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Knoerl R, Grandinetti K, Smener L, Doll E, Fecher LA, Henry NL, Karimi Y, Pettit K, Schuetze S, Walling E, Zhang A, Barton D. Exploring Adolescent and Young Adult Cancer Survivors' Experience with Cancer Treatment-Related Symptoms: A Qualitative Analysis of Semi-Structured Interviews. J Adolesc Young Adult Oncol 2024. [PMID: 38634665 DOI: 10.1089/jayao.2024.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Purpose: Few studies have specifically targeted symptom management interventions for adolescent and young adult (AYA) cancer survivors. A greater understanding of AYA cancer survivors' experiences with cancer treatment-related symptoms would help develop age-appropriate oncology symptom management interventions. The purpose of this qualitative analysis was to explore AYA cancer survivors' experience with cancer treatment-related symptoms. Methods: Nineteen post-treatment AYA cancer survivors (18-39 years old) who self-reported moderate-severe cancer treatment-related symptom severity participated in video conferencing or telephone interviews. The questions in the interview guide queried participants to share their experience with cancer treatment-related symptoms. Inductive content analysis was used to identify themes from the interviews. Results: The themes that emerged from the interviews included (1) cancer treatment-related symptoms negatively affected AYA cancer survivors' quality of life (e.g., symptoms served as a reminder of cancer recurrence possibility); (2) AYA cancer survivors' attitudes and feelings about communicating cancer treatment-related symptom concerns to clinicians (e.g., patient-clinician communication was bolstered when AYAs perceived that symptoms were being taken seriously); (3) AYA cancer survivors are interested in oncology symptom management clinical trials, but logistical challenges are barriers to participation; and (4) AYA cancer survivors are interested in nonpharmacological treatments for symptom management. Conclusion: Results highlight the burden of cancer treatment-related symptoms on day-to-day life among post-treatment AYA cancer survivors. Future work is needed to identify nonpharmacological symptom management interventions, strategies to improve patient-clinician communication about symptoms, and strategies to increase the visibility and accessibility of symptom management clinical trials for AYA cancer survivors.
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Affiliation(s)
- Robert Knoerl
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | | | - Liat Smener
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Doll
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Leslie A Fecher
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - N Lynn Henry
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Yasmin Karimi
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kristen Pettit
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott Schuetze
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily Walling
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Debra Barton
- College of Nursing, The University of Tennessee, Knoxville, Tennessee, USA
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Castellano CA, Sun T, Ravindranathan D, Hwang C, Balanchivadze N, Singh SRK, Griffiths EA, Puzanov I, Ruiz-Garcia E, Vilar-Compte D, Cárdenas-Delgado AI, McKay RR, Nonato TK, Ajmera A, Yu PP, Nadkarni R, O'Connor TE, Berg S, Ma K, Farmakiotis D, Vieira K, Arvanitis P, Saliby RM, Labaki C, El Zarif T, Wise-Draper TM, Zamulko O, Li N, Bodin BE, Accordino MK, Ingham M, Joshi M, Polimera HV, Fecher LA, Friese CR, Yoon JJ, Mavromatis BH, Brown JT, Russell K, Nanchal R, Singh H, Tachiki L, Moria FA, Nagaraj G, Cortez K, Abbasi SH, Wulff-Burchfield EM, Puc M, Weissmann LB, Bhatt PS, Mariano MG, Mishra S, Halabi S, Beeghly A, Warner JL, French B, Bilen MA. The impact of cancer metastases on COVID-19 outcomes: A COVID-19 and Cancer Consortium registry-based retrospective cohort study. Cancer 2024. [PMID: 38376917 DOI: 10.1002/cncr.35247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND COVID-19 can have a particularly detrimental effect on patients with cancer, but no studies to date have examined if the presence, or site, of metastatic cancer is related to COVID-19 outcomes. METHODS Using the COVID-19 and Cancer Consortium (CCC19) registry, the authors identified 10,065 patients with COVID-19 and cancer (2325 with and 7740 without metastasis at the time of COVID-19 diagnosis). The primary ordinal outcome was COVID-19 severity: not hospitalized, hospitalized but did not receive supplemental O2 , hospitalized and received supplemental O2 , admitted to an intensive care unit, received mechanical ventilation, or died from any cause. The authors used ordinal logistic regression models to compare COVID-19 severity by presence and specific site of metastatic cancer. They used logistic regression models to assess 30-day all-cause mortality. RESULTS Compared to patients without metastasis, patients with metastases have increased hospitalization rates (59% vs. 49%) and higher 30 day mortality (18% vs. 9%). Patients with metastasis to bone, lung, liver, lymph nodes, and brain have significantly higher COVID-19 severity (adjusted odds ratios [ORs], 1.38, 1.59, 1.38, 1.00, and 2.21) compared to patients without metastases at those sites. Patients with metastasis to the lung have significantly higher odds of 30-day mortality (adjusted OR, 1.53; 95% confidence interval, 1.17-2.00) when adjusting for COVID-19 severity. CONCLUSIONS Patients with metastatic cancer, especially with metastasis to the brain, are more likely to have severe outcomes after COVID-19 whereas patients with metastasis to the lung, compared to patients with cancer metastasis to other sites, have the highest 30-day mortality after COVID-19.
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Affiliation(s)
| | - Tianyi Sun
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Nino Balanchivadze
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA
- Virginia Oncology Associates, US Oncology, Norfolk, Virginia, USA
| | - Sunny R K Singh
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan, USA
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | | | | | | | - Rana R McKay
- Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Taylor K Nonato
- Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Archana Ajmera
- Moores Comprehensive Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Peter P Yu
- Hartford HealthCare Cancer Institute, Hartford, Connecticut, USA
| | - Rajani Nadkarni
- Hartford HealthCare Cancer Institute, Hartford, Connecticut, USA
| | | | - Stephanie Berg
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Kim Ma
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Dimitrios Farmakiotis
- Brown University, Providence, Rhode Island, USA
- Lifespan Cancer Institute, Providence, Rhode Island, USA
| | - Kendra Vieira
- Brown University, Providence, Rhode Island, USA
- Lifespan Cancer Institute, Providence, Rhode Island, USA
| | | | - Renee M Saliby
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Talal El Zarif
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Olga Zamulko
- University of Cincinnati Cancer Center, Cincinnati, Ohio, USA
| | - Ningjing Li
- University of Cincinnati Cancer Center, Cincinnati, Ohio, USA
| | - Brianne E Bodin
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Matthew Ingham
- Columbia University Irving Medical Center, New York, New York, USA
| | - Monika Joshi
- Penn State Health/Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Hyma V Polimera
- Penn State Health/Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Leslie A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | | | - James J Yoon
- University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | | | | | - Karen Russell
- Tallahassee Memorial Healthcare, Tallahassee, Florida, USA
| | - Rahul Nanchal
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Lisa Tachiki
- University of Washington and Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Gayathri Nagaraj
- Loma Linda University Cancer Center, Loma Linda, California, USA
| | - Kimberly Cortez
- Loma Linda University Cancer Center, Loma Linda, California, USA
| | - Saqib H Abbasi
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | | | | | | | - Sanjay Mishra
- Brown University, Providence, Rhode Island, USA
- Lifespan Cancer Institute, Providence, Rhode Island, USA
| | - Susan Halabi
- Duke Cancer Institute at Duke University Medical Center, Durham, North Carolina, USA
| | - Alicia Beeghly
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Benjamin French
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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Larkin J, Del Vecchio M, Mandalá M, Gogas H, Arance Fernandez AM, Dalle S, Cowey CL, Schenker M, Grob JJ, Chiarion-Sileni V, Marquez-Rodas I, Butler MO, Di Giacomo AM, Middleton MR, Lutzky J, de la Cruz-Merino L, Arenberger P, Atkinson V, Hill AG, Fecher LA, Millward M, Nathan PD, Khushalani NI, Queirolo P, Ritchings C, Lobo M, Askelson M, Tang H, Dolfi S, Ascierto PA, Weber J. Adjuvant Nivolumab versus Ipilimumab in Resected Stage III/IV Melanoma: 5-Year Efficacy and Biomarker Results from CheckMate 238. Clin Cancer Res 2023; 29:3352-3361. [PMID: 37058595 PMCID: PMC10472092 DOI: 10.1158/1078-0432.ccr-22-3145] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 11/07/2022] [Revised: 01/31/2023] [Accepted: 04/12/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE In the phase III CheckMate 238 study, adjuvant nivolumab significantly improved recurrence-free survival (RFS) and distant metastasis-free survival versus ipilimumab in patients with resected stage IIIB-C or stage IV melanoma, with benefit sustained at 4 years. We report updated 5-year efficacy and biomarker findings. PATIENTS AND METHODS Patients with resected stage IIIB-C/IV melanoma were stratified by stage and baseline programmed death cell ligand 1 (PD-L1) expression and received nivolumab 3 mg/kg every 2 weeks or ipilimumab 10 mg/kg every 3 weeks for four doses and then every 12 weeks, both intravenously for 1 year until disease recurrence, unacceptable toxicity, or withdrawal of consent. The primary endpoint was RFS. RESULTS At a minimum follow-up of 62 months, RFS with nivolumab remained superior to ipilimumab (HR = 0.72; 95% confidence interval, 0.60-0.86; 5-year rates of 50% vs. 39%). Five-year distant metastasis-free survival (DMFS) rates were 58% with nivolumab versus 51% with ipilimumab. Five-year overall survival (OS) rates were 76% with nivolumab and 72% with ipilimumab (75% data maturity: 228 of 302 planned events). Higher levels of tumor mutational burden (TMB), tumor PD-L1, intratumoral CD8+ T cells and IFNγ-associated gene expression signature, and lower levels of peripheral serum C-reactive protein were associated with improved RFS and OS with both nivolumab and ipilimumab, albeit with limited clinically meaningful predictive value. CONCLUSIONS Nivolumab is a proven adjuvant treatment for resected melanoma at high risk of recurrence, with sustained, long-term improvement in RFS and DMFS compared with ipilimumab and high OS rates. Identification of additional biomarkers is needed to better predict treatment outcome. See related commentary by Augustin and Luke, p. 3253.
