porto Alegre, Brazil
| | | | - Ran Wei
- Eli Lilly and Company, IN, USA
| | | | | | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañon, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | | | | | - Nadia Harbeck
- Breast Centre, Department of Gynaecology and Obstetrics, Comprehensive Cancer Centre Munich, LMU University Hospital, Munich, Germany
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2
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Westin SN, Moore K, Chon HS, Lee JY, Thomes Pepin J, Sundborg M, Shai A, de la Garza J, Nishio S, Gold MA, Wang K, McIntyre K, Tillmanns TD, Blank SV, Liu JH, McCollum M, Contreras Mejia F, Nishikawa T, Pennington K, Novak Z, De Melo AC, Sehouli J, Klasa-Mazurkiewicz D, Papadimitriou C, Gil-Martin M, Brasiuniene B, Donnelly C, del Rosario PM, Liu X, Van Nieuwenhuysen E. Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer: The Phase III DUO-E Trial. J Clin Oncol 2024; 42:283-299. [PMID: 37864337 PMCID: PMC10824389 DOI: 10.1200/jco.23.02132] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023] Open
Abstract
PURPOSE Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair (MMR)-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a poly(ADP-ribose) polymerase inhibitor may improve outcomes, especially in pMMR disease. METHODS This phase III, global, double-blind, placebo-controlled trial randomly assigned eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab + olaparib arm). The primary end points were progression-free survival (PFS) in the durvalumab arm versus control and the durvalumab + olaparib arm versus control. RESULTS Seven hundred eighteen patients were randomly assigned. In the intention-to-treat population, statistically significant PFS benefit was observed in the durvalumab (hazard ratio [HR], 0.71 [95% CI, 0.57 to 0.89]; P = .003) and durvalumab + olaparib arms (HR, 0.55 [95% CI, 0.43 to 0.69]; P < .0001) versus control. Prespecified, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42 [95% CI, 0.22 to 0.80]; HR [durvalumab + olaparib v control], 0.41 [95% CI, 0.21 to 0.75]) and pMMR subgroups (HR [durvalumab v control], 0.77 [95% CI, 0.60 to 0.97]; HR [durvalumab + olaparib v control] 0.57; [95% CI, 0.44 to 0.73]); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63 [95% CI, 0.48 to 0.83]; HR [durvalumab + olaparib v control], 0.42 [95% CI, 0.31 to 0.57]). Interim overall survival results (maturity approximately 28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77 [95% CI, 0.56 to 1.07]; P = .120; durvalumab + olaparib v control: HR, 0.59 [95% CI, 0.42 to 0.83]; P = .003). The safety profiles of the experimental arms were generally consistent with individual agents. CONCLUSION Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer.
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Affiliation(s)
| | - Kathleen Moore
- Stephenson Cancer Center at the University of Oklahoma Medical Center, Oklahoma, OK
| | | | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Ayelet Shai
- RAMBAM Health Care Campus, Haifa, and Israeli Society of Gynecologic Oncology (ISGO), Israel
| | | | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Michael A. Gold
- Oklahoma Cancer Specialists and Research Institute, Tulsa, OK
| | - Ke Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | | | - Todd D. Tillmanns
- West Cancer Center Research Institute & University of Tennessee Health Science Center, Memphis, TN
| | - Stephanie V. Blank
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, and GOG Foundation (GOG-F), USA
| | - Ji-Hong Liu
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Michael McCollum
- Virginia Oncology Associates, Brock Cancer Center, Norfolk, VA, and GOG Foundation (GOG-F), USA
| | | | - Tadaaki Nishikawa
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kathryn Pennington
- Fred Hutchinson Cancer Center, University of Washington Medical Center, Seattle, WA
| | - Zoltan Novak
- National Institute of Oncology, Budapest, and Central and Eastern European Gynecologic Oncology Group (CEEGOG), Hungary
| | - Andreia Cristina De Melo
- Clinical Research and Technological Development Division, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Jalid Sehouli
- Charité—Department of Gynecology with Center of Oncological Surgery, Universitätsmedizin Berlin, Berlin, and North Eastern German Society of Gynecological Oncology (NOGGO), Germany
| | - Dagmara Klasa-Mazurkiewicz
- Department of Obstetrics and Gynecology, Gynecological Oncology and Gynecological Endocrinology, Medical University of Gdańsk, Gdańsk, and Polish Gynecologic Oncology Group (PGOG), Poland
| | - Christos Papadimitriou
- Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, and Hellenic Cooperative Oncology Group (HeCOG), Greece
| | - Marta Gil-Martin
- Medical Oncology Department, Catalan Institute of Oncology-Institut d'Investigació Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals, L'Hospitalet-Barcelona, Barcelona, and Grupo Español de Investigación en Cáncer de Ovario (GEICO), Spain
| | - Birute Brasiuniene
- Department of Medical Oncology, National Cancer Institute of Lithuania, Faculty of Medicine of Vilnius University, Vilnius, and Nordic Society of Gynaecological Oncology (NSGO), Lithuania
| | - Conor Donnelly
- Oncology Biometrics, AstraZeneca, Cambridge, United Kingdom
| | | | - Xiaochun Liu
- Oncology R&D, Late-stage Development, AstraZeneca, Gaithersburg, MD
| | - Els Van Nieuwenhuysen
- University Hospital Leuven, Leuven, and Luxembourg Gynaecological Oncology Group (BGOG), Belgium
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Jamshidi A, Liu MC, Klein EA, Venn O, Hubbell E, Beausang JF, Gross S, Melton C, Fields AP, Liu Q, Zhang N, Fung ET, Kurtzman KN, Amini H, Betts C, Civello D, Freese P, Calef R, Davydov K, Fayzullina S, Hou C, Jiang R, Jung B, Tang S, Demas V, Newman J, Sakarya O, Scott E, Shenoy A, Shojaee S, Steffen KK, Nicula V, Chien TC, Bagaria S, Hunkapiller N, Desai M, Dong Z, Richards DA, Yeatman TJ, Cohn AL, Thiel DD, Berry DA, Tummala MK, McIntyre K, Sekeres MA, Bryce A, Aravanis AM, Seiden MV, Swanton C. Evaluation of cell-free DNA approaches for multi-cancer early detection. Cancer Cell 2022; 40:1537-1549.e12. [PMID: 36400018 DOI: 10.1016/j.ccell.2022.10.022] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 08/03/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
In the Circulating Cell-free Genome Atlas (NCT02889978) substudy 1, we evaluate several approaches for a circulating cell-free DNA (cfDNA)-based multi-cancer early detection (MCED) test by defining clinical limit of detection (LOD) based on circulating tumor allele fraction (cTAF), enabling performance comparisons. Among 10 machine-learning classifiers trained on the same samples and independently validated, when evaluated at 98% specificity, those using whole-genome (WG) methylation, single nucleotide variants with paired white blood cell background removal, and combined scores from classifiers evaluated in this study show the highest cancer signal detection sensitivities. Compared with clinical stage and tumor type, cTAF is a more significant predictor of classifier performance and may more closely reflect tumor biology. Clinical LODs mirror relative sensitivities for all approaches. The WG methylation feature best predicts cancer signal origin. WG methylation is the most promising technology for MCED and informs development of a targeted methylation MCED test.
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Affiliation(s)
| | - Minetta C Liu
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | - Nan Zhang
- GRAIL, LLC, Menlo Park, CA 94025, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Zhao Dong
- GRAIL, LLC, Menlo Park, CA 94025, USA
| | | | - Timothy J Yeatman
- Gibbs Cancer Center and Research Institute, Spartanburg, SC 29303, USA; Department of Surgery, University of Utah, Salt Lake City, UT 84112, USA
| | - Allen L Cohn
- Rocky Mountain Cancer Center, Denver, CO 80218, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Donald A Berry
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | | | | | | | | | - Charles Swanton
- Francis Crick Institute, London, NW1 1AT, UK; UCL Cancer Institute, CRUK Lung Cancer Centre of Excellence, London, WC1E 6DD, UK
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Geyer CE, Sikov WM, Huober J, Rugo HS, Wolmark N, O'Shaughnessy J, Maag D, Untch M, Golshan M, Ponce Lorenzo J, Metzger O, Dunbar M, Symmans WF, Rastogi P, Sohn J, Young R, Wright GS, Harkness C, McIntyre K, Yardley D, Loibl S. Long-term efficacy and safety of addition of carboplatin with or without veliparib to standard neoadjuvant chemotherapy in triple-negative breast cancer: 4-year follow-up data from BrighTNess, a randomized phase 3 trial. Ann Oncol 2022; 33:384-394. [PMID: 35093516 DOI: 10.1016/j.annonc.2022.01.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [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: 09/07/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Primary analyses of the phase 3 BrighTNess trial showed addition of carboplatin with/without veliparib to neoadjuvant chemotherapy significantly improved pathological complete response (pCR) rates with manageable acute toxicity in patients with triple-negative breast cancer (TNBC). Here, we report 4.5-year follow-up data from the trial. DESIGN Women with untreated stage II-III TNBC were randomized (2:1:1) to paclitaxel (weekly for 12 doses) plus either: (a) carboplatin (every 3 weeks for four cycles) plus veliparib (twice daily); (b) carboplatin plus veliparib placebo; or (c) carboplatin placebo plus veliparib placebo. All patients then received doxorubicin and cyclophosphamide (AC) every 2‒3 weeks for four cycles. The primary endpoint was pCR. Secondary endpoints included event-free survival (EFS), overall survival (OS), and safety. Since the co-primary endpoint of increased pCR with carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel was not met, secondary analyses are descriptive. RESULTS Of 634 patients, 316 were randomized to carboplatin plus veliparib with paclitaxel, 160 to carboplatin with paclitaxel, and 158 to paclitaxel. With median follow-up of 4.5 years, the hazard ratio [HR] for EFS for carboplatin plus veliparib with paclitaxel versus paclitaxel was 0.63 (95% confidence interval [CI] 0.43‒0.92, P=0.02), but 1.12 (95% CI 0.72‒1.72, P=0.62) for carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel. In post hoc analysis, HR for EFS was 0.57 (95% CI 0.36‒0.91, P=0.02) for carboplatin with paclitaxel versus paclitaxel. OS did not differ significantly between treatment arms, nor did rates of myelodysplastic syndromes, acute myeloid leukemia, or other secondary malignancies. CONCLUSION Improvement in pCR with addition of carboplatin was associated with long-term EFS benefit with a manageable safety profile, and without increasing the risk of second malignancies, while adding veliparib did not impact EFS. These findings support the addition of carboplatin to weekly paclitaxel followed by AC neoadjuvant chemotherapy for early stage TNBC.
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Affiliation(s)
- C E Geyer
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; Houston Methodist Cancer Center, Houston, TX, USA.
| | - W M Sikov
- Women, Infants Hospital of Rhode Island, Providence, RI, USA
| | - J Huober
- Breast Center Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - H S Rugo
- University of California San Francisco Hellen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - N Wolmark
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA; Baylor University Medical Center, Dallas, TX, USA
| | - D Maag
- AbbVie Inc., North Chicago, IL, USA
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Golshan
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - J Ponce Lorenzo
- University General Hospital of Alicante, ISABIAL, Alicante, Spain
| | - O Metzger
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M Dunbar
- AbbVie Inc., North Chicago, IL, USA
| | | | - P Rastogi
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; UPMC Hillman Cancer Center/University of Pittsburgh, Pittsburgh, PA, USA
| | - J Sohn
- Yonsei University College of Medicine, Seoul, Korea
| | - R Young
- Division of Breast Oncology, The Center for Cancer and Blood Disorders, Fort Worth, USA
| | - G S Wright
- Florida Cancer Specialists and Sarah Cannon Research Institute, New Port Richey, FL, USA
| | - C Harkness
- Hope Women's Cancer Centers, Asheville, NC, USA
| | - K McIntyre
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA
| | - D Yardley
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN, USA
| | - S Loibl
- German Breast Group, c/o GBG Forschungs GmbH, Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
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Liu M, Jamshidi A, Klein E, Venn O, Hubbell E, Beausang J, Zhang N, Kurtzman K, Hou C, Richards D, Yeatman T, Cohn A, Thiel D, Tummala M, McIntyre K, Sekeres M, Bryce A, Seiden M, Swanton C. 1123O Evaluation of cell-free DNA approaches for multi-cancer early detection. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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O’Shaughnessy J, McIntyre K, Wilks S, Ma L, Block M, Andorsky D, Danso M, Locke T, Scales A, Wang Y. Efficacy and Safety of Weekly Paclitaxel With or Without Oral Alisertib in Patients With Metastatic Breast Cancer: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e214103. [PMID: 33877311 PMCID: PMC8058641 DOI: 10.1001/jamanetworkopen.2021.4103] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Elevated expression of AURKA adversely affects prognosis in estrogen receptor (ER)-positive and ERBB2 (formerly HER2)-negative and triple-negative breast cancer and is associated with resistance to taxanes. OBJECTIVE To compare paclitaxel alone vs paclitaxel plus alisertib in patients with ER-positive and ERBB2-negative or triple-negative metastatic breast cancer (MBC). DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial conducted with the US Oncology Network, participants were randomized to intravenous (IV) paclitaxel 90 mg/m2 on days 1, 8, and 15 on a 28-day cycle or IV paclitaxel 60 mg/m2 on days 1, 8, and 15 plus oral alisertib 40 mg twice daily on days 1 to 3, 8 to 10, and 15 to 17 on a 28-day cycle. Stratification was by prior neo or adjuvant taxane and by line of metastatic therapy. Eligible patients were those who had undergone endocrine therapy, 0 or 1 prior chemotherapy regimens for MBC, more than 12 months treatment-free interval from neo or adjuvant taxane therapy, and with measurable or evaluable lytic bone-disease. Data were analyzed from March 2019 through May 2019. MAIN OUTCOMES AND MEASURES The main outcome was progression-free survival (PFS) with secondary end points of overall survival (OS), overall response rate, clinical benefit rate, safety, and analysis of archival breast cancer tissues for molecular markers associated with benefit from alisertib. RESULTS A total of 174 patients were randomized, including with 86 randomized to paclitaxel and 88 patients randomized to paclitaxel plus alisertib, and 169 patients received study treatment. The final cohort included 139 patients with a median (interquartile range [IQR]) age of 62 (27-84) years with ER-positive and ERBB2-negative MBC, with 70 randomized to paclitaxel and 69 randomized to paclitaxel plus alisertib. The TNBC cohort closed with only 35 patients enrolled due to slow accrual and were not included in efficacy analyses. The median (IQR) follow-up was 22 (10.6-25.1) months, and median (IQR) PFS was 10.2 (3.8-15.7) months with paclitaxel plus alisertib vs 7.1 (3.8-10.6) months with paclitaxel alone (HR, 0.56; 95% CI, 0.37-0.84; P = .005). Median (IQR) OS was 26.3 (12.4-37.2) months for patients who received paclitaxel plus alisertib vs 25.1 (11.0-31.4) months for paclitaxel alone (HR, 0.89; 95% CI, 0.58-1.38; P = .61). Grade 3 or 4 adverse events occurred in 56 patients (84.8%) receiving paclitaxel plus alisertib vs 34 patients (48.6%) receiving paclitaxel alone. The main grade 3 or 4 adverse events with paclitaxel plus alisertib vs paclitaxel alone were neutropenia (50 patients [59.5%] vs 14 patients [16.4%]), anemia (8 patients [9.5%] vs 1 patient [1.2%]), diarrhea (9 patients [10.7%] vs 0 patients), and stomatitis or oral mucositis (13 patients [15.5%] vs 0 patients). One patient receiving paclitaxel plus alisertib died of sepsis. CONCLUSIONS AND RELEVANCE This randomized clinical trial found that the addition of oral alisertib to a reduced dose of weekly paclitaxel significantly improved PFS compared with paclitaxel alone, and toxic effects with paclitaxel plus alisertib were manageable with alisertib dose reduction. These data support further evaluation of alisertib in patients with ER-positive, ERBB2-negative MBC. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02187991.