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Affiliation(s)
- James Larkin
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Helen Gogas
- National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | | | - Ivan Marquez-Rodas
- General University Hospital Gregorio Marañón and CIBERONC, Madrid, Spain
| | | | | | | | - Jose Lutzky
- Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Luis de la Cruz-Merino
- Hospital Universitario Virgen Macarena, Clinical Oncology Department, University of Seville, Seville, Spain
| | - Petr Arenberger
- Charles University Third Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Victoria Atkinson
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | | | | | - Michael Millward
- University of Western Australia and Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | | | | | | | | | | | | | - Hao Tang
- Bristol Myers Squibb, Princeton, New Jersey
| | | | - Paolo A. Ascierto
- Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Naples, Italy
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, New York
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4
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Moey MYY, Hennessy C, French B, Warner JL, Tucker MD, Hausrath DJ, Shah DP, DeCara JM, Bakouny Z, Labaki C, Choueiri TK, Dent S, Akhter N, Ismail-Khan R, Tachiki L, Slosky D, Polonsky TS, Awosika JA, Crago A, Wise-Draper T, Balanchivadze N, Hwang C, Fecher LA, Gomez CG, Hayes-Lattin B, Glover MJ, Shah SA, Gopalakrishnan D, Griffiths EA, Kwon DH, Koshkin VS, Mahmood S, Bashir B, Nonato T, Razavi P, McKay RR, Nagaraj G, Oligino E, Puc M, Tregubenko P, Wulff-Burchfield EM, Xie Z, Halfdanarson TR, Farmakiotis D, Klein EJ, Robilotti EV, Riely GJ, Durand JB, Hayek SS, Kondapalli L, Berg S, O'Connor TE, Bilen MA, Castellano C, Accordino MK, Sibel B, Weissmann LB, Jani C, Flora DB, Rudski L, Dutra MS, Nathaniel B, Ruíz-García E, Vilar-Compte D, Gupta S, Morgans A, Nohria A. COVID-19 severity and cardiovascular outcomes in SARS-CoV-2-infected patients with cancer and cardiovascular disease. Transl Oncol 2023; 34:101709. [PMID: 37302348 PMCID: PMC10235676 DOI: 10.1016/j.tranon.2023.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/20/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Background Data regarding outcomes among patients with cancer and co-morbid cardiovascular disease (CVD)/cardiovascular risk factors (CVRF) after SARS-CoV-2 infection are limited. Objectives To compare Coronavirus disease 2019 (COVID-19) related complications among cancer patients with and without co-morbid CVD/CVRF. Methods Retrospective cohort study of patients with cancer and laboratory-confirmed SARS-CoV-2, reported to the COVID-19 and Cancer Consortium (CCC19) registry from 03/17/2020 to 12/31/2021. CVD/CVRF was defined as established CVD or no established CVD, male ≥ 55 or female ≥ 60 years, and one additional CVRF. The primary endpoint was an ordinal COVID-19 severity outcome including need for hospitalization, supplemental oxygen, intensive care unit (ICU), mechanical ventilation, ICU or mechanical ventilation plus vasopressors, and death. Secondary endpoints included incident adverse CV events. Ordinal logistic regression models estimated associations of CVD/CVRF with COVID-19 severity. Effect modification by recent cancer therapy was evaluated. Results Among 10,876 SARS-CoV-2 infected patients with cancer (median age 65 [IQR 54-74] years, 53% female, 52% White), 6253 patients (57%) had co-morbid CVD/CVRF. Co-morbid CVD/CVRF was associated with higher COVID-19 severity (adjusted OR: 1.25 [95% CI 1.11-1.40]). Adverse CV events were significantly higher in patients with CVD/CVRF (all p<0.001). CVD/CVRF was associated with worse COVID-19 severity in patients who had not received recent cancer therapy, but not in those undergoing active cancer therapy (OR 1.51 [95% CI 1.31-1.74] vs. OR 1.04 [95% CI 0.90-1.20], pinteraction <0.001). Conclusions Co-morbid CVD/CVRF is associated with higher COVID-19 severity among patients with cancer, particularly those not receiving active cancer therapy. While infrequent, COVID-19 related CV complications were higher in patients with comorbid CVD/CVRF. (COVID-19 and Cancer Consortium Registry [CCC19]; NCT04354701).
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Affiliation(s)
- Melissa Y Y Moey
- Department of Cardiovascular Disease, Vidant Medical Center/East Carolina University, Greenville, NC, United States
| | - Cassandra Hennessy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jeremy L Warner
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, United States
| | - Matthew D Tucker
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States
| | - Daniel J Hausrath
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University, Nashville, TN, United States
| | - Dimpy P Shah
- Mays Cancer Center at UTHealth San Antonio MD Anderson, San Antonio, TX, United States
| | - Jeanne M DeCara
- Section of Cardiology, University of Chicago Medical Center, Chicago, IL, United States
| | - Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, MA, United States
| | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, MA, United States
| | | | - Susan Dent
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Roohi Ismail-Khan
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and Moffitt Cancer Center, Tampa, FL, United States
| | - Lisa Tachiki
- University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - David Slosky
- Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Joy A Awosika
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | - Audrey Crago
- University of Cincinnati Cancer Center, Cincinnati, OH, United States
| | | | - Nino Balanchivadze
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, United States
| | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, United States
| | - Leslie A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, United States
| | | | - Brandon Hayes-Lattin
- Division of Hematology and Medical Oncology, Knight Cancer Institute at Oregon Health and Science University, Portland, OR, United States
| | - Michael J Glover
- Stanford Cancer Institute at Stanford University, Stanford, CA, United States
| | - Sumit A Shah
- Stanford Cancer Institute at Stanford University, Stanford, CA, United States
| | - Dharmesh Gopalakrishnan
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Elizabeth A Griffiths
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Daniel H Kwon
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States
| | - Vadim S Koshkin
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, CA, United States
| | - Sana Mahmood
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Taylor Nonato
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Pedram Razavi
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Rana R McKay
- Moores Cancer Center, University of California San Diego, La Jolla, CA, United States
| | - Gayathri Nagaraj
- Division of Medical Oncology and Hematology, Loma Linda University, Loma Linda, CA, United States
| | - Eric Oligino
- Cardio-Oncology, Hartford HealthCare Cancer, Hartford, CT, United States
| | | | - Polina Tregubenko
- The University of Kansas Health System, Kansas City, KS, United States
| | | | - Zhuoer Xie
- Mayo Clinic, Rochester, MN, United States
| | | | | | - Elizabeth J Klein
- Brown University and Lifespan Cancer Institute, Providence, RI, United States
| | | | - Gregory J Riely
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | | | - Salim S Hayek
- Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, MI, United States
| | - Lavanya Kondapalli
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Stephanie Berg
- Loyola University Medical Center, Chicago, IL, United States
| | | | - Mehmet A Bilen
- Winship Cancer Institute of Emory University, Emory University, Atlanta, GA, United States
| | - Cecilia Castellano
- Winship Cancer Institute of Emory University, Emory University, Atlanta, GA, United States
| | - Melissa K Accordino
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY, United States
| | - Blau Sibel
- Northwest Medical Specialties, Tacoma, WA, United States
| | | | - Chinmay Jani
- Mount Auburn Hospital, Cambridge, MA, United States
| | | | - Lawrence Rudski
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Miriam Santos Dutra
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | | | | | | | - Alicia Morgans
- Dana-Farber Cancer Institute, Boston, MA, United States.
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, United States.
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Chen YC, Jaffer M, Zhou L, Moslehi J, Forsyth PA, Fecher LA. A Brain, A Heart, and the Courage: Balancing Benefit and Toxicity of Immunotherapy in Melanoma. Am Soc Clin Oncol Educ Book 2023; 43:e390594. [PMID: 37229626 DOI: 10.1200/edbk_390594] [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: 05/27/2023]
Abstract
The overall survival of advanced melanoma has improved dramatically. Immunotherapies, specifically checkpoint inhibitors, have played a large role in this improvement. These agents have also shown benefit in the adjuvant setting, are approved for treatment of resected stage II, III, and IV melanoma, and play an evolving role in the neoadjuvant setting. Although generally well tolerated, immune-related adverse events occur and can be severe. Here we focus on some severe and potentially long term toxicities, including cardiovascular and neurologic toxicities. Our understanding of the acute and long-term toxicities of immune checkpoint inhibitors continues to evolve. Oncologists must continue to balance cancer risk and treatment-related toxicities.
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Affiliation(s)
- Yen-Chou Chen
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Jaffer
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
| | - Lylybell Zhou
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Javid Moslehi
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
- Department of Oncology, Moffitt Cancer Center and University of South Florida, Tampa, FL
| | - Leslie A Fecher
- Rogel Cancer Center at the University of Michigan, Ann Arbor, MI
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6
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Johnson DB, Atkins MB, Hennessy C, Wise-Draper T, Heilman H, Awosika J, Bakouny Z, Labaki C, Saliby RM, Hwang C, Singh SRK, Balanchivadze N, Friese CR, Fecher LA, Yoon JJ, Hayes-Lattin B, Bilen MA, Castellano CA, Lyman GH, Tachiki L, Shah SA, Glover MJ, Flora DB, Wulff-Burchfield E, Kasi A, Abbasi SH, Farmakiotis D, Viera K, Klein EJ, Weissman LB, Jani C, Puc M, Fahey CC, Reuben DY, Mishra S, Beeghly-Fadiel A, French B, Warner JL. Impact of COVID-19 in patients on active melanoma therapy and with history of melanoma. BMC Cancer 2023; 23:265. [PMID: 36949413 PMCID: PMC10033295 DOI: 10.1186/s12885-023-10708-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/06/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION COVID-19 particularly impacted patients with co-morbid conditions, including cancer. Patients with melanoma have not been specifically studied in large numbers. Here, we sought to identify factors that associated with COVID-19 severity among patients with melanoma, particularly assessing outcomes of patients on active targeted or immune therapy. METHODS Using the COVID-19 and Cancer Consortium (CCC19) registry, we identified 307 patients with melanoma diagnosed with COVID-19. We used multivariable models to assess demographic, cancer-related, and treatment-related factors associated with COVID-19 severity on a 6-level ordinal severity scale. We assessed whether treatment was associated with increased cardiac or pulmonary dysfunction among hospitalized patients and assessed mortality among patients with a history of melanoma compared with other cancer survivors. RESULTS Of 307 patients, 52 received immunotherapy (17%), and 32 targeted therapy (10%) in the previous 3 months. Using multivariable analyses, these treatments were not associated with COVID-19 severity (immunotherapy OR 0.51, 95% CI 0.19 - 1.39; targeted therapy OR 1.89, 95% CI 0.64 - 5.55). Among hospitalized patients, no signals of increased cardiac or pulmonary organ dysfunction, as measured by troponin, brain natriuretic peptide, and oxygenation were noted. Patients with a history of melanoma had similar 90-day mortality compared with other cancer survivors (OR 1.21, 95% CI 0.62 - 2.35). CONCLUSIONS Melanoma therapies did not appear to be associated with increased severity of COVID-19 or worsening organ dysfunction. Patients with history of melanoma had similar 90-day survival following COVID-19 compared with other cancer survivors.
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Affiliation(s)
| | - Michael B Atkins
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | | | - Joy Awosika
- University of Cincinnati Cancer Center, Cincinnati, USA
| | | | | | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Sunny R K Singh
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, MI, USA
| | | | | | - Leslie A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - James J Yoon
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Brandon Hayes-Lattin
- Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | | | | | - Sumit A Shah
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Michael J Glover
- Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | | | | | - Anup Kasi
- The University of Kansas Cancer Center, Lawrence, KS, USA
| | - Saqib H Abbasi
- The University of Kansas Cancer Center, Lawrence, KS, USA
| | | | - Kendra Viera
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA
| | - Elizabeth J Klein
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA
| | | | | | | | | | - Daniel Y Reuben
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | | | - Benjamin French
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Jeremy L Warner
- Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island, USA
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Patel SP, Othus M, Chen Y, Wright GP, Yost KJ, Hyngstrom JR, Hu-Lieskovan S, Lao CD, Fecher LA, Truong TG, Eisenstein JL, Chandra S, Sosman JA, Kendra KL, Wu RC, Devoe CE, Deutsch GB, Hegde A, Khalil M, Mangla A, Reese AM, Ross MI, Poklepovic AS, Phan GQ, Onitilo AA, Yasar DG, Powers BC, Doolittle GC, In GK, Kokot N, Gibney GT, Atkins MB, Shaheen M, Warneke JA, Ikeguchi A, Najera JE, Chmielowski B, Crompton JG, Floyd JD, Hsueh E, Margolin KA, Chow WA, Grossmann KF, Dietrich E, Prieto VG, Lowe MC, Buchbinder EI, Kirkwood JM, Korde L, Moon J, Sharon E, Sondak VK, Ribas A. Neoadjuvant-Adjuvant or Adjuvant-Only Pembrolizumab in Advanced Melanoma. N Engl J Med 2023; 388:813-823. [PMID: 36856617 PMCID: PMC10410527 DOI: 10.1056/nejmoa2211437] [Citation(s) in RCA: 169] [Impact Index Per Article: 169.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Whether pembrolizumab given both before surgery (neoadjuvant therapy) and after surgery (adjuvant therapy), as compared with pembrolizumab given as adjuvant therapy alone, would increase event-free survival among patients with resectable stage III or IV melanoma is unknown. METHODS In a phase 2 trial, we randomly assigned patients with clinically detectable, measurable stage IIIB to IVC melanoma that was amenable to surgical resection to three doses of neoadjuvant pembrolizumab, surgery, and 15 doses of adjuvant pembrolizumab (neoadjuvant-adjuvant group) or to surgery followed by pembrolizumab (200 mg intravenously every 3 weeks for a total of 18 doses) for approximately 1 year or until disease recurred or unacceptable toxic effects developed (adjuvant-only group). The primary end point was event-free survival in the intention-to-treat population. Events were defined as disease progression or toxic effects that precluded surgery; the inability to resect all gross disease; disease progression, surgical complications, or toxic effects of treatment that precluded the initiation of adjuvant therapy within 84 days after surgery; recurrence of melanoma after surgery; or death from any cause. Safety was also evaluated. RESULTS At a median follow-up of 14.7 months, the neoadjuvant-adjuvant group (154 patients) had significantly longer event-free survival than the adjuvant-only group (159 patients) (P = 0.004 by the log-rank test). In a landmark analysis, event-free survival at 2 years was 72% (95% confidence interval [CI], 64 to 80) in the neoadjuvant-adjuvant group and 49% (95% CI, 41 to 59) in the adjuvant-only group. The percentage of patients with treatment-related adverse events of grades 3 or higher during therapy was 12% in the neoadjuvant-adjuvant group and 14% in the adjuvant-only group. CONCLUSIONS Among patients with resectable stage III or IV melanoma, event-free survival was significantly longer among those who received pembrolizumab both before and after surgery than among those who received adjuvant pembrolizumab alone. No new toxic effects were identified. (Funded by the National Cancer Institute and Merck Sharp and Dohme; S1801 ClinicalTrials.gov number, NCT03698019.).
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Affiliation(s)
- Sapna P Patel
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Megan Othus
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Yuanbin Chen
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - G Paul Wright
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Kathleen J Yost
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - John R Hyngstrom
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Siwen Hu-Lieskovan
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Christopher D Lao
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Leslie A Fecher
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Thach-Giao Truong
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Jennifer L Eisenstein
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Sunandana Chandra
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Jeffrey A Sosman
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Kari L Kendra
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Richard C Wu
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Craig E Devoe
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Gary B Deutsch
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Aparna Hegde
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Maya Khalil
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Ankit Mangla
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Amy M Reese
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Merrick I Ross
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Andrew S Poklepovic
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Giao Q Phan
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Adedayo A Onitilo
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Demet G Yasar
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Benjamin C Powers
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Gary C Doolittle
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Gino K In
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Niels Kokot
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Geoffrey T Gibney
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Michael B Atkins
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Montaser Shaheen
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - James A Warneke
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Alexandra Ikeguchi
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Jose E Najera
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Bartosz Chmielowski
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Joseph G Crompton
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Justin D Floyd
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Eddy Hsueh
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Kim A Margolin
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Warren A Chow
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Kenneth F Grossmann
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Eliana Dietrich
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Victor G Prieto
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Michael C Lowe
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Elizabeth I Buchbinder
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - John M Kirkwood
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Larissa Korde
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - James Moon
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Elad Sharon
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Vernon K Sondak
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
| | - Antoni Ribas
- From the University of Texas M.D. Anderson Cancer Center, Houston (S.P.P., M.I.R., V.G.P.), and the University of Texas Health Science Center at San Antonio, San Antonio (M.S.); Southwest Oncology Group Statistics and Data Management Center (M.O., J.M.) and the Fred Hutchinson Cancer Center (M.O., E.D., J.M.) - both in Seattle; the Cancer Research Consortium of West Michigan National Cancer Institute Community Oncology Research Program (NCORP)-Cancer and Hematology Centers of Western Michigan (Y.C.), the Cancer Research Consortium of West Michigan NCORP-Spectrum Health (G.P.W.), and the Cancer Research Consortium of West Michigan NCORP (K.J.Y.), Grand Rapids, and the University of Michigan Rogel Cancer Center, Ann Arbor (C.D.L., L.A.F.); the University of Utah Huntsman Cancer Institute, Salt Lake City (J.R.H., S.H.-L.); Kaiser Permanente Northern California, Vallejo (T.-G.T.), University of Southern California Norris Comprehensive Cancer Center (G.K.I., N.K.) and University of California Los Angeles Jonsson Comprehensive Cancer Center (B.C., J.G.C., A.R.), Los Angeles, City of Hope Comprehensive Cancer Center-Saint John's Cancer Institute, Santa Monica (K.A.M.), and City of Hope Comprehensive Cancer Center-University of California, Irvine, Irvine (W.A.C.) - all in California; Kaiser Permanente Colorado, Lafayette (J.L.E.); Northwestern University, Chicago (S.C., J.A.S.), and the Cancer Care Specialists of Illinois-Heartland NCORP, O'Fallon (J.D.F.) - both in Illinois; Ohio State University Wexner Medical Center, Columbus (K.L.K., R.C.W.), and University Hospitals Seidman Cancer Center-Case Western Reserve University Case Comprehensive Cancer Center, Cleveland (A.M., A.M.R.); Northwell Health Cancer Institute, Lake Success, NY (C.E.D., G.B.D.); the University of Alabama at Birmingham, Birmingham (A.H., M.K.); Virginia Commonwealth University-Massey Cancer Center-VCU Massey Cancer Center Minority Underserved NCORP, Richmond (A.S.P., G.Q.P.); Marshfield Medical Center Wisconsin NCORP, Weston (A.A.O.), and Marshfield Medical Center Wisconsin NCORP, Minocqua (D.G.Y.); the University of Kansas Cancer Center, Overland Park (B.C.P.), and the University of Kansas Hospital-Westwood Cancer Center, Westwood (G.C.D.); MedStar Georgetown University Hospital, Washington, DC (G.T.G., M.B.A.); Banner University Medical Center-University of Arizona Cancer Center, Tucson (M.S., J.A.W.); the University of Oklahoma, Oklahoma City (A.I.), and the University of Oklahoma-Cancer Centers of Southwest Oklahoma, Lawton (J.E.N.); Saint Louis University School of Medicine, St. Louis (E.H.); Merck, Rahway, NJ (K.F.G.); Emory University, Atlanta (M.C.L.); Dana-Farber Cancer Institute-Harvard Cancer Center, Boston (E.I.B.); the University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh (J.M.K.); the National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, MD (L.K., E.S.); and Moffitt Cancer Center, Tampa, FL (V.K.S.)
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Li G, Choi JE, Kryczek I, Sun Y, Liao P, Li S, Wei S, Grove S, Vatan L, Nelson R, Schaefer G, Allen SG, Sankar K, Fecher LA, Mendiratta-Lala M, Frankel TL, Qin A, Waninger JJ, Tezel A, Alva A, Lao CD, Ramnath N, Cieslik M, Harms PW, Green MD, Chinnaiyan AM, Zou W. Intersection of immune and oncometabolic pathways drives cancer hyperprogression during immunotherapy. Cancer Cell 2023; 41:304-322.e7. [PMID: 36638784 PMCID: PMC10286807 DOI: 10.1016/j.ccell.2022.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
Immune checkpoint blockade (ICB) can produce durable responses against cancer. We and others have found that a subset of patients experiences paradoxical rapid cancer progression during immunotherapy. It is poorly understood how tumors can accelerate their progression during ICB. In some preclinical models, ICB causes hyperprogressive disease (HPD). While immune exclusion drives resistance to ICB, counterintuitively, patients with HPD and complete response (CR) following ICB manifest comparable levels of tumor-infiltrating CD8+ T cells and interferon γ (IFNγ) gene signature. Interestingly, patients with HPD but not CR exhibit elevated tumoral fibroblast growth factor 2 (FGF2) and β-catenin signaling. In animal models, T cell-derived IFNγ promotes tumor FGF2 signaling, thereby suppressing PKM2 activity and decreasing NAD+, resulting in reduction of SIRT1-mediated β-catenin deacetylation and enhanced β-catenin acetylation, consequently reprograming tumor stemness. Targeting the IFNγ-PKM2-β-catenin axis prevents HPD in preclinical models. Thus, the crosstalk of core immunogenic, metabolic, and oncogenic pathways via the IFNγ-PKM2-β-catenin cascade underlies ICB-associated HPD.
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Affiliation(s)
- Gaopeng Li
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Jae Eun Choi
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Ilona Kryczek
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Peng Liao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Shasha Li
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Shuang Wei
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Sara Grove
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Linda Vatan
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Reagan Nelson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Grace Schaefer
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Steven G Allen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kamya Sankar
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Leslie A Fecher
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Angel Qin
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jessica J Waninger
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Alangoya Tezel
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai Alva
- Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher D Lao
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nithya Ramnath
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Marcin Cieslik
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Green
- Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Graduate Program in Immunology, University of Michigan, Ann Arbor, MI, USA; Graduate Program in Cancer Biology, University of Michigan, Ann Arbor, MI, USA.
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA; Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA
| | - Weiping Zou
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Center of Excellence for Cancer Immunology and Immunotherapy, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA; Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Graduate Program in Immunology, University of Michigan, Ann Arbor, MI, USA; Graduate Program in Cancer Biology, University of Michigan, Ann Arbor, MI, USA.