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Affiliation(s)
- Joyce O’Shaughnessy
- Baylor University Medical Center, Dallas, Texas
- Texas Oncology, Dallas
- US Oncology, Houston, Texas
| | | | - Sharon Wilks
- Texas Oncology, Dallas
- US Oncology, Houston, Texas
| | - Ling Ma
- US Oncology, Houston, Texas
- Rocky Mountain Cancer Centers, Lakewood, Colorado
| | - Margaret Block
- US Oncology, Houston, Texas
- Nebraska Cancer Specialists, Omaha
| | - David Andorsky
- US Oncology, Houston, Texas
- Rocky Mountain Cancer Centers, Boulder, Colorado
| | - Michael Danso
- US Oncology, Houston, Texas
- Virginia Oncology Associates, Norfolk
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Muscarella P, Bekaii-Saab T, McIntyre K, Rosemurgy A, Ross SB, Richards DA, Fisher WE, Flynn PJ, Mattson A, Coeshott C, Roder H, Roder J, Harrell FE, Cohn A, Rodell TC, Apelian D. A Phase 2 Randomized Placebo-Controlled Adjuvant Trial of GI-4000, a Recombinant Yeast Expressing Mutated RAS Proteins in Patients with Resected Pancreas Cancer. J Pancreat Cancer 2021; 7:8-19. [PMID: 33786412 PMCID: PMC7997807 DOI: 10.1089/pancan.2020.0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose: GI-4000, a series of recombinant yeast expressing four different mutated RAS proteins, was evaluated in subjects with resected ras-mutated pancreas cancer. Methods: Subjects (n = 176) received GI-4000 or placebo plus gemcitabine. Subjects' tumors were genotyped to identify which matched GI-4000 product to administer. Immune responses were measured by interferon-γ (IFNγ) ELISpot assay and by regulatory T cell (Treg) frequencies on treatment. Pretreatment plasma was retrospectively analyzed by matrix-assisted laser desorption/ionization-time-of-flight (MALDI-ToF) mass spectrometry for proteomic signatures predictive of GI-4000 responsiveness. Results: GI-4000 was well tolerated, with comparable safety findings between treatment groups. The GI-4000 group showed a similar pattern of median recurrence-free and overall survival (OS) compared with placebo. For the prospectively defined and stratified R1 resection subgroup, there was a trend in 1 year OS (72% vs. 56%), an improvement in OS (523.5 vs. 443.5 days [hazard ratio (HR) = 1.06 [confidence interval (CI): 0.53-2.13], p = 0.872), and increased frequency of immune responders (40% vs. 8%; p = 0.062) for GI-4000 versus placebo and a 159-day improvement in OS for R1 GI-4000 immune responders versus placebo (p = 0.810). For R0 resection subjects, no increases in IFNγ responses in GI-4000-treated subjects were observed. A higher frequency of R0/R1 subjects with a reduction in Tregs (CD4+/CD45RA+/Foxp3low) was observed in GI-4000-treated subjects versus placebo (p = 0.033). A proteomic signature was identified that predicted response to GI-4000/gemcitabine regardless of resection status. Conclusion: These results justify continued investigation of GI-4000 in studies stratified for likely responders or in combination with immune check-point inhibitors or other immunomodulators, which may provide optimal reactivation of antitumor immunity. ClinicalTrials.gov Number: NCT00300950.
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Affiliation(s)
- Peter Muscarella
- Department of Surgery, Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | | | | | | | - Sharona B Ross
- Digestive Disorders Institute, AdventHealth Tampa, Tampa, Florida, USA
| | | | | | - Patrick J Flynn
- Minnesota Oncology, US Oncology Research, Minneapolis, Minnesota, USA
| | - Alicia Mattson
- Smuggler Mountain Group (SMG, Inc.), Aspen, Colorado, USA
| | | | | | | | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Allen Cohn
- Rocky Mountain Cancer Center, Denver, Colorado, USA
| | | | - David Apelian
- Smuggler Mountain Group (SMG, Inc.), Aspen, Colorado, USA
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Gopinath D, Yong C, Mckenzie D, Harding-Forrester S, McIntyre K, Carey M. Laparoscopic and Robotic Mesh-Free Suture Hysteropexy Versus Mesh Sacral Hysteropexy: A Non-Randomised Comparison. J Minim Invasive Gynecol 2020. [DOI: 10.1016/j.jmig.2020.08.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Diab S, Socoteanu MP, Encarnacion CA, Osborne CRC, Hendricks CB, McIntyre K, Thomas VT, Bhaskaran R, Mittempergher L, Menicucci A, Audeh W, O'Shaughnessy J. High-risk breast cancer genes at 8q22-24 and their role in over 5,000 patients evaluated with the 70-gene risk of recurrence assay. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3569] [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
3569 Background: Previous studies have shown that CCNE2 expression is higher in patients’ cancers resistant to CDK4/6 inhibitors. Increased expression of CCNE2, MTDH, or TSPYL5, genes contained within the 70-gene risk of distant recurrence signature (70GS), has also been implicated in breast oncogenesis, poor prognosis, and chemoresistance. These genes are located on chromosome region 8q22.1, one of the most recurrently amplified regions out of all 70GS genes in breast tumors (Fatima et al. 2017). MYC, located on 8q24, is overexpressed in 40% of all breast cancers (BC). Here we examined the expression of CCNE2, MTDH, and TSPYL5 in relation to 70GS risk and the 80-gene molecular subtype signature (80GS), and their correlation with MYC expression in early stage BC patients. Methods: CCNE2, MTDH, TSPYL5, and MYC mRNA expression was measured in 5022 BC samples sent to Agendia (Irvine, CA) for 70GS and 80GS testing, which included FFPE microarray full-transcriptome data. 70GS was used to stratify patients into Ultra Low Risk (UL), Low Risk (LR), High Risk (HR), and Ultra High Risk (UH). Both 70GS and 80GS were used to classify patient samples into Luminal A, Luminal B, HER2, or Basal type. Wilcoxon rank sum test was used to assess expression differences. Results: The expression of CCNE2, MTDH, and TSPYL5 significantly correlated with each other and was higher in HR patients compared to LR patients (p < 0.001) and higher in UH patients compared to HR patients (p < 0.001). Expression of these genes was highest in Basal type tumors, 83% of which were UH, followed by Luminal B type tumors, and lowest in Luminal A type tumors. CCNE2 and MYC expression was elevated in LR compared to UL patients (p < 0.001 and p = 0.0043). There was no difference in MYC expression between HR vs. LR or UH vs. HR. Lastly, there was no association between the expression of 8q22.1 genes and MYC in any 70GS subgroup. Conclusions: Within the 70GS, CCNE2, MTDH, and TSPYL5 have similar expression patterns and when overexpressed may identify an UH cohort of BC. This observation, in addition to their physical proximity at 8q22.1 suggests a possible amplicon in this region. The highest expression of CCNE2, MTDH, and TSPYL5 associated with UH patients and is concordant with previous studies that support the role of these genes in BC metastasis. Furthermore, this analysis suggests MYC may not stratify patients based on metastatic potential. These data may be clinically relevant for stratifying patients in ongoing clinical trials evaluating response and resistance to targeted therapies in early stage BC.
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Affiliation(s)
- Sami Diab
- Rocky Mountain Cancer Center-Aurora, Aurora, CO
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10
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Wilks S, McIntyre K, Han LK, Cairo MM, Barone J, Haan J, Mittempergher L, Yoder E, Menicucci A, Wang S, Audeh W. Distinct molecular profiles of interval and screen-detected tumors in a real-world breast cancer registry. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e15587] [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
e15587 Background: Interval breast cancers (BC) are detected between routine screening mammograms and are associated with worse prognosis, requiring more aggressive treatment compared to screen-detected BC identified during scheduled mammograms. Identifying molecular differences between interval BC and screen detected BC may lay the foundation for developing novel therapies. In this study, we compared gene expression profiles of interval BC to screen-detected BC. Methods: This analysis included a subset of 2260 patients enrolled in the FLEX Registry (NCT03053193), an ongoing, prospective study evaluating primary tumor samples from stage I-III BC patients who receive 70-gene risk of recurrence testing (70GS), 80-gene molecular subtyping (80GS), and consent to collection of clinically annotated full genome data. Interval BC were diagnosed < 12 months following a normal screening mammogram. Breast tumors were classified by 70GS as having a Low Risk (LR) or High Risk (HR) of distant metastases. Tumors were classified as Luminal, HER2, or Basal type by 80GS. Differential gene expression analysis was performed with limma and subsequent pathway analysis with DAVID and GSEA. Differences in the proportion of 70GS or 80GS results, 70GS index, and Ki67 were assessed by Chi-squared test or t-test. Results: In this study, 81% (1834/2260) of patients had screen-detected BC and 19% (426) had interval BC. A higher proportion of interval BC (51%) were HR compared to screen-detected BC (44%; p = 0.01). Most LR tumors were invasive ductal carcinoma (78% interval and 73% screen-detected) and over 99% were Luminal type. Between the two LR groups, 70GS indices were similar and there was no significant difference in transcriptional profiles. Basal and HER2 subtypes were more frequent among HR interval BC compared to screen-detected BC (p = 0.03). HR interval BC had 70GS indices of higher risk compared to HR screen-detected BC (p = 0.02). Differentially expressed genes in HR interval BC compared to HR screen-detected BC were associated with MYC signaling and mitosis, which was concordant with higher Ki67 by IHC (p = 0.007). Conclusions: This real-world data analysis shows interval BC are not all biologically High Risk and can be further stratified by the 70GS, aiding in treatment decisions. Preliminary results suggest that following 70GS LR classification, there is no biological difference between interval BC and screen-detected BC. In contrast, there are distinct biological processes associated with HR interval BC, which may have implications in the management of these cancers. Clinical trial information: NCT03053193.