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Bakouny Z, Labaki C, Grover P, Awosika J, Gulati S, Hsu CY, Alimohamed SI, Bashir B, Berg S, Bilen MA, Bowles D, Castellano C, Desai A, Elkrief A, Eton OE, Fecher LA, Flora D, Galsky MD, Gatti-Mays ME, Gesenhues A, Glover MJ, Gopalakrishnan D, Gupta S, Halfdanarson TR, Hayes-Lattin B, Hendawi M, Hsu E, Hwang C, Jandarov R, Jani C, Johnson DB, Joshi M, Khan H, Khan SA, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Matar S, McKay RR, Mishra S, Moria FA, Nizam A, Nock NL, Nonato TK, Panasci J, Pomerantz L, Portuguese AJ, Provenzano D, Puc M, Rao YJ, Rhodes TD, Riely GJ, Ripp JJ, Rivera AV, Ruiz-Garcia E, Schmidt AL, Schoenfeld AJ, Schwartz GK, Shah SA, Shaya J, Subbiah S, Tachiki LM, Tucker MD, Valdez-Reyes M, Weissmann LB, Wotman MT, Wulff-Burchfield EM, Xie Z, Yang YJ, Thompson MA, Shah DP, Warner JL, Shyr Y, Choueiri TK, Wise-Draper TM, Gandhi R, Gartrell BA, Goel S, Halmos B, Makower DF, O' Sullivan D, Ohri N, Portes M, Shapiro LC, Shastri A, Sica RA, Verma AK, Butt O, Campian JL, Fiala MA, Henderson JP, Monahan RS, Stockerl-Goldstein KE, Zhou AY, Bitran JD, Hallmeyer S, Mundt D, Pandravada S, Papaioannou PV, Patel M, Streckfuss M, Tadesse E, Gatson NTN, Kundranda MN, Lammers PE, Loree JM, Yu IS, Bindal P, Lam B, Peters MLB, Piper-Vallillo AJ, Egan PC, Farmakiotis D, Arvanitis P, Klein EJ, Olszewski AJ, Vieira K, Angevine AH, Bar MH, Del Prete SA, Fiebach MZ, Gulati AP, Hatton E, Houston K, Rose SJ, Steve Lo KM, Stratton J, Weinstein PL, Garcia JA, Routy B, Hoyo-Ulloa I, Dawsey SJ, Lemmon CA, Pennell NA, Sharifi N, Painter CA, Granada C, Hoppenot C, Li A, Bitterman DS, Connors JM, Demetri GD, Florez (Duma) N, Freeman DA, Giordano A, Morgans AK, Nohria A, Saliby RM, Tolaney SM, Van Allen EM, Xu WV, Zon RL, Halabi S, Zhang T, Dzimitrowicz H, Leighton JC, Graber JJ, Grivas P, Hawley JE, Loggers ET, Lyman GH, Lynch RC, Nakasone ES, Schweizer MT, Vinayak S, Wagner MJ, Yeh A, Dansoa Y, Makary M, Manikowski JJ, Vadakara J, Yossef K, Beckerman J, Goyal S, Messing I, Rosenstein LJ, Steffes DR, Alsamarai S, Clement JM, Cosin JA, Daher A, Dailey ME, Elias R, Fein JA, Hosmer W, Jayaraj A, Mather J, Menendez AG, Nadkarni R, Serrano OK, Yu PP, Balanchivadze N, Gadgeel SM, Accordino MK, Bhutani D, Bodin BE, Hershman DL, Masson C, Alexander M, Mushtaq S, Reuben DY, Bernicker EH, Deeken JF, Jeffords KJ, Shafer D, Cárdenas AI, Cuervo Campos R, De-la-Rosa-Martinez D, Ramirez A, Vilar-Compte D, Gill DM, Lewis MA, Low CA, Jones MM, Mansoor AH, Mashru SH, Werner MA, Cohen AM, McWeeney S, Nemecek ER, Williamson SP, Peters S, Smith SJ, Lewis GC, Zaren HA, Akhtari M, Castillo DR, Cortez K, Lau E, Nagaraj G, Park K, Reeves ME, O'Connor TE, Altman J, Gurley M, Mulcahy MF, Wehbe FH, Durbin EB, Nelson HH, Ramesh V, Sachs Z, Wilson G, Bardia A, Boland G, Gainor JF, Peppercorn J, Reynolds KL, Rosovsky RP, Zubiri L, Bekaii-Saab TS, Joyner MJ, Riaz IB, Senefeld JW, Shah S, Ayre SK, Bonnen M, Mahadevan D, McKeown C, Mesa RA, Ramirez AG, Salazar M, Shah PK, Wang CP, Bouganim N, Papenburg J, Sabbah A, Tagalakis V, Vinh DC, Nanchal R, Singh H, Bahadur N, Bao T, Belenkaya R, Nambiar PH, O’Cearbhaill RE, Papadopoulos EB, Philip J, Robson M, Rosenberg JE, Wilkins CR, Tamimi R, Cerrone K, Dill J, Faller BA, Alomar ME, Chandrasekhar SA, Hume EC, Islam JY, Ajmera A, Brouha SS, Cabal A, Choi S, Hsiao A, Jiang JY, Kligerman S, Park J, Razavi P, Reid EG, Bhatt PS, Mariano MG, Thomson CC, Glace M(G, Knoble JL, Rink C, Zacks R, Blau SH, Brown C, Cantrell AS, Namburi S, Polimera HV, Rovito MA, Edwin N, Herz K, Kennecke HF, Monfared A, Sautter RR, Cronin T, Elshoury A, Fleissner B, Griffiths EA, Hernandez-Ilizaliturri F, Jain P, Kariapper A, Levine E, Moffitt M, O'Connor TL, Smith LJ, Wicher CP, Zsiros E, Jabbour SK, Misdary CF, Shah MR, Batist G, Cook E, Ferrario C, Lau S, Miller WH, Rudski L, Santos Dutra M, Wilchesky M, Mahmood SZ, McNair C, Mico V, Dixon B, Kloecker G, Logan BB, Mandapakala C, Cabebe EC, Jha A, Khaki AR, Nagpal S, Schapira L, Wu JTY, Whaley D, Lopes GDL, de Cardenas K, Russell K, Stith B, Taylor S, Klamerus JF, Revankar SG, Addison D, Chen JL, Haynam M, Jhawar SR, Karivedu V, Palmer JD, Pillainayagam C, Stover DG, Wall S, Williams NO, Abbasi SH, Annis S, Balmaceda NB, Greenland S, Kasi A, Rock CD, Luders M, Smits M, Weiss M, Chism DD, Owenby S, Ang C, Doroshow DB, Metzger M, Berenberg J, Uyehara C, Fazio A, Huber KE, Lashley LN, Sueyoshi MH, Patel KG, Riess J, Borno HT, Small EJ, Zhang S, Andermann TM, Jensen CE, Rubinstein SM, Wood WA, Ahmad SA, Brownfield L, Heilman H, Kharofa J, Latif T, Marcum M, Shaikh HG, Sohal DPS, Abidi M, Geiger CL, Markham MJ, Russ AD, Saker H, Acoba JD, Choi H, Rho YS, Feldman LE, Gantt G, Hoskins KF, Khan M, Liu LC, Nguyen RH, Pasquinelli MM, Schwartz C, Venepalli NK, Vikas P, Zakharia Y, Friese CR, Boldt A, Gonzalez CJ, Su C, Su CT, Yoon JJ, Bijjula R, Mavromatis BH, Seletyn ME, Wood BR, Zaman QU, Kaklamani V, Beeghly A, Brown AJ, Charles LJ, Cheng A, Crispens MA, Croessmann S, Davis EJ, Ding T, Duda SN, Enriquez KT, French B, Gillaspie EA, Hausrath DJ, Hennessy C, Lewis JT, Li X(L, Prescott LS, Reid SA, Saif S, Slosky DA, Solorzano CC, Sun T, Vega-Luna K, Wang LL, Aboulafia DM, Carducci TM, Goldsmith KJ, Van Loon S, Topaloglu U, Moore J, Rice RL, Cabalona WD, Cyr S, Barrow McCollough B, Peddi P, Rosen LR, Ravindranathan D, Hafez N, Herbst RS, LoRusso P, Lustberg MB, Masters T, Stratton C. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:128-134. [PMID: 36326731 PMCID: PMC9634600 DOI: 10.1001/jamaoncol.2022.5357] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Punita Grover
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Joy Awosika
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saif I Alimohamed
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | | | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Arielle Elkrief
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Omar E Eton
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | - Mohamed Hendawi
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Emily Hsu
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, Michigan
| | - Roman Jandarov
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Shaheer A Khan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Natalie Knox
- Loyola University Medical Center, Maywood, Illinois
| | - Vadim S Koshkin
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | | | - Daniel H Kwon
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | - Sara Matar
- Hollings Cancer Center, MUSC, Charleston
| | - Rana R McKay
- Moores Cancer Center, UCSD, San Diego, California
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nora L Nock
- Case Comprehensive Cancer Center, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | | | - Justin Panasci
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | - Yuan J Rao
- George Washington University, Washington, DC
| | | | | | - Jacob J Ripp
- University of Kansas Medical Center, Kansas City
| | - Andrea V Rivera
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Justin Shaya
- Moores Cancer Center, UCSD, San Diego, California
| | - Suki Subbiah
- Stanley S. Scott Cancer Center, LSU, New Orleans, Louisiana
| | - Lisa M Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Zhuoer Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael A Thompson
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.,Tempus Labs, Chicago, Illinois
| | - Dimpy P Shah
- Mays Cancer Center, UT Health, San Antonio, Texas
| | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Omar Butt
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ang Li
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lau
- for the COVID-19 and Cancer Consortium
| | | | - Kyu Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ting Bao
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin Cook
- for the COVID-19 and Cancer Consortium
| | | | - Susie Lau
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anup Kasi
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li C Liu
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | - Chris Su
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tan Ding
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | - Sara Saif
- for the COVID-19 and Cancer Consortium
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Vasbinder A, Chen Y, Procureur A, Gradone A, Azam TU, Perry D, Shadid H, Anderson E, Catalan T, Blakely P, Nelapudi N, Fardous M, Bretagne MC, Adie SK, Pogue KT, Leja M, Yentz S, Schneider B, Fecher LA, Lao CD, Salem JE, Hayek SS. Biomarker Trends, Incidence, and Outcomes of Immune Checkpoint Inhibitor-Induced Myocarditis. JACC CardioOncol 2022; 4:689-700. [PMID: 36636441 PMCID: PMC9830199 DOI: 10.1016/j.jaccao.2022.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background Myocarditis is a dreaded and unpredictable complication of immune checkpoint inhibitors (ICI). We sought to determine whether routinely measured biomarkers could be helpful in monitoring for ICI myocarditis. Objectives The authors examined biomarker trends of patients on ICI and their association with the incidence of ICI myocarditis and outcomes. Methods We conducted an observational cohort study of adults who received at least one dose of ICI at Michigan Medicine between June 2014 and December 2021 and underwent systematic serial testing for aspartate aminotransferase (AST) and alanine aminotransferase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase during ICI therapy. Results Among 2,606 patients (mean age 64 ± 13 years; 60.7% men), 27 (1.0%) were diagnosed with ICI myocarditis. At diagnosis, patients with myocarditis had an elevated high-sensitivity troponin T (100%), ALT (88.9%), AST (85.2%), CPK (88.9%), and lactate dehydrogenase (92.6%). Findings were confirmed in an independent cohort of 30 patients with biopsy-confirmed ICI myocarditis. A total of 95% of patients with ICI myocarditis had elevations in at least 3 biomarkers compared with 5% of patients without myocarditis. Among the noncardiac biomarkers, only CPK was associated (per 100% increase) with the development of myocarditis (HR: 1.83; 95% CI: 1.59-2.10) and all-cause mortality (HR: 1.10; 95% CI: 1.01-1.20) in multivariable analysis. Elevations in CPK had a sensitivity of 99% and specificity of 23% for identifying myocarditis. Conclusions ICI myocarditis is associated with changes in AST, ALT, and CPK. An increase in noncardiac biomarkers during ICI treatment, notably CPK, should prompt further evaluation for ICI myocarditis.