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Affiliation(s)
- Sharon Wilks
- Texas Oncology-San Antonio Northeast, US Oncology, San Antonio, TX
| | | | | | | | | | - Josien Haan
- Research and Development, Agendia NV, Amsterdam, Netherlands
| | | | - Erin Yoder
- Medical Affairs, Agendia, Inc., Irvine, CA
| | | | - Shiyu Wang
- Medical Affairs, Agendia Inc., Irvine, CA
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O'Shaughnessy J, McIntyre K, Wilks S, Ma L, Fintel W, Block M, Andorsky D, Danso M, Koutrelakos N, Locke T, Scales A, Steckel L, Wang Y. Abstract PD7-10: Randomized, multicenter phase II trial of weekly paclitaxel with or without the oral selective aurora kinase A (AURKA) inhibitor, Alisertib, in patients with ER+ HER2- metastatic breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd7-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Elevated expression of AURKA adversely affects prognosis in ER+ breast cancer and is associated with resistance to taxanes, endocrine therapy, and PI3K inhibitors. A recent randomized phase II trial of combined paclitaxel plus alisertib (P+A) in recurrent ovarian cancer patients (pts) showed improved progression-free survival (PFS) compared to paclitaxel (P) alone (Falchook G. JAMA Oncol 2019). We conducted a randomized phase II trial of P alone versus P+A in pts with ER+ HER2- metastatic breast cancer (MBC). Methods: The primary objective of the trial was PFS in the intent-to-treat (ITT) population with secondary endpoints of overall survival (OS), overall response rate (ORR), clinical benefit rate (CBR; CR+PR+SD>6 mos), safety and analysis of archival breast cancer for molecular predictors of benefit from alisertib. ER+ HER2- MBC pts who had had prior endocrine therapy, 0 or 1 prior chemotherapy regimens for MBC, > 12 mos treatment-free interval from neo/adjuvant taxane therapy, and who had measurable or evaluable lytic bone disease were randomized to receive P 90 mg/m2 IV D1, 8, 15 on a 28-day cycle or P 60mg/m2 D1, 8, 15 plus A 40 mg PO BID D1-3, 8-10, 15-17 on a 28-day cycle until disease progression or unacceptable toxicity. Pts were stratified by prior neo/adjuvant taxane (yes/no) and by whether they were receiving first (1L)- or second (2L)-therapy for MBC. Proportions of ORR and CBR were compared using Chi-square test between the two study arms. Kaplan-Meier estimator was applied to estimate OS and PFS and univariate Cox regression was used to assess the hazard ratio of study treatment. Results: 139 pts were randomized (69 to P+A; 70 to P) in the US Oncology Network between 2/2015 and 2/2018 and 136 pts received treatment on trial. At data cut-off, 76% of pts had had a documented PFS event and the median followup was 19.7 mos. The median age was 62 and 69% of pts received trial therapy as 1L treatment; 41% had had prior neo/adjuvant taxane therapy. Median PFS in the ITT population was 10.2 mos with P+A vs 7.1 mos with P alone, HR 0.56, 95% CI 0.37-0.84, p=0.005. Median OS was 29.8 mos with P+A vs 24.4 mos with P alone, HR 0.85, p=0.486. ORR and CBR in the response evaluable population were 31% and 67%, respectively, in the P+A arm vs 34% and 57%, respectively, in the P alone arm (p>0.05). Grade 3/4 adverse events (AEs) occurred in 83% of P+A pts vs 47% with P alone. The main grade 3/4 AEs with P+A vs P were neutropenia 59% vs 15%, anemia 10% vs 1%, febrile neutropenia 1.5% vs 0, diarrhea 11% vs 0, stomatitis 15% vs 0, peripheral neuropathy 1.5% vs 9%. 1 pt died of sepsis with P+A. Conclusions: Addition of oral A to weekly P significantly improved PFS, the primary endpoint, compared with P alone, and toxicity with P+A was manageable with A dose reduction. These data support further evaluation of alisertib in ER+ HER2- MBC pts.
Citation Format: Joyce O'Shaughnessy, Kristi McIntyre, Sharon Wilks, Ling Ma, William Fintel, Margaret Block, David Andorsky, Michael Danso, Nicholas Koutrelakos, Tracy Locke, Amy Scales, Lauren Steckel, Yunfei Wang. Randomized, multicenter phase II trial of weekly paclitaxel with or without the oral selective aurora kinase A (AURKA) inhibitor, Alisertib, in patients with ER+ HER2- metastatic breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD7-10.
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Affiliation(s)
| | | | | | - Ling Ma
- 3Rocky Mountain Cancer Centers/US Oncology, Lakewood, CO
| | | | | | | | - Michael Danso
- 7Virginia Oncology Associates/US Oncology, Norfolk, VA
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Holmes FA, Levin MK, Cao Y, Balasubramanian S, Ross JS, Krekow L, McIntyre K, Osborne C, Espina V, Liotta L, O’Shaughnessy J. Comutation of PIK3CA and TP53 in Residual Disease After Preoperative Anti-HER2 Therapy in ERBB2 (HER2)-Amplified Early Breast Cancer. JCO Precis Oncol 2019; 3:1-26. [DOI: 10.1200/po.18.00292] [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
PURPOSE To identify proteomic and genomic alterations in residual disease (RD) for human epidermal growth factor receptor 2 (HER2)-positive (HER2+) breast cancer (BC) after preoperative trastuzumab (H), lapatinib (L), or both (H+L) in combination with chemotherapy. PATIENTS AND METHODS Patients with stage II/III HER2+ BC (n = 100) were randomly assigned to preoperative treatment with H versus L 1,250mg versus H+L (L: 750 to 1,000 mg) plus 5-fluorouracil, epirubicin, and cyclophosphamide, followed by weekly paclitaxel. After receiving institutional review board–approved informed consent, targeted next-generation sequencing was performed on 20 patients’ formalin-fixed paraffin embedded tumors to characterize genomic alterations across 287 cancer-related genes. Reverse phase protein array (RPPA) analysis was performed on both the baseline biopsy and RD specimens, when available. RESULTS Two of 20 RD tissues were HER2 negative per next-generation sequencing; one sample had insufficient tissue. Of six pretreatment biopsy specimens, four were comutated with TP53 and PIK3CA. Of 17 HER2+ RD, seven specimens (41%) had PIK3CA mutations always comutated with TP53, and four (24%) also had concurrent CDK12 amplification. Overall, CDK12 amplification was observed in eight of the 17 (47%) HER2+ RD specimens. A total of 12 RD specimens (71%) had TP53 mutations. Although prevalence of individual TP53 and PIK3CA mutations was only modestly higher than published estimates for those in HER2+ primary BCs (55% and 32% for TP53 and PIK3CA, respectively), prevalence of these as comutations appeared higher (41%), compared with less than 10% in several series. On RPPA analysis of the RD tissue with comutations, the strongest Spearman ρ correlations were limited to EGFR and phospho-AKT (ρ, 0.999; P = .019) and phospho-mTOR and phospho-S6 ribosomal protein (ρ, 0.994; P = .048). CONCLUSION HER2-amplified RD tissue after preoperative H, L, or H+L plus chemotherapy was enriched for PIK3CA and TP53 comutations, and the RD tissue demonstrated activation of EGFR/AKT/mTOR signaling on RPPA.
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Affiliation(s)
- Frankie Ann Holmes
- Texas Oncology, Houston, TX
- US Oncology McKesson Specialty Health, The Woodlands, TX
| | | | - Ying Cao
- Valley Medical Oncology Consultants, Pleasanton, CA
| | | | - Jeffrey S. Ross
- Upstate Medical University, Syracuse, NY
- Foundation Medicine, Cambridge, MA
| | - Lea Krekow
- US Oncology McKesson Specialty Health, The Woodlands, TX
- Texas Oncology, Bedford, TX
| | - Kristi McIntyre
- US Oncology McKesson Specialty Health, The Woodlands, TX
- Texas Oncology, Dallas, TX
| | - Cynthia Osborne
- US Oncology McKesson Specialty Health, The Woodlands, TX
- Texas Oncology, Dallas, TX
| | | | | | - Joyce O’Shaughnessy
- US Oncology McKesson Specialty Health, The Woodlands, TX
- Baylor University Medical Center, Dallas, TX
- Texas Oncology, Dallas, TX
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McIntyre K. C-68 Expanding Pediatric Performance Validity Tests. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.230] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Effort testing with children has started to gain traction in the literature. The following case presents data from several number recall tasks similar to the Wechsler Digit Span and may expand the opportunities for embedded performance validity tests (PVTs).
Method
For the purpose of psychoeducational testing, a comprehensive battery of standardized neuropsychological tests was administered, including visual and auditory attention, language, visual-motor and fine motor skills, visual and auditory processing, executive functioning, and academics.
Results
The child showed impaired performance on Number Recall from the Kaufman Assessment Battery for Children, 2nd Edition (KABC-II) and Memory for Digits on the Comprehensive Test of Phonological Processing, 2nd Edition (CTOPP-2) that met the Weschler Digit Span cutoff indicative of poor effort. Evidence of Ganser symptoms (e.g., nearly correct or approximate answers) was present on math calculation performance on the Woodcock Johnson Tests of Achievement, 4th Edition (WJTA-IV). Further, apparently deliberate markings of “X” solely on his incorrect responses on a dichotomous (yes/no) reading task also suggested deliberate feigning of low reading skills.
Conclusions
This case highlights the importance of effort testing in children, especially as poor effort was not apparent to the examiner, nor did there appear to be any obvious gain. Comparing data on tasks similar to already established PVTs may help expand opportunities to test effort systematically and frequently throughout a neuropsychological evaluation, and has implications for other professionals (e.g., School Psychologists, Speech Language Pathologists, etc.) who evaluate children.
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Schwartzberg L, McIntyre K, Wilks S, Puhalla S, O'Shaughnessy J, Berrak E, He Y, Vahdat L. Health-related quality of life in patients receiving first-line eribulin mesylate with or without trastuzumab for locally recurrent or metastatic breast cancer. BMC Cancer 2019; 19:578. [PMID: 31195996 PMCID: PMC6567408 DOI: 10.1186/s12885-019-5674-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/03/2019] [Indexed: 01/22/2023] Open
Abstract
Background Eribulin mesylate is a nontaxane microtubule dynamics inhibitor approved for second-line (European Union) or third-line (United States) treatment of metastatic breast cancer. Two phase 2 single trials, evaluating first-line eribulin as monotherapy (Study 206; NCT01268150) or in combination with trastuzumab (Study 208; NCT01269346) in locally recurrent or metastatic breast cancer, demonstrated objective response rates of 28.6 and 71.2%, respectively. Median progression-free survival was 6.8 and 11.6 months, respectively. Tolerability profiles were similar to those from previous studies. This secondary analysis was conducted to assess health-related quality of life (HRQoL) in both phase 2 trials. Methods Patients received eribulin mesylate 1.4 mg/m2 intravenously on days 1 and 8 of each 21-day cycle. Patients in Study 208 also received intravenous trastuzumab on day 1 of each cycle (8 mg/kg in cycle 1, then 6 mg/kg). HRQoL was assessed by the European Organization for Research and Treatment of Cancer Quality-of-Life (QLQ-C30) assessment tool and the Quality-of-Life Questionnaire for Breast Cancer (QLQ-BR23) at baseline and cycles 2, 4, and 6. Results for clinically meaningful changes were based on previously published minimum important differences. Results Of the 108 patients (56 in Study 206 and 52 in Study 208) treated, 57 and 87%, respectively, completed 6 cycles. Completion rates for both questionnaires were 94 and 98%, respectively, at cycle 6. Most patients had stable/improved HRQoL scores with some exceptions; for example, more patients experienced a worsening in cognitive functioning and systemic therapy side effects than experienced improvement. Mean QLQ-C30 symptom scores correlated with corresponding adverse event rates for nausea/vomiting, dyspnea, appetite loss, constipation, and diarrhea in Study 206 and for fatigue, nausea/vomiting, pain, dyspnea, insomnia, constipation, and diarrhea in Study 208. Conclusions First-line eribulin ± trastuzumab therapy did not lead to deterioration of overall HRQoL in most patients, with more than 60% of patients having stable/improved global health status/quality-of-life scores. Eribulin has been demonstrated to be comparable with other chemotherapy agents with an acceptable safety profile. Therefore, further evaluation is warranted to determine whether eribulin ± trastuzumab therapy may be a potential option for first-line treatment in some patients with metastatic breast cancer who were recently treated in the neoadjuvant setting. Trial registration NCT01268150 (December 29, 2010), NCT01269346 (January 4, 2011) Electronic supplementary material The online version of this article (10.1186/s12885-019-5674-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lee Schwartzberg
- West Cancer Center, 7945 Wolf River Blvd, Germantown, TN 38138, TN, 38120, USA.
| | - Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, US Oncology, Dallas, TX, USA
| | - Sharon Wilks
- US Oncology-Cancer Care Centers of South Texas, San Antonio, TX, USA
| | - Shannon Puhalla
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA
| | - Erhan Berrak
- Eisai Inc. (former employees), Woodcliff Lake, NJ, USA
| | - Yaohua He
- Eisai Inc. (former employees), Woodcliff Lake, NJ, USA
| | - Linda Vahdat
- Weill Cornell Medical College, New York, NY, USA
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Milidonis M, Roberts S, Keehan J, McIntyre K. HEALTH LITERACY TOOLS: BARRIERS, FACILITATORS AND BENEFITS IN PHYSICAL THERAPY EXERCISE INTERVENTIONS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McIntyre K, Blackwood R, Riley V, Carballo L, Plant H, Marler-Hausen T. Group pre-chemotherapy education: Improving patient experience through education and empowerment. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hansra DM, McIntyre K, Ramdial J, Sacks S, Patrick CS, Cutler J, McIntyre B, Feister K, Miller M, Taylor AK, Farooq F, de Mayolo JA, Ahn E. Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center. Evid Based Complement Alternat Med 2018; 2018:8081018. [PMID: 29849727 PMCID: PMC5925032 DOI: 10.1155/2018/8081018] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 11/20/2022]
Abstract
Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P ≤ 0.05). Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.
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Affiliation(s)
- D. M. Hansra
- Cancer Treatment Centers of America, Atlanta, GA, USA
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - K. McIntyre
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J. Ramdial
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - S. Sacks
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - C. S. Patrick
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J. Cutler
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - B. McIntyre
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - K. Feister
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - M. Miller
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - A. K. Taylor
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - F. Farooq
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - E. Ahn
- Cancer Treatment Centers of America, Atlanta, GA, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Miller School of Medicine, University of Miami, Miami, FL, USA
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Loibl S, O'Shaughnessy J, Untch M, Sikov WM, Rugo HS, McKee MD, Huober J, Golshan M, von Minckwitz G, Maag D, Sullivan D, Wolmark N, McIntyre K, Ponce Lorenzo JJ, Metzger Filho O, Rastogi P, Symmans WF, Liu X, Geyer CE. Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase 3 trial. Lancet Oncol 2018; 19:497-509. [DOI: 10.1016/s1470-2045(18)30111-6] [Citation(s) in RCA: 401] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022]
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19
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Geyer CE, O'Shaughnessy J, Untch M, Sikov W, Rugo HS, McKee MD, Huober JB, Golshan M, Giranda VL, Von Minckwitz G, Maag D, Sullivan DM, Wolmark N, McIntyre K, Ponce Lorenzo JJ, Metzger Filho O, Rastogi P, Symmans WF, Liu X, Loibl S. Phase 3 study evaluating efficacy and safety of veliparib (V) plus carboplatin (Cb) or Cb in combination with standard neoadjuvant chemotherapy (NAC) in patients (pts) with early stage triple-negative breast cancer (TNBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.520] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
520 Background: Clinical studies suggest that TNBC is sensitive to DNA-damaging agents, including Cb. V is a potent PARP inhibitor that may enhance the antitumor activity of such agents. We present primary response data from a phase 3 randomized, placebo-controlled study (NCT02032277) evaluating the addition of V + Cb or Cb to neoadjuvant paclitaxel (P) followed by doxorubicin + cyclophosphamide (AC). Methods: Pts with histologically confirmed, invasive TNBC (T2–T4 N0–2 or T1 N1–2) amenable to surgical resection were randomized 2:1:1 to (Arm A) P 80 mg/m2 weekly + Cb AUC 6 mg/mL/min q3 weeks + V 50 mg PO BID; (Arm B) P + Cb + PO placebo; or (Arm C) P + IV placebo + PO placebo, for 12 weeks followed by AC (60 mg/m2 or 600 mg/m2 q2 or 3 weeks) × 4. Primary endpoint was pathologic complete response (pCR) in breast and nodes with > 80% power at 2-sided α of 0.05 using pair-wise comparisons for A vs B and A vs C to detect significant treatment effects using Χ2 test; secondary endpoint was rate of conversion to eligibility for breast conservation surgery (BCS). Adverse events (AEs) were assessed with NCI CTCAE V4.0. Results: Six hundred thirty-four pts (median age 50 years; range 22–79) were randomized to Arms A (n = 316), B (n = 160), or C (n = 158). Baseline characteristics were well balanced. No pCR difference was observed between Arms A and B (53.2% vs 57.5% p = 0.36), but pCR in Arm A was higher than Arm C (53.2% vs 31.0% p < 0.001). In non-prespecified analysis, pCR in Arm B was also higher than Arm C (57.5% vs 31.0% p < 0.001). Among pts ineligible for BCS at screening (n = 141), 62% were eligible after NAC in Arm A vs 44% each in Arms B (p = 0.13) and C (p = 0.14). Grade 3–4 AEs (Arms A/B/C, 86%/85%/45%) and serious AEs (30%/27%/14%) neutropenia, thrombocytopenia, anemia, nausea, and vomiting were increased with the addition of Cb; V did not impact toxicity. Median cycles of NAC were not reduced with V + Cb + P or Cb + P vs P. Conclusions: Addition of V to neoadjuvant Cb + P followed by AC did not increase pCR rate in breast and nodes in stage II–III TNBC, while addition of V + Cb or Cb alone to P followed by AC did. Cb (+/– V) increased toxicity but did not impact delivery of NAC. Clinical trial information: NCT02032277.
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Affiliation(s)
- Charles E. Geyer
- Virginia Commonwealth University Massey Cancer Center, Richmond, VA
| | | | | | - William Sikov
- Women and Infants Hospital in Rhode Island, Providence, RI
| | - Hope S. Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | | | | | - Mehra Golshan
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | - Norman Wolmark
- National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA
| | - Kristi McIntyre
- Texas Oncology, The US Oncology Network, McKesson Specialty Health, Dallas, TX
| | - Jose Juan Ponce Lorenzo
- Hospital General Universitario de Alicante, GEICAM (Grupo Español de Investigación en Cáncer de Mama), Alicante, Spain
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Berenson J, Manges R, Badarinath S, Cartmell A, McIntyre K, Lyons R, Harb W, Mohamed H, Nourbakhsh A, Rifkin R. A phase 2 safety study of accelerated elotuzumab infusion, over less than 1 h, in combination with lenalidomide and dexamethasone, in patients with multiple myeloma. Am J Hematol 2017; 92:460-466. [PMID: 28213943 DOI: 10.1002/ajh.24687] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/27/2017] [Accepted: 02/14/2017] [Indexed: 12/21/2022]
Abstract
Elotuzumab, an immunostimulatory SLAMF7-targeting monoclonal antibody, induces myeloma cell death with minimal effects on normal tissue. In a previous phase 3 study in patients with relapsed/refractory multiple myeloma (RRMM), elotuzumab (10 mg/kg, ∼3-h infusion), combined with lenalidomide and dexamethasone, demonstrated durable efficacy and acceptable safety; 10% (33/321) of patients had infusion reactions (IRs; Grade 1/2: 29; Grade 3: 4). This phase 2 study (NCT02159365) investigated an accelerated infusion schedule in 70 patients with newly diagnosed multiple myeloma or RRMM. The primary endpoint was cumulative incidence of Grade 3/4 IRs by completion of treatment Cycle 2. Dosing comprised elotuzumab 10 mg/kg intravenously (weekly, Cycles 1-2; biweekly, Cycles 3+), lenalidomide 25 mg (daily, Days 1-21), and dexamethasone (28 mg orally and 8 mg intravenously, weekly, Cycles 1-2; 40 mg orally, weekly, Cycles 3+), in 28-day cycles. Premedication with diphenhydramine, acetaminophen, and ranitidine (or their equivalents) was given as in previous studies. If no IRs occurred, infusion rate was increased in Cycle 1 from 0.5 to 2 mL/min during dose 1 (∼2 h 50 min duration) to 5 mL/min for the entire infusion by dose 3 and also during all subsequent infusions (∼1-h duration). Median number of treatment cycles was six. No Grade 3/4 IRs occurred; only one Grade 1 and one Grade 2 IR occurred, both during the first infusion. These data support the safety of a faster infusion of elotuzumab administered over ∼1 h by the third dose, providing a more convenient alternative dosing option for patients.
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Affiliation(s)
- James Berenson
- Institute for Myeloma and Bone Cancer ResearchWest Hollywood California
| | - Robert Manges
- Investigative Clinical Research of IndianaIndianapolis Indiana
| | | | - Alan Cartmell
- Comprehensive Blood & Cancer CentersBakersfield California
| | | | - Roger Lyons
- US Oncology Research and Texas OncologySan Antonio Texas
| | - Wael Harb
- Horizon Oncology ResearchLafayette Indiana
| | | | | | - Robert Rifkin
- US Oncology Research and Rocky Mountain Cancer CentersDenver Colorado
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Smith I, Yardley D, Burris H, De Boer R, Amadori D, McIntyre K, Ejlertsen B, Gnant M, Jonat W, Pritchard KI, Dowsett M, Hart L, Poggio S, Comarella L, Salomon H, Wamil B, O'Shaughnessy J. Comparative Efficacy and Safety of Adjuvant Letrozole Versus Anastrozole in Postmenopausal Patients With Hormone Receptor-Positive, Node-Positive Early Breast Cancer: Final Results of the Randomized Phase III Femara Versus Anastrozole Clinical Evaluation (FACE) Trial. J Clin Oncol 2017; 35:1041-1048. [PMID: 28113032 DOI: 10.1200/jco.2016.69.2871] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The Letrozole (Femara) Versus Anastrozole Clinical Evaluation (FACE) study compared the efficacy and safety of adjuvant letrozole versus anastrozole in postmenopausal patients with hormone receptor (HR) -positive and node-positive early breast cancer (eBC). Methods Postmenopausal women with HR-positive and node-positive eBC were randomly assigned to receive adjuvant therapy with either letrozole (2.5 mg) or anastrozole (1 mg) once per day for 5 years or until recurrence of disease. Patients were stratified on the basis of the number of lymph nodes and human epidermal growth factor receptor 2 status. The primary end point was 5-year disease-free survival (DFS), and the key secondary end points were overall survival and safety. Results A total of 4,136 patients were randomly assigned to receive either letrozole (n = 2,061) or anastrozole (n = 2,075). The final analysis was done at 709 DFS events (letrozole, 341 [16.5%]; anastrozole, 368 [17.7%]). The 5-year estimated DFS rate was 84.9% for letrozole versus 82.9% for anastrozole arm (hazard ratio, 0.93; 95% CI, 0.80 to 1.07; P = .3150). Exploratory analysis showed similar DFS with letrozole and anastrozole in all evaluated subgroups. The 5-year estimated overall survival rate was 89.9% for letrozole versus 89.2% for anastrozole arm (hazard ratio, 0.98; 95% CI, 0.82 to 1.17; P = .7916). Most common grade 3 to 4 adverse events (> 5% of patients) reported for letrozole versus anastrozole were arthralgia (3.9% v 3.3%, and 48.2% v 47.9% for all adverse events), hypertension (1.2% v 1.0%), hot flushes (0.8% v 0.4%), myalgia (0.8% v 0.7%), dyspnea (0.8% v 0.5%), and depression (0.8% v 0.6%). Conclusion Letrozole did not demonstrate significantly superior efficacy or safety compared with anastrozole in postmenopausal patients with HR-positive, node-positive eBC.
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Affiliation(s)
- Ian Smith
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Denise Yardley
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Howard Burris
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Richard De Boer
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Dino Amadori
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Kristi McIntyre
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Bent Ejlertsen
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Michael Gnant
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Walter Jonat
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Kathleen I Pritchard
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Mitch Dowsett
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Lowell Hart
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Susan Poggio
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Lisa Comarella
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Herve Salomon
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Barbara Wamil
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
| | - Joyce O'Shaughnessy
- Ian Smith and Mitch Dowsett, Royal Marsden Hospital; Institute of Cancer Research, London, United Kingdom; Denise Yardley and Howard Burris, Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN; Richard De Boer, Royal Melbourne and Western Hospitals, Melbourne, Australia; Dino Amadori, Istituto Scientifico Romagnolo per lo Studio e la Cura del Tumori Istituto di Ricovero eCura a Carattere Scientifico, Meldola; Lisa Comarella, CROS NT, Verona, Italy; Kristi McIntyre and Joyce O'Shaughnessy, Texas Oncology, US Oncology; Joyce O'Shaughnessy, Baylor University Medical Center; Baylor Charles A. Sammons Cancer Center; The US Oncology Network, Dallas, TX; Bent Ejlertsen, Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark; Michael Gnant, Medical University of Vienna, Vienna, Austria; Walter Jonat, Universitätsklinikum Schleswig-Holstein, Kiel, Germany; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Lowell Hart, Florida Cancer Specialists, Fort Myers, FL; Susan Poggio and Barbara Wamil, Novartis Pharmaceuticals Corporation, East Hanover, NJ; and Herve Salomon, Novartis Pharma, Rueil-Malmaison, France
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Bianco KE, McIntyre K. The Rise of Post-Grant Proceedings. ACS Med Chem Lett 2017; 8:4-6. [PMID: 28105262 DOI: 10.1021/acsmedchemlett.6b00460] [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: 11/28/2022] Open
Abstract
This viewpoint provides a brief overview of the procedures for initiating post-grant proceedings before the United States Patent Trial and Appeal Board, including a discussion of why companies are now commonly electing to use those proceedings, both as part of an overall litigation strategy and outside of the litigation context.
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Affiliation(s)
- Krista E. Bianco
- Finnegan, Henderson, Farabow, Garrett, and Dunner LLP, Washington, DC 20001-4413, United States
| | - Kristi McIntyre
- Finnegan, Henderson, Farabow, Garrett, and Dunner LLP, Washington, DC 20001-4413, United States
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Wilks S, McIntyre K. Case Studies in the Management of Metastatic Breast Cancer with Eribulin. Clin Med Insights Oncol 2015; 9:81-5. [PMID: 26508896 PMCID: PMC4607072 DOI: 10.4137/cmo.s27962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/12/2015] [Accepted: 07/14/2015] [Indexed: 11/06/2022]
Abstract
Outcomes for triple-negative or hormone-refractory metastatic breast cancer (MBC) are poor and treatment options are limited. Described herein are cases of two women who developed MBC following adjuvant chemotherapy and endocrine therapy for human epidermal growth factor receptor 2 (HER2)-negative ductal carcinoma. Both underwent treatment with fulvestrant, followed by paclitaxel and letrozole or nab-paclitaxel. Following disease progression, both patients started single-agent eribulin mesylate (1.4 mg/m2 on Days 1 and 8 of a 21-day cycle). The first patient is currently continuing on eribulin at full dose, despite interruption for hip surgery and the presence of grade 1 neuropathy in the hands and feet. The second patient had a partial response with eribulin, which was sustained for 4 months. She was able to tolerate the full dose of eribulin despite slight worsening of the neuropathy that was present at baseline. Eribulin may be a beneficial option for hormone-refractory MBC with extensive treatment experience.