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Affiliation(s)
- Alexi Vasbinder
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - YeeAnn Chen
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Adrien Procureur
- Department of Pharmacology and Clinical Investigation Centre, Pitié-Salpêtrière Hospital, Sorbonne Universite, Paris, France
| | - Allison Gradone
- Rogel Cancer Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tariq U. Azam
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Perry
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Husam Shadid
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Anderson
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tonimarie Catalan
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pennelope Blakely
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Namratha Nelapudi
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mohamad Fardous
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Marie C. Bretagne
- Department of Pharmacology and Clinical Investigation Centre, Pitié-Salpêtrière Hospital, Sorbonne Universite, Paris, France
| | - Sarah K. Adie
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristen T. Pogue
- Department of Clinical Pharmacy, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Leja
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah Yentz
- Rogel Cancer Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Bryan Schneider
- Rogel Cancer Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Leslie A. Fecher
- Rogel Cancer Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher D. Lao
- Rogel Cancer Center, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Joe-Elie Salem
- Department of Pharmacology and Clinical Investigation Centre, Pitié-Salpêtrière Hospital, Sorbonne Universite, Paris, France
| | - Salim S. Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA,Address for correspondence: Dr Salim Hayek, Department of Medicine, Division of Cardiology, University of Michigan Frankel Cardiovascular Center, 1500 East Medical Center Drive, CVC #2709, Ann Arbor, Michigan 48109, USA. @salimhayek
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11
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Chen W, Bhatia S, Brohl AS, Chandra S, Dakhil S, Fecher LA, Gao L, Gooley TA, Hanna GJ, Hibbert R, Kelly CM, Kiriluk SM, Lewis K, Moschos S, Nghiem P, Thompson JA, Tykodi SS. ADAM Trial: A multicenter, randomized, double-blinded, placebo-controlled, phase 3 trial of adjuvant avelumab (anti-PD-L1 antibody) in Merkel cell carcinoma patients with lymph node metastases; NCT03271372. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.08.007] [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: 11/30/2022]
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12
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Homan M, Warrier G, Lao CD, Yentz S, Kraft S, Fecher LA. Treatment related toxicities with combination BRAF and MEK inhibitor therapy in resected stage III melanoma. Front Oncol 2022; 12:855794. [PMID: 36212431 PMCID: PMC9538392 DOI: 10.3389/fonc.2022.855794] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Combination dabrafenib (D) and trametinib (T) is an FDA approved adjuvant therapy for patients with resected stage III BRAF-mutant melanoma. We describe treatment-related toxicities with adjuvant D+T in a real-world population through a retrospective case series. The primary endpoint was development of toxicities.
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Affiliation(s)
- Morgan Homan
- Department of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Govind Warrier
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Christopher D. Lao
- Department of Internal Medicine and Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Yentz
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shawna Kraft
- Department of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Leslie A. Fecher
- Department of Internal Medicine and Dermatology, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Leslie A. Fecher,
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13
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Balinski AM, Vasbinder AL, Kerndt CC, Catalan TC, Parry NP, Rehman RA, Blakely P, Yeow RY, Leja MJ, Lao CD, Fecher LA, Hayek SS. Metastatic melanoma of the heart: Retrospective cohort study and systematic review of prevalence, clinical characteristics, and outcomes. Cancer Med 2022; 12:2356-2367. [PMID: 35894689 PMCID: PMC9939187 DOI: 10.1002/cam4.5058] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cardiac metastasis of melanoma is rare and typically diagnosed post-mortem. Here we perform a retrospective cohort study and systematic review of patients with metastatic melanoma to characterize prevalence, clinical characteristics, and outcomes of cardiac metastasis. METHODS We reviewed the electronic medical records of all outpatients with metastatic melanoma who underwent evaluation at the University of Michigan in Ann Arbor from January 2009 to January 2022, identifying patients with a clinical or histopathologic diagnosis of cardiac metastasis. We performed a systematic review of the literature to summarize the clinical characteristics and outcomes of patients with melanoma and cardiac metastasis. RESULTS Overall, 23 of 1254 (1.8%) patients with metastatic melanoma were diagnosed with cardiac metastasis. Cardiac metastasis was reported in the right ventricle (65%), left ventricle (35%), and right atrium (35%). A total of 11 (48%) patients experienced at least one cardiovascular complication after the diagnosis of cardiac metastasis, the most common being arrhythmia (30%), heart failure (22%), and pericardial effusion (17%). Immunotherapy was more commonly used in patients with cardiac metastasis (80% vs 65%; p = 0.005). Mortality at 2-years post-diagnosis was higher for patients with cardiac metastasis compared to those without (59% vs 37%; p = 0.034). Progression of malignancy was the underlying cause of death of all patients. CONCLUSIONS Cardiac metastasis occurs in <2% of patients with metastatic melanoma, can affect all cardiac structures, and is associated with various cardiovascular complications and high mortality.
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Affiliation(s)
| | - Alexi L. Vasbinder
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Connor C. Kerndt
- Department of Internal MedicineSpectrum Health/Michigan State University College of Human MedicineGrand RapidsMichiganUSA
| | - Tonimarie C. Catalan
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Nathan P. Parry
- Oakland University William Beaumont School of MedicineRochesterMichiganUSA
| | - Rafey A. Rehman
- Oakland University William Beaumont School of MedicineRochesterMichiganUSA
| | - Pennelope Blakely
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Raymond Y. Yeow
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Monika J. Leja
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
| | - Christopher D. Lao
- Department of Internal MedicineDivision of Hematology/Oncology, University of MichiganAnn ArborMichiganUSA
| | - Leslie A. Fecher
- Department of Internal MedicineDivision of Hematology/Oncology, University of MichiganAnn ArborMichiganUSA
| | - Salim S. Hayek
- Department of Internal Medicine, Division of CardiologyUniversity of MichiganAnn ArborMichiganUSA
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Ma VT, Chamila Perera AA, Sun Y, Sitto M, Waninger JJ, Warrier G, Green MD, Fecher LA, Lao CD. Early Response Assessment in Advanced Stage Melanoma Treated with Combination Ipilimumab/Nivolumab. Front Immunol 2022; 13:860421. [PMID: 35874737 PMCID: PMC9296775 DOI: 10.3389/fimmu.2022.860421] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Standard combination ipilimumab/nivolumab (I/N) is given as 4 induction doses for advanced stage melanoma followed by nivolumab single-agent maintenance therapy. While many patients receive less than 4 doses due to immune-related toxicities, it is unclear if fewer doses of I/N may still provide long term clinical benefit. Our aim is to determine if response assessment after 1 or 2 doses of I/N can predict long-term survival and assess if fewer doses of I/N can lead to similar survival outcomes. Methods We performed a retrospective analysis on a cohort of patients with advanced melanoma who w0ere treated with standard I/N. Cox regression of progression-free survival (PFS) and overall survival (OS) models were performed to assess the relationship between response after 1 or 2 doses of I/N and risk of progression and/or death. Clinical benefit response (CBR) was assessed, defined as SD (stable disease) + PR (partial response) + CR (complete response) by imaging. Among patients who achieved a CBR after 1 or 2 doses of I/N, a multivariable Cox regression of survival was used to compare 1 or 2 vs 3 or 4 doses of I/N adjusted by known prognostic variables in advanced melanoma. Results 199 patients were evaluated. Patients with CBR after 1 dose of I/N had improved PFS (HR: 0.16, 95% CI 0.08-0.33; p<0.001) and OS (HR: 0.12, 0.05-0.32; p<0.001) compared to progressive disease (PD). Patients with CBR (vs PD) after 2 doses of I/N also had improved PFS (HR: 0.09, 0.05-0.16; p<0.001) and OS (HR: 0.07, 0.03-0.14; p<0.001). There was no survival risk difference comparing 1 or 2 vs 3 or 4 doses of I/N for PFS (HR: 0.95, 0.37-2.48; p=0.921) and OS (HR: 1.04, 0.22-4.78; p=0.965). Conclusions Early interval imaging with response during induction with I/N may be predictive of long-term survival in advanced stage melanoma. CBR after 1 or 2 doses of I/N is associated with favorable survival outcomes, even in the setting of fewer I/N doses received. Further studies are warranted to evaluate if electively administering fewer combination I/N doses despite tolerance in select patients may balance the benefits of therapy while decreasing toxicities.
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Affiliation(s)
- Vincent T. Ma
- Department of Internal Medicine, Division of Hematology, Medical Oncology, and Palliative Care, University of Wisconsin, Madison, WI, United States
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Vincent T. Ma,
| | | | - Yilun Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Merna Sitto
- Department of Medical Education, University of Michigan, Ann Arbor, MI, United States
| | - Jessica J. Waninger
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
- Department of Medical Education, University of Michigan, Ann Arbor, MI, United States
| | - Govind Warrier
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael D. Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
- Department of Radiation Oncology, Veteran Affairs Ann Arbor Hospital System, Ann Arbor, MI, United States
| | - Leslie A. Fecher
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Christopher D. Lao
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
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15
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Yuen KCJ, Samson SL, Bancos I, Gosmanov AR, Jasim S, Fecher LA, Weber JS. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGY (AACE) DISEASE STATE CLINICAL REVIEW EVALUATION AND MANAGEMENT OF IMMUNE CHECKPOINT INHIBITOR-MEDIATED ENDOCRINOPATHIES: A PRACTICAL CASE-BASED CLINICAL APPROACH. Endocr Pract 2022; 28:719-731. [PMID: 35477029 DOI: 10.1016/j.eprac.2022.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this case-based clinical review is to provide a practical approach for clinicians regarding the management of patients with immune checkpoint inhibitor (ICI)-mediated endocrinopathies. METHODS A literature search was conducted using PubMed, Embase and Scopus, and appropriate keywords. The discussions and strategies for diagnosis and management of ICI-mediated endocrinopathies are based on evidence available from prospective randomized clinical studies, cohort studies, cross-sectional studies, case-based studies, and expert consensus. RESULTS Immunotherapy with ICIs has transformed the treatment landscape of diverse cancer types, but frequently results in immune-mediated endocrinopathies that can cause acute and persistent morbidity, and rarely, death. The patterns of endocrinopathies differ between inhibitors of the CTLA-4 and PD-1/PD-L1 pathways, but most often involve the thyroid and pituitary glands. Less common but important presentations include insulin-deficient diabetes mellitus, primary adrenal insufficiency, primary hypoparathyroidism, central diabetes insipidus, primary hypogonadism, and pancreatitis with or without subsequent progression to diabetes or exocrine insufficiency. CONCLUSION In recent years, with increasing numbers of cancer patients being treated with ICIs, more clinicians in a variety of specialties are called upon to diagnose and treat ICI-mediated endocrinopathies. Herein, we review case scenarios of various clinical manifestations, and emphasize the need for a high index of clinical suspicion by all clinicians caring for these patients including endocrinologists, oncologists, primary care providers, and emergency department physicians. We also provide diagnostic and therapeutic approaches for ICI-induced endocrinopathies, and we propose that patients on ICI-therapy be evaluated and treated in a multidisciplinary team in collaboration with endocrinologists.