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Affiliation(s)
- Sharon Wilks
- US Oncology-Cancer Care Centers of South Texas, San Antonio, TX, USA
| | - Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, US Oncology, Dallas, TX, USA
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O'Shaughnessy J, McIntyre K, Schwartzberg L, Wilks S, Puhalla S, Berrak E, Song J, Vahdat L. Impact of prior anthracycline or taxane use on eribulin effectiveness as first-line treatment for metastatic breast cancer: results from two phase 2, multicenter, single-arm studies. Springerplus 2015; 4:532. [PMID: 26413438 PMCID: PMC4577494 DOI: 10.1186/s40064-015-1322-y] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/08/2015] [Indexed: 01/07/2023]
Abstract
Eribulin mesylate has efficacy in patients who have received ≥2 prior chemotherapies for metastatic breast cancer (MBC) including an anthracycline and taxane. Phase 2 trials showed clinical activity and acceptable tolerability of first-line eribulin (HER2− MBC; Study 206) and eribulin plus trastuzumab (HER2+ MBC; Study 208). Prespecified analyses evaluated efficacy by prior anthracycline and/or taxane use. Patients received eribulin mesylate (1.4 mg/m2 IV; Days 1 and 8) and, in Study 208, trastuzumab (8 mg/kg IV/Cycle 1, then 6 mg/kg; Day 1) in 21-day cycles. Endpoints included objective response rate (ORR), progression-free survival (PFS), and tolerability. In Study 206 (N = 56), 48 % of patients had received prior anthracycline, 46 % prior taxane, 36 % prior anthracycline and taxane, and 41 % were chemotherapy-naïve. In Study 208 (N = 52), these percentages were 21, 44, 17, and 52 %, respectively. In Study 206, ORR and median PFS were similar for anthracycline-pretreated (25.9 %, 5.8 months), taxane-pretreated (26.9 %, 5.8 months), anthracycline- and taxane-pretreated (25.0 %, 6.7 months), and anthracycline/taxane-naïve patients (30.4 %, 7.6 months). In Study 208, ORR/median PFS were 63.6 %/6.7 months among anthracycline-pretreated patients, 56.5 %/6.8 months among taxane-pretreated patients, 55.6 %/5.9 months among anthracycline- and taxane-pretreated patients, and 81.5 %/13.1 months among anthracycline/taxane-naïve patients. Tolerability was generally similar among subgroups. In these studies, first-line eribulin in HER2− MBC and eribulin/trastuzumab in HER2+ MBC was effective with acceptable tolerability, regardless of prior anthracycline/taxane treatment. Prior chemotherapy was associated with lower ORR and shorter PFS with eribulin/trastuzumab in HER2+ MBC but not with eribulin in HER2− MBC.
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Affiliation(s)
- Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, US Oncology, 3410 Worth Street, Ste 400, Dallas, TX 75246 USA
| | - Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, US Oncology, Dallas, TX 75231 USA
| | | | - Sharon Wilks
- US Oncology-Cancer Care Centers of South Texas, San Antonio, TX 78217 USA
| | - Shannon Puhalla
- University of Pittsburgh Medical Center, Pittsburgh, PA 15213 USA
| | | | - James Song
- Eisai Inc., Woodcliff Lake, NJ 07677 USA
| | - Linda Vahdat
- Weill Cornell Medical College, New York, NY 10065 USA
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Smith JW, Vukelja S, Hoffman AD, Jones VE, McIntyre K, Berrak E, Song JX, O'Shaughnessy J. Phase II, Multicenter, Single-Arm, Feasibility Study of Eribulin Combined With Capecitabine for Adjuvant Treatment in Estrogen Receptor-Positive, Early-Stage Breast Cancer. Clin Breast Cancer 2015; 16:31-7. [PMID: 26433876 DOI: 10.1016/j.clbc.2015.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 06/02/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The present phase II, open-label, multicenter study explored the feasibility, safety, and tolerability of eribulin, a novel non-taxane microtubule inhibitor, plus capecitabine as adjuvant therapy. PATIENTS AND METHODS Postmenopausal women with early-stage, human epidermal growth factor receptor 2 (HER2)-negative, estrogen-receptor (ER)-positive breast cancer received four 21-day cycles of treatment with eribulin mesylate (1.4 mg/m(2) intravenously on days 1 and 8 of each cycle) combined with capecitabine (900 mg/m(2) orally twice daily on days 1-14 of each cycle [standard schedule] or 1500 mg orally twice daily using a 7-days on/7-days off schedule [weekly schedule]). Feasibility was determined by the relative dose intensity (RDI) of the combination using prespecified criteria for 80% of patients achieving an RDI of ≥ 85%, with a lower 95% confidence boundary > 70%. RESULTS The mean RDI was 90.6%, and the feasibility rate was 81.3% among women (n = 67, mean age, 61.3 years) receiving the standard schedule and 95.6% and 100% among women (n = 10, mean age 62.3 years) receiving the weekly schedule. Dose reductions, missed doses, and withdrawals due to adverse events (most commonly hand-foot syndrome) ascribed to capecitabine led to a higher RDI (93.5% vs. 87.8%) and feasibility rate (82.8% vs. 71.9%) for eribulin than for capecitabine using the standard dosing schedule. The most common adverse events were alopecia and fatigue. CONCLUSION Eribulin plus capecitabine with standard or weekly dosing schedules is feasible in patients with early-stage, HER2-negative, ER-positive breast cancer. Full-dose eribulin (1.4 mg/m(2) on days 1 and 8) with capecitabine (1500 mg orally twice daily, 7 days on/7 days off) is recommended as a regimen for further evaluation.
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Affiliation(s)
- John W Smith
- Compass Oncology, The US Oncology Network, Portland, OR.
| | | | | | - Vicky E Jones
- Yakima Valley Memorial Hospital-North Star Lodge Cancer Center, Yakima, WA
| | - Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, The US Oncology Network, Dallas, TX
| | | | | | - Joyce O'Shaughnessy
- Texas Oncology-Baylor Charles A. Sammons Cancer Center, The US Oncology Network, Dallas, TX
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O'Shaughnessy J, Koeppen H, Xiao Y, Lackner MR, Paul D, Stokoe C, Pippen J, Krekow L, Holmes FA, Vukelja S, Lindquist D, Sedlacek S, Rivera R, Brooks R, McIntyre K, Brownstein C, Hoersch S, Blum JL, Jones S. Patients with Slowly Proliferative Early Breast Cancer Have Low Five-Year Recurrence Rates in a Phase III Adjuvant Trial of Capecitabine. Clin Cancer Res 2015; 21:4305-11. [PMID: 26041745 DOI: 10.1158/1078-0432.ccr-15-0636] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE We conducted a randomized phase III study to determine whether patients with early breast cancer would benefit from the addition of capecitabine (X) to a standard regimen of doxorubicin (A) plus cyclophosphamide (C) followed by docetaxel (T). EXPERIMENTAL DESIGN Treatment comprised eight cycles of AC→T (T dose: 100 mg/m(2) on day 1) or AC→XT (X dose: 825 mg/m(2) twice daily, days 1-14; T dose: 75 mg/m(2) on day 1). The primary endpoint was 5-year disease-free survival (DFS). RESULTS Of 2,611 women, 1,304 were randomly assigned to receive AC→T and 1,307 to receive AC→XT. After a median follow-up of 5 years, the study failed to meet its primary endpoint [HR, 0.84; 95% confidence interval (CI), 0.67-1.05; P = 0.125]. A significant improvement in overall survival, a secondary endpoint, was seen with AC→XT versus AC→T (HR, 0.68; 95% CI, 0.51-0.92; P = 0.011). There were no unexpected adverse events. Of patients with estrogen receptor (ER)-positive/HER2-negative disease, 70% of whom were node-positive, 26% and 59% had tumors with a centrally assessed Ki-67 score of <10% or <20%, respectively, and only 17 (2%) and 53 (6%) DFS events, respectively, occurred in these groups at 7 years. CONCLUSIONS The very low event rate in patients with ER-positive, low Ki-67 cancers, regardless of nodal status, strongly suggests that these patients should not be enrolled in adjuvant trials that assess 5-year DFS rates and that central Ki-67 analyses can identify these patients.
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Affiliation(s)
| | | | | | | | | | | | - John Pippen
- Texas Oncology Baylor-Sammons Cancer Center, US Oncology, Dallas, Texas
| | - Lea Krekow
- Texas Oncology-The Breast Care Center of North Texas, US Oncology, Bedford, Texas
| | | | | | | | | | - Ragene Rivera
- Texas Oncology-El Paso Cancer Treatment Center, US Oncology, El Paso, Texas
| | - Robert Brooks
- Arizona Oncology Associates, US Oncology, Tucson, Arizona
| | - Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, US Oncology, Dallas, Texas
| | | | | | - Joanne L Blum
- Texas Oncology Baylor-Sammons Cancer Center, US Oncology, Dallas, Texas
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Schwartzberg L, McIntyre K, O'Shaughnessy J, Glück S, Berrak E, Song J, Cox D, Vahdat L. Abstract P5-17-02: Quality of life in patients receiving first-line eribulin mesylate for HER2- locally recurrent or MBC. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p5-17-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Eribulin mesylate is a nontaxane microtubule inhibitor approved to treat MBC in patients (pts) who previously received ≥2 chemotherapeutic regimens for MBC. A phase 2 study of first-line eribulin for HER2-negative (HER2-) MBC showed an overall response rate of 29%, median 6.8 m progression-free survival, and tolerability consistent with earlier studies. We present prespecified quality of life (QoL) results for this trial.
Methods: Pts (N=56) received eribulin mesylate 1.4 mg/m2 IV on days 1 and 8 of each 3-wk cycle (median: 7 cycles). QoL was assessed using the EORTC QoL assessment (QLQ-C30) and a breast-cancer specific questionnaire (QLQ-BR23) pretreatment (baseline) and on day 1 of every other cycle during treatment. Percentage of pts with at least ±10-point change from baseline was summarized descriptively. Linear mixed-effects models were used to evaluate changes over time and compare responders vs nonresponders controlling for baseline score and time effect. Time-to-event analysis was performed on time to deterioration, defined as time from 1st dose to 1st occurrence of worsening in QoL score that reached minimally clinically important difference (MID; eg, 10 points in global health status in QLQ-C30) from baseline without further improvement of at least MID.
Results: For QLQ-C30 at cycle 6 (n=29), more pts had at least a 10-point improvement from baseline in role, emotional, and social functioning; fatigue, nausea/vomiting, pain, dyspnea, and insomnia item scores, than had worsening. More pts had worsening in global health status/QoL, cognitive functioning, and diarrhea (Table).
Category, n (%) ImprovedStableWorsenedGlobal health status/QoL2 (7)16 (55)11 (38)Physical functioning9 (31)13 (45)7 (24)Role functioning14 (48)10 (35)5 (17)Emotional functioning9 (31)14 (48)6 (21)Cognitive functioning2 (7)13 (45)14 (48)Social functioning10 (35)13 (45)6 (21)Fatigue16 (55)5 (17)8 (28)Nausea and vomiting8 (28)16 (55)5 (17)Pain15 (52)8 (28)6 (21)Dyspnea9 (31)18 (62)2 (7)Insomnia12 (41)15 (52)2 (7)Appetite loss7 (24)16 (55)6 (21)Constipation5 (17)18 (62)6 (21)Diarrhea2 (7)21 (72)6 (21)
Median time to deterioration in global health status/QoL was 5.06 m (responders, 8.54 m; nonresponders, 3.71 m; hazard ratio=0.60, P=0.22). In linear mixed models, responders (n=16) performed better than nonresponders (n=40) in role functioning (P=0.011), emotional functioning (P=0.031), fatigue (P=0.007), pain (P=0.047), insomnia (P=0.018), and appetite loss (P=0.032). Mean symptom scores were significantly correlated with corresponding adverse event rates for nausea and vomiting, dyspnea, appetite loss, constipation, and diarrhea; Spearman rank correlation coefficients ranged from 0.31 to 0.54. For QLQ-BR23 at cycle 6, symptom scores were mostly stable; more pts had worsening in body image and systemic therapy side effects than had improvement and more pts had improvement in breast and arm symptoms than had worsening. Responders also had longer time to symptom deterioration.
Conclusions: In this study of first-line eribulin treatment for HER2- MBC, a majority of pts had stable or improvement in QoL scales. Responders to eribulin were more likely than nonresponders to have stable or improved QoL.
Citation Format: Lee Schwartzberg, Kristi McIntyre, Joyce O'Shaughnessy, Stefan Glück, Erhan Berrak, James Song, David Cox, Linda Vahdat. Quality of life in patients receiving first-line eribulin mesylate for HER2- locally recurrent or MBC [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-17-02.
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Affiliation(s)
| | | | | | - Stefan Glück
- 4Sylvester Comprehensive Cancer Center, University of Miami Health System
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Smith II JW, Vukelja S, Hoffman A, Jones V, McIntyre K, Berrak E, Teng A, Cox D, O'Shaughnessy J. Abstract P3-09-09: Eribulin mesylate plus capecitabine for adjuvant treatment in post-menopausal ER+ early-stage breast cancer: A phase 2, multicenter, open-label study using 2 different dosage regimens. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p3-09-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Eribulin mesylate is a novel non-taxane microtubule inhibitor. The primary objective of this study was to explore feasibility of administering eribulin plus capecitabine as adjuvant therapy in subjects with early-stage, estrogen receptor-positive (ER+) breast cancer.
Methods: In this phase 2, open-label, multicenter study, 67 postmenopausal women with early HER2-normal/HER2-negative, ER+ breast cancer received four 21-day cycles of treatment with eribulin mesylate (1.4 mg/m2 IV on day 1 and day 8 of each cycle) in combination with capecitabine (900 mg/m2 orally twice daily on days 1 through 14 of each cycle). A second dosage regimen for capecitabine was initiated after dose reductions and treatment discontinuations were noted and attributed to capecitabine-related toxicities, such as grade 3/4 GI events and hand-foot syndrome. As a consequence, capecitabine was administered to an additional cohort of 10 subjects at a fixed dose of 1500 mg given orally twice daily on a 7 days on/7 days off schedule for the 4 cycles; eribulin mesylate was administered on the same dosage schedule as the original regimen (1.4 mg/m2 IV on day 1 and day 8 of each cycle). The 7 days on/7 days off regimen for capecitabine was based on mathematical modeling and has been shown to have an acceptable toxicity profile, including minimal gastrointestinal toxicity, when given in combination with bevacizumab to patients with metastatic breast cancer. Feasibility was assessed based on relative dose intensity (RDI) of the combination using prespecified criteria of 80% of subjects achieving an RDI of at least 85% of the regimen with lower 95% confidence boundary >70%; safety and tolerability were also assessed.
Results: Among subjects on the original eribulin plus capecitabine dosing schedule (n=64), the average (SD) RDI was 90.6% (11.94%) and the feasibility rate was 81.3% (95% lower CI: 71.4%), indicating that this dosage regimen is feasible. Dose reductions, missed doses, and withdrawals due to adverse events were ascribed more to capecitabine (36%, 85%, and 18%, respectively) than to eribulin (21%, 8%, and 12%, respectively), which led to higher RDI and feasibility rates for eribulin (93.5% and 82.8%, respectively) than for capecitabine (87.8% and 71.9%). Grade 3/4 hand-foot syndrome ascribed to capecitabine only, led to dose reductions in 11.9% of subjects under the original dosing schedule. The most common adverse events under the original dosing schedule were alopecia (77.6%), fatigue (58.2%), and nausea (52.2%). With the new dosing schedule (n=9), higher RDI and feasibility rates were achieved, the average RDI was 96% and the feasibility rate was 100%, indicating that this alternative regimen is also feasible, and probably better. (Detailed feasibility and safety data with new dosing regimen will be available at the time of the presentation.)
Conclusions: Adjuvant use of the combination of eribulin plus capecitabine is feasible in patients with early, HER2-normal/HER2-negative, ER+ breast cancer. The combination had an acceptable safety profile under the original dosing schedule and has the potential to be improved by use of a 7 day on/7 day off regimen of capecitabine.
Citation Format: John W Smith II, Svetislava Vukelja, Anthony Hoffman, Vicky Jones, Kristi McIntyre, Erhan Berrak, Angela Teng, David Cox, Joyce O'Shaughnessy. Eribulin mesylate plus capecitabine for adjuvant treatment in post-menopausal ER+ early-stage breast cancer: A phase 2, multicenter, open-label study using 2 different dosage regimens [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-09-09.
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Affiliation(s)
| | | | | | - Vicky Jones
- 4Yakima Valley Memorial Hospital, North Star Lodge Cancer Center
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Gluck S, O'Shaughnessy J, McIntyre K, Schwartzberg LS, Wilks S, Huggins-Puhalla SL, Berrak E, Song JX, Cox D, Vahdat LT. Clinical effects of prior anthracycline or taxane use on eribulin as first-line treatment for HER+/- locally recurrent or metastatic breast cancer (BC): Results from 2 phase 2, multicenter, single-arm studies. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.140] [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
140 Background: Eribulin mesylate, a nontaxane microtubule dynamics inhibitor, has demonstrated an overall survival benefit relative to other commonly used agents in patients (pts) with at least 2 prior MBC cytotoxic therapies. Primary data presented from 2 phase 2 trials, Study 206 (eribulin in HER2- BC pts) and Study 208 (combination eribulin + trastuzumab [TRAS] in HER2+ BC pts), showed clinical activity and acceptable tolerability profiles as first-line cytotoxic therapy (tx). Here we present prespecified efficacy data for both trials based on prior anthracycline (A) and taxane (T) use. Methods: In both studies, pts received eribulin mesylate 1.4 mg/m2 IV on days 1 and 8 of each 21-day cycle. Pts in Study 208 (HER2+) also received initial TRAS (8 mg/kg IV/Day 1), followed by 6 mg/kg/day 1 of each subsequent cycle. Objective response rate (ORR), progression-free survival (PFS), and tolerability were assessed. Results: In Study 206 (N=56), 48% and 46% received prior A and T, and in Study 208 (N=52), 21% and 44% received prior A and T, respectively. ORR, the primary endpoint, was similar in pts, regardless of prior A or T, except in pts w/o prior T in Study 208 whose ORR trended higher (table). Clinical benefit rate (CBR), PFS, and duration of response (DOR) were either similar or trended higher in pts w/o prior A or T. PFS was higher in HER2+ BC patients receiving eribulin + TRAS who had not received prior A or T compared with those who had. Grade (G) 3-5 adverse event rates were similar or lower in pts who had not received prior A or T. Conclusions: As first-line therapy, eribulin in HER2- BC pts and eribulin + TRAS in HER2+ BC pts were effective and well tolerated, regardless of prior A or T tx. However, in HER2+ BC pts receiving eribulin + TRAS, the lack of prior A or T tx may be a lead to longer median PFS. Clinical trial information: NCT01268150/NCT01269346. [Table: see text]
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Affiliation(s)
- Stefan Gluck
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Joyce O'Shaughnessy
- Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | - Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, US Oncology, Dallas, TX
| | | | - Sharon Wilks
- US Oncology-Cancer Care Centers of South Texas, San Antonio, TX
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Holmes FA, Wang K, Levin MK, Cao Y, Palmer GA, Palma NA, Balasubramanian S, Ross JS, Yelensky R, Krekow L, McIntyre K, Osborne CRC, O'Shaughnessy J. Evidence of PIK3CA and TP53 co-mutation in breast cancer identification on next-generation sequencing (NGS) of ERBB2 ( HER2)-amplified residual disease following preoperative anti-HER2 therapy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Kai Wang
- Foundation Medicine, Inc., Cambridge, MA
| | | | - Ying Cao
- Valley Medical Oncology Consultants, Pleasanton, CA
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Gluck S, O'Shaughnessy J, McIntyre K, Schwartzberg LS, Wilks S, Puhalla S, Berrak E, Song J, Cox D, Vahdat LT. Clinical effects of prior anthracycline or taxane use on eribulin as first-line treatment for HER+/- locally recurrent or metastatic breast cancer (BC): Results from two phase II, multicenter, single-arm studies. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stefan Gluck
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | | | | | | | - Sharon Wilks
- Cancer Care Centers of South Texas, US Oncology Research, McKesson Specialty Health, San Antonio, TX
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McIntyre K, O'Shaughnessy J, Schwartzberg L, Glück S, Berrak E, Song JX, Cox D, Vahdat LT. Phase 2 study of eribulin mesylate as first-line therapy for locally recurrent or metastatic human epidermal growth factor receptor 2-negative breast cancer. Breast Cancer Res Treat 2014; 146:321-8. [PMID: 24699910 PMCID: PMC4085472 DOI: 10.1007/s10549-014-2923-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/17/2014] [Indexed: 01/02/2023]
Abstract
Eribulin mesylate, a novel non-taxane microtubule dynamics inhibitor, is approved for treatment of metastatic breast cancer (MBC) in patients who have previously received at least 2 chemotherapeutic regimens for MBC that should have included an anthracycline and a taxane in the adjuvant or metastatic setting. This phase 2 study evaluated efficacy and safety of eribulin as first-line therapy for human epidermal growth factor receptor 2-negative (HER2-negative) MBC. Patients with measurable HER2-negative locally recurrent breast cancer or MBC with ≥12 months since prior neoadjuvant or adjuvant (neo/adjuvant) chemotherapy received eribulin mesylate 1.4 mg/m(2) IV on days 1 and 8 of each 3-week cycle. Endpoints included objective response rate (ORR) per RECIST v1.1 (primary), safety, progression-free survival (PFS), clinical benefit rate (ORR + stable disease ≥6 months; CBR), and duration of response (DOR). Fifty-six patients were enrolled and received eribulin; 38 (68 %) had prior neo/adjuvant therapy, including 33 who had anthracycline and/or taxane-containing chemotherapy; 41 (73 %) had estrogen receptor-positive disease, and 12 (21 %) had estrogen receptor-negative, progesterone receptor-negative, and HER2-negative (triple-negative) disease. Patients received a median of 7 cycles (range 1-43); 6 (11 %) received treatment for ≥12 months. ORR was 29 % (95 % CI 17.3-42.2), CBR was 52 %, and median DOR was 5.8 months. Median PFS was 6.8 months. Thirty-six patients (64 %) had grade 3/4 treatment-related adverse events; most common were neutropenia (50 %), leukopenia (21 %), and peripheral neuropathy (21 %). These results demonstrate that eribulin has substantial antitumor activity as first-line treatment for HER2-negative MBC with acceptable safety.
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Affiliation(s)
- Kristi McIntyre
- Texas Oncology-Dallas Presbyterian Hospital, US Oncology, Dallas, TX, USA
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Tsiountsioura M, Wong JE, Upton J, McIntyre K, Dimakou D, Buchanan E, Cardigan T, Flynn D, Bishop J, Russell RK, Barclay A, McGrogan P, Edwards C, Gerasimidis K. Detailed assessment of nutritional status and eating patterns in children with gastrointestinal diseases attending an outpatients clinic and contemporary healthy controls. Eur J Clin Nutr 2014; 68:700-6. [DOI: 10.1038/ejcn.2013.286] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 01/04/2023]
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McIntyre K, O'Shaughnessy J, Schwartzberg L, Glück S, Berrak E, Song J, Rege J, Cox D, Vahdat L. Abstract P3-13-05: Eribulin mesylate as first-line therapy for locally recurrent or metastatic HER2-negative breast cancer: Results of a phase 2, multicenter, single-arm study. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-13-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Eribulin mesylate is a novel nontaxane microtubule dynamics inhibitor that is approved for treatment of metastatic breast cancer (MBC) in patients who have previously received at least two chemotherapeutic regimens for MBC. We present final data from a phase 2 study that evaluated the efficacy and safety of eribulin as first-line therapy for HER2-negative (HER2-) MBC.
Methods: Patients with measureable HER2- locally recurrent or MBC with ≥12 months since prior neoadjuvant or adjuvant chemotherapy received eribulin mesylate 1.4 mg/m2 IV on days 1 and 8 of each 3-week cycle. Endpoints included objective response rate (ORR) (primary), safety, progression-free survival (PFS), time to response (TTR), and duration of response (DOR). Tumor assessments were conducted every 6 weeks for the first 6 cycles and every 6-12 weeks thereafter per RECIST 1.1.
Results: Fifty-six patients enrolled and received eribulin. Patients had a median age of 56 years (range 31-85); 32 (57%) had an ECOG status of 0; 17 (30%) had de novo stage IV; 33 (59%) had prior (neo)adjuvant therapy, including anthracycline and/or taxane (A/T) chemotherapy. Thirty-nine patients (70%) had visceral disease (45% liver, 32% lung); 41(73%) had estrogen receptor-positive (ER+) disease and 12 (21%) had triple negative (TN) disease. Thirty-two patients (57%) completed at least 6 cycles of treatment; among the 24 patients who completed fewer than 6 cycles, reasons for not completing were progressive disease (PD; n = 18), adverse events (AEs; n = 3) and patient choice (n = 3). The median number of cycles delivered was 7 (range 1-39); 6 patients (11%) received treatment for ≥12 months. Overall ORR was 27%, with median TTR of 1.4 months and median DOR of 7.4 months; stable disease (SD) rate was 48% (Table 1). Median PFS was 6.8 months. Thirty-five patients (63%) had grade 3/4 treatment-related AEs (Table 2). Treatment-related serious AEs occurred in 5 (9%) patients: neutropenia (5%), febrile neutropenia (5%), and leukopenia (2%).
Conclusions: The results of this study suggest that first-line eribulin has antitumor activity in ER+/HER2- and TN MBC with safety consistent with the known profile. Further exploration of this treatment as part of earlier lines of breast cancer therapy, including neo/adjuvant, is warranted.
Table 1. Summary of EfficacyEfficacyEribulin-treated patients N = 56ORR, n (%)15 (27)CR0PR15 (27)SD27 (48)PD12 (21)Clinical benefit rate (ORR + ≥6 mo SD)27 (48)Median months (95% CI) TTR1.4 (1.2, 2.7)DOR7.4 (4.7, NE)PFS6.8 (4.4, 7.4)NE, not estimable
Table 2. Treatment-Related AEsAE (N = 56)All events (%)Grade 3/4 (%)Leading to study drug withdrawal1111Leading to dose reduction3427Common AEs (≥25%) Alopecia820Neutropenia7050Fatigue572Peripheral neuropathy5420Nausea460Anemia364Leukopenia3018Constipation270
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-13-05.