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Affiliation(s)
- Kevin C J Yuen
- Co-Chair of Task Force; Professor of Medicine, Department of Medicine, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona.
| | - Susan L Samson
- Co-Chair of Task Force; Senior Associate Consultant, Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic, Jacksonville, Florida
| | - Irina Bancos
- Associate Professor of Medicine; Associate Program Director, Endocrinology Fellowship Program, Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
| | - Aidar R Gosmanov
- Professor of Medicine, Division of Endocrinology, Albany Medical College; Chief, Endocrinology Section, Stratton VAMC, Albany, NY
| | - Sina Jasim
- Associate Professor of Medicine, Washington University in St. Louis, School of Medicine, Division of Endocrinology, Metabolism and Lipid Research, St. Louis, Missouri
| | - Leslie A Fecher
- ASCO Representative, Associate Professor of Medicine and Dermatology, University of Michigan, Rogel Cancer Center, Ann Arbor, Michigan
| | - Jeffrey S Weber
- ASCO Representative, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, New York
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16
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Ma VT, Lao CD, Fecher LA, Schiopu E. Successful use of secukinumab in two melanoma patients with immune checkpoint inhibitor-induced inflammatory arthropathy. Immunotherapy 2022; 14:593-598. [PMID: 35416067 DOI: 10.2217/imt-2021-0274] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Immune-related adverse events (irAEs) are a major concern when treating cancer patients with immune checkpoint inhibitor (ICI) therapy. Selecting the most appropriate management of irAEs remains an ongoing challenge because prolonged use of glucocorticoids come with their own side effects and may counteract the antineoplastic effects from immunotherapy. In this case report, we present two patients with metastatic melanoma who developed symptoms of inflammatory arthritis attributed to ICI therapy. We found that treatment with secukinumab, an anti-IL-17A inhibitor, effectively managed their symptoms and did not lead to tumor progression. Our study suggests that secukinumab can be a safe and effective treatment option for ICI-induced inflammatory arthropathy.
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Affiliation(s)
- Vincent T Ma
- Department of Internal Medicine, University of Wisconsin, Division of Hematology, Medical Oncology and Palliative Care, Madison, WI, USA.,Department of Internal Medicine, University of Michigan, Division of Hematology and Oncology, Ann Arbor, MI, USA
| | - Christopher D Lao
- Department of Internal Medicine, University of Michigan, Division of Hematology and Oncology, Ann Arbor, MI, USA
| | - Leslie A Fecher
- Department of Internal Medicine, University of Michigan, Division of Hematology and Oncology, Ann Arbor, MI, USA
| | - Elena Schiopu
- Department of Internal Medicine, University of Michigan, Division of Rheumatology, Ann Arbor, MI, USA
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17
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Fecher LA, Bishu S, Fontana RJ, Hayek SS, Schneider BJ. The Role of Tissue Biopsy in the Management of Immune Checkpoint Inhibitor Toxicity. J Natl Compr Canc Netw 2022; 20:417-425. [PMID: 35390763 DOI: 10.6004/jnccn.2022.7011] [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] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
Immune checkpoint inhibitors have revolutionized the treatment of cancer and are now omnipresent. However, immune-related adverse events can present with varying phenotypes and timing, which can pose diagnostic and therapeutic challenges for the treating oncologist as well as subspecialty consultants. Biopsies of affected organs may provide insight into biologic mechanisms as well as potentially guide management in certain circumstances.
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Affiliation(s)
| | | | | | - Salim S Hayek
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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18
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Fu J, Reid SA, French B, Hennessy C, Hwang C, Gatson NT, Duma N, Mishra S, Nguyen R, Hawley JE, Singh SRK, Chism DD, Venepalli NK, Warner JL, Choueiri TK, Schmidt AL, Fecher LA, Girard JE, Bilen MA, Ravindranathan D, Goyal S, Wise-Draper TM, Park C, Painter CA, McGlown SM, de Lima Lopes G, Serrano OK, Shah DP. Racial Disparities in COVID-19 Outcomes Among Black and White Patients With Cancer. JAMA Netw Open 2022; 5:e224304. [PMID: 35344045 PMCID: PMC8961318 DOI: 10.1001/jamanetworkopen.2022.4304] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Non-Hispanic Black individuals experience a higher burden of COVID-19 than the general population; hence, there is an urgent need to characterize the unique clinical course and outcomes of COVID-19 in Black patients with cancer. OBJECTIVE To investigate racial disparities in severity of COVID-19 presentation, clinical complications, and outcomes between Black patients and non-Hispanic White patients with cancer and COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the COVID-19 and Cancer Consortium registry from March 17, 2020, to November 18, 2020, to examine the clinical characteristics and outcomes of COVID-19 in Black patients with cancer. Data analysis was performed from December 2020 to February 2021. EXPOSURES Black and White race recorded in patient's electronic health record. MAIN OUTCOMES AND MEASURES An a priori 5-level ordinal scale including hospitalization intensive care unit admission, mechanical ventilation, and all-cause death. RESULTS Among 3506 included patients (1768 women [50%]; median [IQR] age, 67 [58-77] years), 1068 (30%) were Black and 2438 (70%) were White. Black patients had higher rates of preexisting comorbidities compared with White patients, including obesity (480 Black patients [45%] vs 925 White patients [38%]), diabetes (411 Black patients [38%] vs 574 White patients [24%]), and kidney disease (248 Black patients [23%] vs 392 White patients [16%]). Despite the similar distribution of cancer type, cancer status, and anticancer therapy at the time of COVID-19 diagnosis, Black patients presented with worse illness and had significantly worse COVID-19 severity (unweighted odds ratio, 1.34 [95% CI, 1.15-1.58]; weighted odds ratio, 1.21 [95% CI, 1.11-1.33]). CONCLUSIONS AND RELEVANCE These findings suggest that Black patients with cancer experience worse COVID-19 outcomes compared with White patients. Understanding and addressing racial inequities within the causal framework of structural racism is essential to reduce the disproportionate burden of diseases, such as COVID-19 and cancer, in Black patients.
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Affiliation(s)
- Julie Fu
- Department of Internal Medicine, Hematology-Oncology, Tufts Medical Center Cancer Center, Stoneham, Massachusetts
| | - Sonya A. Reid
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, Tennessee
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Cassandra Hennessy
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Clara Hwang
- Department of Internal Medicine, Division of Hematology-Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Na Tosha Gatson
- Geisinger Health System, Danville, Danville, Pennsylvania
- Department of Cancer Medicine, Division of Neuro-Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Narjust Duma
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sanjay Mishra
- Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ryan Nguyen
- Department of Hematology and Oncology, University of Illinois, Chicago
| | - Jessica E. Hawley
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
- Now with Division of Oncology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle
| | - Sunny R. K. Singh
- Department of Internal Medicine, Division of Hematology-Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | | | - Neeta K. Venepalli
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Jeremy L. Warner
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center at Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Toni K. Choueiri
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrew L. Schmidt
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Mehmet A. Bilen
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Deepak Ravindranathan
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Sharad Goyal
- Department of Radiation Oncology, George Washington University, Washington, DC
| | - Trisha M. Wise-Draper
- Department of Internal Medicine, Division of Hematology-Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Cathleen Park
- Department of Hematology-Oncology, University of California, Davis
| | - Corrie A. Painter
- Count Me In, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | | | - Gilberto de Lima Lopes
- Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami, Florida
| | - Oscar K. Serrano
- Department of Surgery, Hartford HealthCare Cancer Institute, Hartford, Connecticut
| | - Dimpy P. Shah
- Population Health Sciences, Mays Cancer Center at University of Texas Health San Antonio MD Anderson, San Antonio
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19
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Hawley JE, Sun T, Chism DD, Duma N, Fu JC, Gatson NTN, Mishra S, Nguyen RH, Reid SA, Serrano OK, Singh SRK, Venepalli NK, Bakouny Z, Bashir B, Bilen MA, Caimi PF, Choueiri TK, Dawsey SJ, Fecher LA, Flora DB, Friese CR, Glover MJ, Gonzalez CJ, Goyal S, Halfdanarson TR, Hershman DL, Khan H, Labaki C, Lewis MA, McKay RR, Messing I, Pennell NA, Puc M, Ravindranathan D, Rhodes TD, Rivera AV, Roller J, Schwartz GK, Shah SA, Shaya JA, Streckfuss M, Thompson MA, Wulff-Burchfield EM, Xie Z, Yu PP, Warner JL, Shah DP, French B, Hwang C. Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States. JAMA Netw Open 2022; 5:e2142046. [PMID: 34982158 PMCID: PMC8728628 DOI: 10.1001/jamanetworkopen.2021.42046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. OBJECTIVE To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. EXPOSURES Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. RESULTS Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58). CONCLUSIONS AND RELEVANCE In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.