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Affiliation(s)
- K McIntyre
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - J O'Shaughnessy
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - L Schwartzberg
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - S Glück
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - E Berrak
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - J Song
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - J Rege
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - D Cox
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
| | - L Vahdat
- Texas Oncology-Dallas Presbyterian Hospital US Oncology, Dallas, TX; Texas Oncology Baylor-Charles A. Sammons Cancer Center US Oncology, Dallas, TX; The West Clinic, Memphis, TN; Sylvester Comprehensive Cancer Center University of Miami, Leonard M. Miller School of Medicine, Miami, FL; Eisai Inc, Woodcliff Lake, NJ; Weill Cornell Medical College, New York, NY
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Newby JM, Mackenzie A, Williams AD, McIntyre K, Watts S, Wong N, Andrews G. Internet cognitive behavioural therapy for mixed anxiety and depression: a randomized controlled trial and evidence of effectiveness in primary care. Psychol Med 2013; 43:2635-2648. [PMID: 23419552 DOI: 10.1017/s0033291713000111] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [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: 01/22/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) and generalized anxiety disorder (GAD) have the highest co-morbidity rates within the internalizing disorders cluster, yet no Internet-based cognitive behavioural therapy (iCBT) programme exists for their combined treatment. METHOD We designed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression. Study 1 was a randomized controlled trial (RCT) comparing the iCBT programme (n = 46) versus wait-list control (WLC; n = 53) for patients diagnosed by structured clinical interview with MDD, GAD or co-morbid GAD/MDD. Primary outcome measures were the Patient Health Questionnaire nine-item scale (depression), Generalized Anxiety Disorder seven-item scale (generalized anxiety), Kessler 10-item Psychological Distress scale (distress) and 12-item World Health Organization Disability Assessment Schedule II (disability). The iCBT group was followed up at 3 months post-treatment. In study 2, we investigated the adherence to, and efficacy of the same programme in a primary care setting, where patients (n = 136) completed the programme under the supervision of primary care clinicians. RESULTS The RCT showed that the iCBT programme was more effective than WLC, with large within- and between-groups effect sizes found (>0.8). Adherence was also high (89%), and gains were maintained at 3-month follow-up. In study 2 in primary care, adherence to the iCBT programme was low (41%), yet effect sizes were large (>0.8). Of the non-completers, 30% experienced benefit. CONCLUSIONS Together, the results show that iCBT is effective and adherence is high in research settings, but there is a problem of adherence when translated into the 'real world'. Future efforts need to be placed on developing improved adherence to iCBT in primary care settings.
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Affiliation(s)
- J M Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia
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O'Shaughnessy J, Pippen JE, Paul D, Stokoe CT, Blum JL, Krekow L, Holmes FA, Lopez-Diaz C, Vukelja SJ, Lindquist D, Sedlacek SM, Rivera RR, Brooks RJ, McIntyre K, Wang Y. Adjuvant capecitabine for invasive lobular/mixed early breast cancer (EBC): USON 01062 exploratory analyses. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.547] [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
547 Background: Randomized phase III USON 01062 trial determining if patients with EBC would benefit from addition of capecitabine to docetaxel after AC (AC-T vs AC-XT). AC-T: docetaxel 100mg/M2 IV; AC-XT: docetaxel 75mg/M2 IV with capecitabine 825mg/M2 PO BID 14/7 days every 21days for 4 cycles. The primary endpoint, improvement in disease-free survival (DFS) at 5 years, was not met (HR=0.84, p=0.12) likely due to lower-than-expected event rate. The secondary endpoint, overall survival (OS), was improved with capecitabine (HR 0.68, p=0.01) (O’Shaughnessy, J. ASCO, 2011). Methods: Molecular analyses demonstrate that pleomorphic lobular (mixed lobular/ductal) carcinomas evolve from the same precursor and/or through the same genetic pathway as classical lobular cancers (Reis-Filho, J., J Path, 2005). We conducted exploratory analyses to evaluate the addition of adjuvant capecitabine in ductal vs lobular or lobular/ductal (mixed) EBC within USON 01062. Histology was classified according to local pathology assessment on patients’ primary cancers. Results: In ductal patients (n=2195), there was no difference in DFS (HR=0.92, p=0.48) and OS (HR=0.75, p=0.07) with AC-T vs AC-XT. In lobular/mixed patients (n=355), adding capecitabine improved DFS (HR=0.55, p=0.055) and OS (HR=0.38, p=0.04). There was no difference in DFS (HR=1.004, p=0.98) in the ER+ ductal patients (n=1258) with the addition of capecitabine. Conclusions: Ductal and lobular cancers have distinct histologic and molecular characteristics; lobular cancers are generally less sensitive to chemotherapy (Cristofanilli, M. JCO, 2005). This exploratory analysis suggests that patients with lobular/mixed EBC may benefit from adjuvant capecitabine. This hypothesis requires evaluation in other adjuvant capecitabine trials. [Table: see text]
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Affiliation(s)
| | - John E. Pippen
- Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, TX
| | | | | | | | - Lea Krekow
- Texas Oncology, US Oncology, Bedford, TX
| | | | | | | | | | | | | | | | | | - Yunfei Wang
- US Oncology Research, LLC, McKesson Specialty Health, The Woodlands, TX
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Sharman JP, Goldschmidt JH, Burke JM, Hellerstedt BA, McIntyre K, Yasenchak CA, Boyd TE, Ruxer RL, Patel-Donnelly D, Braiteh FS, Forero-Torres A, Savin MA, Albertson TM. CD30 expression in nonlymphomatous malignancies. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3069] [Citation(s) in RCA: 7] [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
3069 Background: CD30 is commonly expressed in Hodgkin lymphoma (HL), anaplastic large cell lymphoma (ALCL), and testicular embryonal carcinoma. Expression of CD30 in other solid tumors and non-lymphomatous malignancies has been reported but not investigated systematically. CD30 is the target of brentuximab vedotin (Adcetris), an antibody drug conjugate (ADC) that is approved for the treatment of patients with relapsed HL and systemic ALCL after failure of other therapies. A study was initiated to determine the incidence of CD30 expression in non-lymphomatous malignancies and to identify patients who may be candidates for treatment with brentuximab vedotin. Methods: Patients with non-lymphomatous malignancies were eligible for screening if they were relapsed or refractory to previous therapy or had no effective treatment options available. Archived tissue from solid tumors was tested for CD30 expression by immunohistochemistry (IHC); fresh bone marrow or blood samples from multiple myeloma or leukemia patients were tested by flow cytometry. Patients were considered CD30 positive and eligible for a companion treatment protocol with brentuximab vedotin if ≥10% of malignant cells stained positive by IHC or ≥20% by flow cytometry. Results: At this interim analysis, a total of 875 patients have been tested for CD30 expression: 95% had solid tumors, 3% had leukemia, and 2% had multiple myeloma. Twenty-two patients (2.5%) were CD30 positive, including 7 of 94 patients with ovarian cancer (7%), 5 of 20 with melanoma (25%), 2 of 5 with mesothelioma (40%), 1 of 4 with skin squamous cell carcinoma (25%), 2 of 41 with triple negative breast cancer (5%), 1 of 37 with pancreatic cancer (3%), 1 of 26 with small cell lung cancer (4%), and 1 of 3 with anal cancer (33%), and thyroid carcinoma (33%). One patient was identified with CD30-positive mast cell leukemia. In positive patients, the percent of CD30-positive malignant cells varied between 10 and 80%. Conclusions: CD30 expression was observed in multiple types of non-lymphomatous malignancies, thereby identifying additional populations who may be candidates for treatment with a CD30-targeted ADC, such as brentuximab vedotin. A companion clinical trial with brentuximab vedotin is currently ongoing.
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Affiliation(s)
| | | | | | | | | | | | - Thomas E. Boyd
- Yakima Valley Memorial Hospital/North Star Lodge, Yakima, WA
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Jones S, Paul D, Sedlacek S, Vukelja S, Wilks ST, Stokoe C, Osborne CR, Krekow L, McIntyre K, Holmes FA, Guerra L, Zhan F, Asmar L, O'Shaughnessy J, Blum JL. P5-18-09: The Incidence of Febrile Neutropenia in the First Course of Adjuvant Chemotherapy with Docetaxel/Cyclophosphamide with or without Pegfilgrastim. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-18-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
In our original doxorubicin-cyclophosphamide/docetaxel-cyclophosphamide (AC/TC) adjuvant study (JCO 27: 1177–1183, 2009), we reported an incidence of febrile neutropenia (FN) of 5% (8% in women ≥65 years) with the TC regimen without prophylactic WBC growth factors but with a recommendation for prophylactic antibiotics. There is a paucity of data on the incidence of FN with the TC regimen aside from this clinical trial. Because we have been conducting a randomized adjuvant study of TC compared to other regimens, we used this opportunity to analyze the incidence of FN during the first course of chemotherapy with TC in the first cohort of randomized patients (US Oncology Network study 06090). The prophylactic use of WBC growth factors was at the investigator's discretion.
Patients and Methods
The study included 1298 patients entered between May 2007 and May 2009. Of these, 649 were included in the TC arm. Median age was 54 years (range 27–71), 75.5% were Caucasian, 561 (86.4%) were in PS 0 at baseline, and about half were node negative. Eight patients did not receive study treatment for various reasons. Among the 641 patients who received TC; 213 (33.3%) received pegfilgrastim, 48 (7.5%) received filgrastim and were not included in this analysis, and 380 (59.2%) patients did not receive either during the first cycle. Thus, this analysis focused on 593 women who did or did not receive prophylactic pegfilgrastim in cycle 1.
Results: All patients with a reported adverse event of FN or with a reported AE of fever with some degree of neutropenia (in order to capture all possible cases of FN) during the first cycle of TC were identified [Table 1]. FN and fever + neutropenia occurred in a total of 6 (2.8%) patients who received pegfilgrastim and 36 (9.5%) patients who did not. A comparison of age, race, performance status and stage of disease between these 2 groups revealed that they were similar. The 213 patients who received pegfilgrastim were slightly older (median 56 years, range 27–71) compared to those who did not (median 53 years, range 30–71).
During all 6 cycles, 41 patients reported FN, and 30 (73%) of these patients experienced FN during cycle 1.
Conclusion: Among 593 women who received TC as adjuvant chemotherapy, the incidence of FN during the first cycle was under 10% whether or not the patients received prophylactic pegfilgrastim.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-18-09.
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Affiliation(s)
- S Jones
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - D Paul
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - S Sedlacek
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - S Vukelja
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - ST Wilks
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - C Stokoe
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - CR Osborne
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - L Krekow
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - K McIntyre
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - FA Holmes
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - L Guerra
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - F Zhan
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - L Asmar
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - J O'Shaughnessy
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
| | - JL Blum
- 1US Oncology, The Woodlands, TX; Baylor-Sammons Cancer Center, Baylor University, Dallas, TX; Rocky Mountain Cancer Center, Denver, CO; Texas Oncology-Tyler, Tyler, TX; Cancer Care Centers of South Texas, San Antonio, TX; Texas Oncology, Plano, TX; Breast Cancer Center of North Texas, Bedford, TX; Texas Oncology-Dallas Presbyterian Hospital, Dallas, TX; Texas Oncology-Houston Memorial City, Houston, TX
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Pippen JE, Paul D, Stokoe CT, Blum JL, Krekow L, Holmes FA, Lindquist DL, Sedlacek SM, Rivera RR, Brooks RJ, Vukelja SJ, McIntyre K, Lopez-Diaz C, O'Shaughnessy J. Randomized, phase III study of adjuvant doxorubicin plus cyclophosphamide (AC) → docetaxel (T) with or without capecitabine (X) in high-risk early breast cancer: Exploratory Ki-67 analyses. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Holmes FA, Nagarwala YM, Espina VA, Liotta LA, Danso MA, Gallagher RI, McIntyre K, Osborne CRC, Mahoney JM, Florance AM, Anderson TC, O'Shaughnessy J. Correlation of molecular effects and pathologic complete response to preoperative lapatinib and trastuzumab, separately and combined prior to neoadjuvant breast cancer chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.506] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Loesch D, Greco FA, Senzer NN, Burris HA, Hainsworth JD, Jones S, Vukelja SJ, Sandbach J, Holmes F, Sedlacek S, Pippen J, Lindquist D, McIntyre K, Blum JL, Modiano MR, Boehm KA, Zhan F, Asmar L, Robert N. Phase III multicenter trial of doxorubicin plus cyclophosphamide followed by paclitaxel compared with doxorubicin plus paclitaxel followed by weekly paclitaxel as adjuvant therapy for women with high-risk breast cancer. J Clin Oncol 2010; 28:2958-65. [PMID: 20479419 DOI: 10.1200/jco.2009.24.1000] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study compared disease-free survival (DFS) obtained with two different regimens of adjuvant therapy in high-risk breast cancer. METHODS Women (who had performance status [PS] of 0 to 1) with operable, histologically confirmed, stage I to III adenocarcinoma of the breast were eligible. Patients had undergone primary surgery with no residual tumor. Treatments were as follows: arm 1 was doxorubicin 60 mg/m(2) plus cyclophosphamide 600 mg/m(2) every 3 weeks for four cycles followed by paclitaxel 175 mg/m(2) every 3 weeks for four cycles (ie, AC-P); and arm 2 was doxorubicin 50 mg/m(2) plus paclitaxel 200 mg/m(2) every 3 weeks for four cycles followed by paclitaxel 80 mg/m(2) weekly for 12 weeks. RESULTS Overall, 1,830 patients were enrolled and 1,801 were treated: arm 1 (n = 906; AC-->P) and arm 2 (n = 895; AP-WP). Overall, patients had a PS of 0 (88%), had estrogen receptor and progesterone receptor-positive disease (52%), had one to three positive nodes (46%), and were postmenopausal (57%); the median age was 52 years. Currently, 1,640 patients (90%) are alive. The 6-year DFS was 79% to 80% in both groups. Disease relapse was the cause of death for 83 patients in arm 1 and in 66 patients of arm 2. Overall 6-year survival rates were 82% and 87% in arms 1 and 2, respectively. Reasons for patients being taken off study treatment included toxicity (13% in arm 1 v 20% in arm 2), progressive disease or recurrence (7% v 5%), and consent withdrawn (9% v 8%), respectively. The most frequent toxicities were hematologic, including neutropenia and leukopenia followed by neuropathy, myalgia, nausea, fatigue, headache, arthralgia, and vomiting. CONCLUSION The results indicate that the AP-WP regimen is an equally effective and tolerable option for the adjuvant treatment of patients with high-risk breast cancer. The substitution of paclitaxel for cyclophosphamide results in comparable effectiveness of the regimen.
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Loesch D, Loesch D, Asmar L, McIntyre K, McIntyre K, Orlando M, Zhan F, Boehm K, O'Shaughnessy J, O'Shaughnessy J, O'Shaughnessy J. Three-Year Follow-Up of Survival and Progression in a Phase II Trial of Gemcitabine Plus Carboplatin (Plus Trastuzumab in HER2+ Patients) in Metastatic Breast Cancer Patients. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We have previously reported (Loesch, et al. Clin Breast Cancer, 2008) the efficacy and safety of gemcitabine and carboplatin with or without trastuzumab in patients with metastatic breast cancer. We now report time-to-progression (TTP) and overall survival (OS) after up to 3.5 years of extended follow-up.Patients and Methods: Patients were stratified into 3 groups at registration; Group 1: HER2 positive (+) regardless of prior taxane; Group 2: HER2 negative (–) and taxane naïve or remote (no taxanes within the past 2 years); and Group 3: HER2– and taxane pretreated. Women ≥18 years of age, with ECOG performance status 0-2, with RECIST-defined measurable disease, and either HER2– or HER2+ (3+ score) by immunohistochemistry or fluorescence in situ hybridization were enrolled. Treatment: Day 1 gemcitabine 1500 mg/m2 over 30 minutes followed by carboplatin AUC=2.5 repeated every 14 days up to Cycle 9. Group 1 also received trastuzumab 8 mg/kg in Cycle 1 followed by 4 mg/kg in Cycles 2-9, followed thereafter by 6 mg/kg every 21 days until progression or intolerable toxicity.Results: A total of 150 patients were registered (50, 51, and 49 in Groups 1, 2, and 3, respectively). Median follow-up for surviving patients, calculated from registration, was 31.3, 27.1, and 25.4 months, respectively. Median TTP (calculated as progression-free survival), was 7.2, 5.6, and 4.6 months, respectively. Median OS (range) has not been reached for Group 1 (range, 1.2-46.9); for Group 2 was 21.7 months (<1-44.3); and, for Group 3 was 11.9 months (<1-33.6). At 24-months, survival rates were 73.3%, 41.4%, and 20.5%, respectively; at 36-months, survival rates were 60.6%, 25.7%, and ≤8.3%, respectively. For Group 1 only, the remaining 3 responding patients were followed for 3.5 years, at which time they were relapse-free.Conclusions: Gemcitabine plus carboplatin with or without trastuzumab has been shown to be highly active in metastatic breast cancer. HER2+ patients receiving trastuzumab had the highest TTP and survival rates of all treatment groups. As expected, taxane-pretreated patients had shortened TTP and decreased OS rates compared to taxane-naïve patients.Research support was provided, in part, by Lilly USA, LLC; Indianapolis, IN.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2105.
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Affiliation(s)
| | - D. Loesch
- 2Central Indiana Cancer Centers, IN,
| | - L. Asmar
- 1US Oncology Research, Inc., TX,
| | | | | | | | - F. Zhan
- 1US Oncology Research, Inc., TX,
| | - K. Boehm
- 1US Oncology Research, Inc., TX,
| | | | | | - J. O'Shaughnessy
- 5Texas Oncology at Baylor - Charles A. Sammons Cancer Center, TX,
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Beebe LH, Burk R, McIntyre K, Smith K, Velligan D, Resnick B, Tavakoli A, Tennison C, Dessieux O. Motivating Persons with Schizophrenia Spectrum Disorders to Exercise: Rationale and Design. Clin Schizophr Relat Psychoses 2009; 3:111-116. [PMID: 20204148 PMCID: PMC2831651 DOI: 10.3371/csrp.3.2.6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Persons with schizophrenia spectrum disorders (SSDs) are not only at risk because of disabling disease symptoms but because necessary medications create health risks associated with high rates of obesity. Despite the well-known benefits of exercise, persons with SSDs rarely adhere to such regimens; few interventions to motivate exercise behavior have been tested in this group.The purpose of this study is to examine effects of the Walk, Address sensations, Learn about exercise, Cue exercise behavior for persons with SSDs (WALC-S) motivational intervention upon exercise behavior. We will recruit a total of eighty outpatients 18-68 years, meeting these criteria: 1) chart diagnosis of schizophrenia, any subtype, schizoaffective disorder or schizophreniform disorder, according to the criteria described in the Diagnostic and Statistical Manual for Mental Disorders, 2) English speaking, 3) Stable medication regimen (defined as no medication changes within the last month), and 4) medical clearance for moderate exercise in writing from primary care provider. Participants will be randomly assigned to the experimental (4-week WALC-S motivational intervention), or the control group (4-week time and attention control). After the first 4 weeks, all participants will attend a 16-week walking group.The primary measures of the effectiveness of the WALC-S are attendance, persistence and compliance to the 16-week walking group. The study will be completed in approximately January 2010. In addition to hypothesis testing, this study will provide information to estimate effect sizes to calculate power and determine appropriate sample sizes for future inquiries. This paper describes the rationale and design of the study.
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Affiliation(s)
- Lora Humphrey Beebe
- 1200 Volunteer Blvd, University of Tennessee, College of Nursing Knoxville, TN 37996, Tel (865) 974-3978, Fax (865) 974 3569
| | | | | | | | - D. Velligan
- University of Texas Health Science Center at San Antonio
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Loesch D, Asmar L, McIntyre K, Doane L, Monticelli M, Paul D, Vukelja S, Orlando M, Vaughn LG, Zhan F, Boehm KA, O'Shaughnessy JA. Phase II trial of gemcitabine/carboplatin (plus trastuzumab in HER2-positive disease) in patients with metastatic breast cancer. Clin Breast Cancer 2008; 8:178-86. [PMID: 18621615 DOI: 10.3816/cbc.2008.n.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gemcitabine and carboplatin have significant preclinical synergy, and both provide synergistic antitumor activity in metastatic breast cancer (MBC) when used in combination with trastuzumab. The gemcitabine/ cisplatin combination is highly active in MBC with response rates (RRs) of approximately 50% in anthracycline- and taxane-pretreated patients and up to 80% in untreated subjects. This phase II trial studied the efficacy and safety of gemcitabine/carboplatin with or without trastuzumab in patients with MBC. PATIENTS AND METHODS Patients were stratified into 3 groups: group 1, HER2-positive; group 2, HER2-negative and taxane- naive/remote (no taxanes within past 2 years); and group 3, HER2-negative and previous taxane therapy. Included were women aged > or = 18 years, Eastern Cooperative Oncology Group performance status of 0-2, with Response Evaluation Criteria in Solid Tumors-defined measurable MBC; HER2-negative or HER2 (3+) by immunohistochemistry or fluorescence in situ hybridization positive. All cycles were repeated every 14 days. On day 1, gemcitabine 1500 mg/m2 over 30 minutes was administered followed by carboplatin area under the curve of 2.5. Group 1 also received trastuzumab 8 mg/kg on day 1 of each cycle followed by 4 mg/kg for every 2 weeks thereafter. RESULTS One hundred fifty patients were registered (50, 51, and 49 in groups 1, 2, and 3, respectively). The overall RRs were 64%, 27%, and 32%, respectively, with median time to progression of 7.2, 5.5, and 4.4 months, respectively. Overall, grade 3/4 toxicities included neutropenia (45%), leukopenia (17%), and thrombocytopenia (7%). Alopecia was infrequent: grade 1 (34%) and grade 2 (3%), and there was no significant cardiac toxicity. CONCLUSION Gemcitabine/carboplatin/trastuzumab is highly active in patients with HER2-positive MBC. Gemcitabine/carboplatin is active in patients with HER2-negative MBC independent of previous taxane therapy. Gemcitabine/carboplatin with or without trastuzumab administered every 2 weeks is associated with a low frequency of serious toxicity.
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Parsons D, McIntyre K, Schulz W, Stray-Gundersen J. Capillarity of elite cross-country skiers: a lectin (Ulex europaeus I) marker. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1993.tb00385.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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De Boer R, Burris HA, Monnier A, Mouridsen H, O’Shaughnessy JA, McIntyre K, Pritchard KI, Smith I, Yardley D. The Head to Head trial: Letrozole vs anastrozole as adjuvant treatment of postmenopausal patients with node positive breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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
10672 Introduction: Aromatase Inhibitors (AIs) have demonstrated both efficacy and safety advantages over tamoxifen (T) in all treatment settings in breast cancer (BC) and are becoming the new standard of care as endocrine therapy for postmenopausal patients (PM) with BC. Rationale: Cumulative evidence suggests that all AIs may not be the same, raising the question of whether there is a superior AI, and whether any specific patient populations derive differing degrees of benefit from a particular AI. In the ATAC trial, evaluating anastrozole (A) in PM patients with early breast cancer (EBC), at 33 months median follow up the risk of recurrence in the hormone receptor positive (HR+) population was reduced by 22%.The BIG 1–98 Trial, evaluating letrozole (L) in PM women with EBC, showed a significant benefit in favor of L over T at a median follow up of 26 months, with a 19% reduction in the risk of recurrence; in subgroup analyses, L significantly decreased the risk of recurrence in LN+ patients and in patients who received adjuvant chemotherapy. This study is a head to head comparison of L and A in HR+, LN+ PM patients with EBC and aims to compare L vs A in the adjuvant treatment of these patients. Design and Methods: This is a Phase IIIb open-label, randomized, multicentre study including 4000 PM patients from up to 250 international sites. PM patients with HR+, LN+ BC who have recently undergone surgery for primary BC will be randomized to either receive L 2.5 mg or A 1 mg daily. Treatment will commence following completion of standard chemotherapy (if given) and concurrently with radiotherapy (if given)Patients will receive treatment until disease recurrence/relapse for up to 5 years. Patients will be stratified by number of LN and HER2 status. The primary objective is disease free survival at 5 years for L and A. Secondary objectives include safety, overall survival, time to distant metastases and time to contralateral breast cancer. Data analysis will be conducted by an independent group of investigators. Summary: Updated patient accrual figures, including any available early safety data, will be presented at the meeting. No significant financial relationships to disclose.
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Affiliation(s)
- R. De Boer
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - H. A. Burris
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - A. Monnier
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - H. Mouridsen
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - J. A. O’Shaughnessy
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - K. McIntyre
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - K. I. Pritchard
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - I. Smith
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
| | - D. Yardley
- Royal Melbourne Hospital, Melbourne, Australia; Sarah Cannon Research Institute, Nashville, TN; Centre Hospitalier A. Boulloche, Montbeliard, France; Righospitalet, Copenhagen, Denmark; US Oncology, Houston, TX; Toronto Sunnybrook Regional Cancer Centre, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom
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Stewart S, Demers C, Murdoch DR, McIntyre K, MacLeod ME, Kendrick S, Capewell S, McMurray JJV. Substantial between-hospital variation in outcome following first emergency admission for heart failure. Eur Heart J 2002; 23:650-7. [PMID: 11969280 DOI: 10.1053/euhj.2001.2890] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 11/11/2022] Open
Abstract
BACKGROUND Following hospitalization with a range of cardiovascular disorders, substantial variation has been noted in clinical outcome, both between and within countries. OBJECTIVES To examine the variation, between hospitals, in the clinical outcomes of death and readmission following hospitalization with heart failure in Scotland. Setting All 29 acute hospitals in Scotland with more than 200 beds. PATIENTS All 31 452 patients discharged from these hospitals between January 1990 and December 1995 with a first-ever, primary, diagnosis at discharge/death of heart failure. ANALYSIS An analysis of the Scottish database of discharge summaries linking index admissions with subsequent admissions and deaths. Death rates and readmission rates were adjusted for baseline age, co-morbidity and socio-economic status and were calculated at different time periods (inpatient, 30 days, 1 year). Rates were calculated separately for large teaching hospitals (n=6, category A), large general hospitals with specialist units (n=8, category B) and medium sized general hospitals with limited specialist units (n=15 category C). RESULTS A total of 31 452 patients were discharged between 1990-1995 - 10 219 (33%), 9735 (31%) and 11 498 (37%) to category A, B and C hospitals, respectively. The national, average, inpatient case fatality rate was 15.3%, ranging, in individual hospitals, from the lowest rate of 8.5% to the highest rate of 23.4%. The average 1 year case fatality rate was 42.4%, ranging between 35.3% and 50.8%. A similar two- to threefold variation was found in hospital readmission rates - thus the average 30 day readmission rate was 5.3% (lowest 3.3%, highest 7.3%). This variation, in both case-fatality and readmission rates, was apparent within all three groups of hospitals and persisted after adjustment for the baseline factors outlined above. CONCLUSIONS A patient admitted to one Scottish hospital with heart failure may be two to three times more likely to die or be readmitted, both in the short and longer term, compared to a patient admitted to another hospital. Although we may not have accounted for some sources of variation, it is both surprising and disturbing that large, statistically significant, differences in adjusted death and readmission rates can apparently exist for such an important condition in a relatively small country with generally homogenous health care provision. Further, detailed investigation of this apparent variation is required.
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Affiliation(s)
- S Stewart
- Clinical Research Initiative in Heart Failure, University of Glasgow, Glasgow, Scotland, U.K
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McIntyre K. Rodent gavage technique concerns: avoiding excess mortality. Contemp Top Lab Anim Sci 2001; 40:7; author reply 8. [PMID: 11488273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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