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Affiliation(s)
- Jessica E. Hawley
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
- now with Division of Oncology, University of Washington/Fred Hutchinson Cancer Research Center, Seattle
| | - Tianyi Sun
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Narjust Duma
- University of Wisconsin Carbone Cancer Center, Madison
| | - Julie C. Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, Massachusetts
| | - Na Tosha N. Gatson
- Geisinger Health System, Danville, Pennsylvania
- Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ryan H. Nguyen
- University of Illinois Hospital & Health Sciences System, Chicago
| | - Sonya A. Reid
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Ziad Bakouny
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Babar Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mehmet A. Bilen
- Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Paolo F. Caimi
- Case Comprehensive Cancer Center at Case Western Reserve University/University Hospitals, Cleveland, Ohio
| | | | | | | | | | | | - Michael J. Glover
- Stanford Cancer Institute at Stanford University, Palo Alto, California
| | | | | | | | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Chris Labaki
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | - Ian Messing
- George Washington University, Washington, DC
| | | | | | | | | | - Andrea V. Rivera
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John Roller
- University of Kansas Medical Center, Kansas City
| | - Gary K. Schwartz
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, New York
| | - Sumit A. Shah
- Stanford Cancer Institute at Stanford University, Palo Alto, California
| | | | | | | | | | | | - Peter Paul Yu
- Hartford HealthCare Cancer Institute, Hartford, Connecticut
| | | | - Dimpy P. Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, San Antonio, Texas
| | | | - Clara Hwang
- Henry Ford Cancer Institute, Henry Ford Hospital, Detroit, Michigan
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20
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Grivas P, Khaki AR, Wise-Draper TM, French B, Hennessy C, Hsu CY, Shyr Y, Li X, Choueiri TK, Painter CA, Peters S, Rini BI, Thompson MA, Mishra S, Rivera DR, Acoba JD, Abidi MZ, Bakouny Z, Bashir B, Bekaii-Saab T, Berg S, Bernicker EH, Bilen MA, Bindal P, Bishnoi R, Bouganim N, Bowles DW, Cabal A, Caimi PF, Chism DD, Crowell J, Curran C, Desai A, Dixon B, Doroshow DB, Durbin EB, Elkrief A, Farmakiotis D, Fazio A, Fecher LA, Flora DB, Friese CR, Fu J, Gadgeel SM, Galsky MD, Gill DM, Glover MJ, Goyal S, Grover P, Gulati S, Gupta S, Halabi S, Halfdanarson TR, Halmos B, Hausrath DJ, Hawley JE, Hsu E, Huynh-Le M, Hwang C, Jani C, Jayaraj A, Johnson DB, Kasi A, Khan H, Koshkin VS, Kuderer NM, Kwon DH, Lammers PE, Li A, Loaiza-Bonilla A, Low CA, Lustberg MB, Lyman GH, McKay RR, McNair C, Menon H, Mesa RA, Mico V, Mundt D, Nagaraj G, Nakasone ES, Nakayama J, Nizam A, Nock NL, Park C, Patel JM, Patel KG, Peddi P, Pennell NA, Piper-Vallillo AJ, Puc M, Ravindranathan D, Reeves ME, Reuben DY, Rosenstein L, Rosovsky RP, Rubinstein SM, Salazar M, Schmidt AL, Schwartz GK, Shah MR, Shah SA, Shah C, Shaya JA, Singh SRK, Smits M, Stockerl-Goldstein KE, Stover DG, Streckfuss M, Subbiah S, Tachiki L, Tadesse E, Thakkar A, Tucker MD, Verma AK, Vinh DC, Weiss M, Wu JT, Wulff-Burchfield E, Xie Z, Yu PP, Zhang T, Zhou AY, Zhu H, Zubiri L, Shah DP, Warner JL, Lopes G. Association of clinical factors and recent anticancer therapy with COVID-19 severity among patients with cancer: a report from the COVID-19 and Cancer Consortium. Ann Oncol 2021; 32:787-800. [PMID: 33746047 PMCID: PMC7972830 DOI: 10.1016/j.annonc.2021.02.024] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with cancer may be at high risk of adverse outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed a cohort of patients with cancer and coronavirus 2019 (COVID-19) reported to the COVID-19 and Cancer Consortium (CCC19) to identify prognostic clinical factors, including laboratory measurements and anticancer therapies. PATIENTS AND METHODS Patients with active or historical cancer and a laboratory-confirmed SARS-CoV-2 diagnosis recorded between 17 March and 18 November 2020 were included. The primary outcome was COVID-19 severity measured on an ordinal scale (uncomplicated, hospitalized, admitted to intensive care unit, mechanically ventilated, died within 30 days). Multivariable regression models included demographics, cancer status, anticancer therapy and timing, COVID-19-directed therapies, and laboratory measurements (among hospitalized patients). RESULTS A total of 4966 patients were included (median age 66 years, 51% female, 50% non-Hispanic white); 2872 (58%) were hospitalized and 695 (14%) died; 61% had cancer that was present, diagnosed, or treated within the year prior to COVID-19 diagnosis. Older age, male sex, obesity, cardiovascular and pulmonary comorbidities, renal disease, diabetes mellitus, non-Hispanic black race, Hispanic ethnicity, worse Eastern Cooperative Oncology Group performance status, recent cytotoxic chemotherapy, and hematologic malignancy were associated with higher COVID-19 severity. Among hospitalized patients, low or high absolute lymphocyte count; high absolute neutrophil count; low platelet count; abnormal creatinine; troponin; lactate dehydrogenase; and C-reactive protein were associated with higher COVID-19 severity. Patients diagnosed early in the COVID-19 pandemic (January-April 2020) had worse outcomes than those diagnosed later. Specific anticancer therapies (e.g. R-CHOP, platinum combined with etoposide, and DNA methyltransferase inhibitors) were associated with high 30-day all-cause mortality. CONCLUSIONS Clinical factors (e.g. older age, hematological malignancy, recent chemotherapy) and laboratory measurements were associated with poor outcomes among patients with cancer and COVID-19. Although further studies are needed, caution may be required in utilizing particular anticancer therapies. CLINICAL TRIAL IDENTIFIER NCT04354701.
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Affiliation(s)
- P Grivas
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA.
| | - A R Khaki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA; Stanford University, Stanford, USA
| | | | - B French
- Vanderbilt University Medical Center, Nashville, USA
| | - C Hennessy
- Vanderbilt University Medical Center, Nashville, USA
| | - C-Y Hsu
- Vanderbilt University Medical Center, Nashville, USA
| | - Y Shyr
- Vanderbilt University Medical Center, Nashville, USA
| | - X Li
- Vanderbilt University School of Medicine, Nashville, USA
| | | | - C A Painter
- Broad Institute, Cancer Program, Cambridge, USA
| | - S Peters
- Lausanne University, Lausanne, Switzerland
| | - B I Rini
- Vanderbilt University Medical Center, Nashville, USA
| | | | - S Mishra
- Vanderbilt University Medical Center, Nashville, USA
| | - D R Rivera
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, USA
| | - J D Acoba
- University of Hawaii Cancer Center, Honolulu, USA
| | - M Z Abidi
- University of Colorado School of Medicine, Aurora, USA
| | - Z Bakouny
- Dana-Farber Cancer Institute, Boston, USA
| | - B Bashir
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | | | - S Berg
- Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, USA
| | | | - M A Bilen
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - P Bindal
- Beth Israel Deaconess Medical Center, Boston, USA
| | - R Bishnoi
- University of Florida, Gainesville, USA
| | - N Bouganim
- McGill University Health Centre, Montréal, Canada
| | - D W Bowles
- University of Colorado School of Medicine, Aurora, USA
| | - A Cabal
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - P F Caimi
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - D D Chism
- Thompson Cancer Survival Center, Knoxville, USA
| | - J Crowell
- St. Elizabeth Healthcare, Edgewood, USA
| | - C Curran
- Dana-Farber Cancer Institute, Boston, USA
| | - A Desai
- Mayo Clinic Cancer Center, Rochester, USA
| | - B Dixon
- St. Elizabeth Healthcare, Edgewood, USA
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - E B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, USA
| | - A Elkrief
- McGill University Health Centre, Montréal, Canada
| | - D Farmakiotis
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - A Fazio
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - L A Fecher
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - D B Flora
- St. Elizabeth Healthcare, Edgewood, USA
| | - C R Friese
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - J Fu
- Tufts Medical Center Cancer Center, Boston and Stoneham, USA
| | - S M Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - D M Gill
- Intermountain Healthcare, Salt Lake City, USA
| | | | - S Goyal
- George Washington University, Washington DC, USA
| | - P Grover
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gulati
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - S Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | | | - B Halmos
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D J Hausrath
- Vanderbilt University School of Medicine, Nashville, USA
| | - J E Hawley
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - E Hsu
- Hartford HealthCare, Hartford, USA; University of Connecticut, Farmington, USA
| | - M Huynh-Le
- George Washington University, Washington DC, USA
| | - C Hwang
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - C Jani
- Mount Auburn Hospital, Cambridge, USA
| | | | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - A Kasi
- University of Kansas Medical Center, Kansas City, USA
| | - H Khan
- The Warren Alpert Medical School of Brown University, Providence, USA
| | - V S Koshkin
- University of California, San Francisco, San Francisco, USA
| | - N M Kuderer
- Advanced Cancer Research Group, LLC, Kirkland, USA
| | - D H Kwon
- University of California, San Francisco, San Francisco, USA
| | | | - A Li
- Baylor College of Medicine, Houston, USA
| | | | - C A Low
- Intermountain Healthcare, Salt Lake City, USA
| | | | - G H Lyman
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - R R McKay
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - C McNair
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - H Menon
- Penn State Health/Penn State Cancer Institute/St. Joseph Cancer Center, Hershey, USA
| | - R A Mesa
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - V Mico
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - D Mundt
- Advocate Aurora Health, Milwaukee, USA
| | - G Nagaraj
- Loma Linda University Cancer Center, Loma Linda, USA
| | - E S Nakasone
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - J Nakayama
- Case Western Reserve University, Cleveland, USA; University Hospitals Cleveland Medical Center, Cleveland, USA
| | - A Nizam
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | - N L Nock
- University Hospitals Seidman Cancer Center, Cleveland, USA; Case Western Reserve University, Cleveland, USA
| | - C Park
- University of Cincinnati Cancer Center, Cincinnati, USA
| | - J M Patel
- Beth Israel Deaconess Medical Center, Boston, USA
| | - K G Patel
- University of California Davis Comprehensive Cancer Center, Sacramento, USA
| | - P Peddi
- Willis-Knighton Cancer Center, Shreveport, USA
| | - N A Pennell
- Cleveland Clinic Taussig Cancer Institute, Cleveland, USA
| | | | - M Puc
- Virtua Health, Marlton, USA
| | | | - M E Reeves
- Loma Linda University Cancer Center, Loma Linda, USA
| | - D Y Reuben
- Medical University of South Carolina, Charleston, USA
| | | | - R P Rosovsky
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - M Salazar
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | | | - G K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, USA
| | - M R Shah
- Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - S A Shah
- Stanford University, Stanford, USA
| | - C Shah
- University of Florida, Gainesville, USA
| | - J A Shaya
- University of California San Diego, Moores Cancer Center, La Jolla, USA
| | - S R K Singh
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, USA
| | - M Smits
- ThedaCare Regional Cancer Center, Appleton, USA
| | | | - D G Stover
- The Ohio State University, Columbus, USA
| | | | - S Subbiah
- Stanley S. Scott Cancer Center, LSU Health Sciences Center, New Orleans, USA
| | - L Tachiki
- University of Washington/Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, USA
| | - E Tadesse
- Advocate Aurora Health, Milwaukee, USA
| | - A Thakkar
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - M D Tucker
- Vanderbilt University Medical Center, Nashville, USA
| | - A K Verma
- Albert Einstein Cancer Center/Montefiore Medical Center, Bronx, USA
| | - D C Vinh
- McGill University Health Centre, Montréal, Canada
| | - M Weiss
- ThedaCare Regional Cancer Center, Appleton, USA
| | - J T Wu
- Stanford University, Stanford, USA
| | | | - Z Xie
- Mayo Clinic Cancer Center, Rochester, USA
| | - P P Yu
- Hartford HealthCare, Hartford, USA
| | - T Zhang
- Duke University, Durham, USA
| | - A Y Zhou
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA
| | - H Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - L Zubiri
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - D P Shah
- Mays Cancer Center at UT Health San Antonio MD Anderson, San Antonio, USA
| | - J L Warner
- Vanderbilt University Medical Center, Nashville, USA
| | - GdL Lopes
- University of Miami/Sylvester Comprehensive Cancer Center, Miami, USA
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21
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Abstract
The treatment of advanced melanoma has changed dramatically over the last decade. With the discovery of activating BRAF mutations and the development of targeted therapies and checkpoint inhibitors, the overall survival of patients with advanced melanoma has improved. This article provides an overview of systemic therapies, including the pivotal agents that have led to these advances.
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Affiliation(s)
- Melissa A Wilson
- Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 700, Philadelphia, PA 19107, USA
| | - Leslie A Fecher
- University of Michigan, Rogel Cancer Center, C343 MIB, 1500 East Medical Center Drive, SPC 5848, Ann Arbor, MI 48109-5848, USA.
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22
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Bishu S, Melia J, Sharfman W, Lao CD, Fecher LA, Higgins PDR. Efficacy and Outcome of Tofacitinib in Immune checkpoint Inhibitor Colitis. Gastroenterology 2021; 160:932-934.e3. [PMID: 33096100 DOI: 10.1053/j.gastro.2020.10.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Shrinivas Bishu
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Joanna Melia
- Division of Gastroenterology, Department of Medicine, John's Hopkins University, Baltimore, Maryland
| | - William Sharfman
- Division of Oncology, Department of Medicine, John's Hopkins University, Baltimore, Maryland
| | - Christopher D Lao
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leslie A Fecher
- Division of Hematology and Oncology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Peter D R Higgins
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan
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23
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Ma VT, Daignault-Newton S, Waninger JJ, Journey S, Chopra Z, Tezel A, Redman BG, Fecher LA, Green MD, Alva AS, Lao CD. The impact of BRAF mutation status on clinical outcomes with anti-PD-1 monotherapy versus combination ipilimumab/nivolumab in treatment-naïve advanced stage melanoma. Pigment Cell Melanoma Res 2020; 34:629-640. [PMID: 33128316 DOI: 10.1111/pcmr.12944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 10/06/2020] [Accepted: 10/27/2020] [Indexed: 01/15/2023]
Abstract
Nearly half of all metastatic melanoma patients possess the BRAF V600 mutation. Several therapies are approved for advanced stage melanoma, but it is unclear if there is a differential outcome to various immunotherapy regimens based on BRAF mutation status. We retrospectively analyzed a cohort of metastatic or unresectable melanoma patients who were treated with combination ipilimumab/nivolumab (ipi/nivo) or anti-PD-1 monotherapy, nivolumab, or pembrolizumab, as first-line treatment. 235 previously untreated patients were identified in our study. Our univariate analysis showed no statistical difference in progression-free survival (PFS) or overall survival (OS) with ipi/nivo versus anti-PD-1 monotherapy in the BRAF V600 mutant cohort, but there was improved PFS [HR: 0.48, 95% CI, 0.28-0.80] and OS [HR: 0.50, 95% CI, 0.26-0.96] with ipi/nivo compared to anti-PD-1 monotherapy in the BRAF WT group. After adjusting for known prognostic variables in our multivariable analysis, the BRAF WT cohort continued to show PFS and OS benefit with ipi/nivo compared to anti-PD-1 monotherapy. Our single-institution analysis suggests ipi/nivo should be considered over anti-PD-1 monotherapy as the initial immunotherapy regimen for metastatic melanoma patients regardless of BRAF mutation status, but possibly with greater benefit in BRAF WT.
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Affiliation(s)
- Vincent T Ma
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Jessica J Waninger
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA.,Department of Medical Education, University of Michigan, Ann Arbor, MI, USA
| | - Sara Journey
- Department of Medical Education, University of Michigan, Ann Arbor, MI, USA
| | - Zoey Chopra
- Department of Medical Education, University of Michigan, Ann Arbor, MI, USA
| | - Alangoya Tezel
- Department of Medical Education, University of Michigan, Ann Arbor, MI, USA
| | - Bruce G Redman
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Leslie A Fecher
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai S Alva
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Christopher D Lao
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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24
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Rivera DR, Peters S, Panagiotou OA, Shah DP, Kuderer NM, Hsu CY, Rubinstein SM, Lee BJ, Choueiri TK, de Lima Lopes G, Grivas P, Painter CA, Rini BI, Thompson MA, Arcobello J, Bakouny Z, Doroshow DB, Egan PC, Farmakiotis D, Fecher LA, Friese CR, Galsky MD, Goel S, Gupta S, Halfdanarson TR, Halmos B, Hawley JE, Khaki AR, Lemmon CA, Mishra S, Olszewski AJ, Pennell NA, Puc MM, Revankar SG, Schapira L, Schmidt A, Schwartz GK, Shah SA, Wu JT, Xie Z, Yeh AC, Zhu H, Shyr Y, Lyman GH, Warner JL. Utilization of COVID-19 Treatments and Clinical Outcomes among Patients with Cancer: A COVID-19 and Cancer Consortium (CCC19) Cohort Study. Cancer Discov 2020; 10:1514-1527. [PMID: 32699031 PMCID: PMC7541683 DOI: 10.1158/2159-8290.cd-20-0941] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
Among 2,186 U.S. adults with invasive cancer and laboratory-confirmed SARS-CoV-2 infection, we examined the association of COVID-19 treatments with 30-day all-cause mortality and factors associated with treatment. Logistic regression with multiple adjustments (e.g., comorbidities, cancer status, baseline COVID-19 severity) was performed. Hydroxychloroquine with any other drug was associated with increased mortality versus treatment with any COVID-19 treatment other than hydroxychloroquine or untreated controls; this association was not present with hydroxychloroquine alone. Remdesivir had numerically reduced mortality versus untreated controls that did not reach statistical significance. Baseline COVID-19 severity was strongly associated with receipt of any treatment. Black patients were approximately half as likely to receive remdesivir as white patients. Although observational studies can be limited by potential unmeasured confounding, our findings add to the emerging understanding of patterns of care for patients with cancer and COVID-19 and support evaluation of emerging treatments through inclusive prospective controlled trials. SIGNIFICANCE: Evaluating the potential role of COVID-19 treatments in patients with cancer in a large observational study, there was no statistically significant 30-day all-cause mortality benefit with hydroxychloroquine or high-dose corticosteroids alone or in combination; remdesivir showed potential benefit. Treatment receipt reflects clinical decision-making and suggests disparities in medication access.This article is highlighted in the In This Issue feature, p. 1426.
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Affiliation(s)
- Donna R. Rivera
- Division of Cancer Control and Population Sciences, NCI, Rockville, Maryland
| | - Solange Peters
- Department of Oncology, University of Lausanne, Lausanne, Switzerland
| | - Orestis A. Panagiotou
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - Dimpy P. Shah
- Department of Population Health Sciences, Mays Cancer Center, UT Health San Antonio MD Anderson, San Antonio, Texas
| | | | - Chih-Yuan Hsu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel M. Rubinstein
- Deparment of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brendan J. Lee
- Deparment of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K. Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Brian I. Rini
- Deparment of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Deborah B. Doroshow
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pamela C. Egan
- Department of Medicine, Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dimitrios Farmakiotis
- Department of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leslie A. Fecher
- Department of Internal Medicine, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | | | - Matthew D. Galsky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sanjay Goel
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Shilpa Gupta
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | | | - Balazs Halmos
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Jessica E. Hawley
- Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Ali Raza Khaki
- Department of Medicine, Division of Oncology, University of Washington, Seattle, Washington
| | | | - Sanjay Mishra
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Adam J. Olszewski
- Department of Medicine, Division of Hematology/Oncology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nathan A. Pennell
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Matthew M. Puc
- Department of Surgery, Section of Thoracic Surgery, Virtua Health, Marlton, New Jersey
| | | | - Lidia Schapira
- Department of Medicine, Division of Oncology, Stanford University, Palo Alto, California
| | - Andrew Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gary K. Schwartz
- Department of Medicine, Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Sumit A. Shah
- Department of Medicine, Division of Oncology, Stanford University, Palo Alto, California
| | - Julie T. Wu
- Department of Medicine, Division of Oncology, Stanford University, Palo Alto, California
| | - Zhuoer Xie
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Albert C. Yeh
- Department of Medicine, Division of Oncology, University of Washington, Seattle, Washington
| | - Huili Zhu
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gary H. Lyman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jeremy L. Warner
- Deparment of Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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25
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Ascierto PA, Del Vecchio M, Mandalá M, Gogas H, Arance AM, Dalle S, Cowey CL, Schenker M, Grob JJ, Chiarion-Sileni V, Márquez-Rodas I, Butler MO, Maio M, Middleton MR, de la Cruz-Merino L, Arenberger P, Atkinson V, Hill A, Fecher LA, Millward M, Khushalani NI, Queirolo P, Lobo M, de Pril V, Loffredo J, Larkin J, Weber J. Adjuvant nivolumab versus ipilimumab in resected stage IIIB-C and stage IV melanoma (CheckMate 238): 4-year results from a multicentre, double-blind, randomised, controlled, phase 3 trial. Lancet Oncol 2020; 21:1465-1477. [PMID: 32961119 DOI: 10.1016/s1470-2045(20)30494-0] [Citation(s) in RCA: 289] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previously, findings from CheckMate 238, a double-blind, phase 3 adjuvant trial in patients with resected stage IIIB-C or stage IV melanoma, showed significant improvements in recurrence-free survival and distant metastasis-free survival with nivolumab versus ipilimumab. This report provides updated 4-year efficacy, initial overall survival, and late-emergent safety results. METHODS This multicentre, double-blind, randomised, controlled, phase 3 trial was done in 130 academic centres, community hospitals, and cancer centres across 25 countries. Patients aged 15 years or older with resected stage IIIB-C or IV melanoma and an Eastern Cooperative Oncology Group performance status of 0 or 1 were randomly assigned (1:1) to receive nivolumab or ipilimumab via an interactive voice response system and stratified according to disease stage and baseline PD-L1 status of tumour cells. Patients received intravenous nivolumab 3 mg/kg every 2 weeks or intravenous ipilimumab 10 mg/kg every 3 weeks for four doses, and then every 12 weeks until 1 year of treatment, disease recurrence, unacceptable toxicity, or withdrawal of consent. The primary endpoint was recurrence-free survival by investigator assessment, and overall survival was a key secondary endpoint. Efficacy analyses were done in the intention-to-treat population (all randomly assigned patients). All patients who received at least one dose of study treatment were included in the safety analysis. The results presented in this report reflect the 4-year update of the ongoing study with a database lock date of Jan 30, 2020. This study is registered with ClinicalTrials.gov, NCT02388906. FINDINGS Between March 30 and Nov 30, 2015, 906 patients were assigned to nivolumab (n=453) or ipilimumab (n=453). Median follow-up was 51·1 months (IQR 41·6-52·7) with nivolumab and 50·9 months (36·2-52·3) with ipilimumab; 4-year recurrence-free survival was 51·7% (95% CI 46·8-56·3) in the nivolumab group and 41·2% (36·4-45·9) in the ipilimumab group (hazard ratio [HR] 0·71 [95% CI 0·60-0·86]; p=0·0003). With 211 (100 [22%] of 453 patients in the nivolumab group and 111 [25%] of 453 patients in the ipilimumab group) of 302 anticipated deaths observed (about 73% of the originally planned 88% power needed for significance), 4-year overall survival was 77·9% (95% CI 73·7-81·5) with nivolumab and 76·6% (72·2-80·3) with ipilimumab (HR 0·87 [95% CI 0·66-1·14]; p=0·31). Late-emergent grade 3-4 treatment-related adverse events were reported in three (1%) of 452 and seven (2%) of 453 patients. The most common late-emergent treatment-related grade 3 or 4 adverse events reported were diarrhoea, diabetic ketoacidosis, and pneumonitis (one patient each) in the nivolumab group, and colitis (two patients) in the ipilimumab group. Two previously reported treatment-related deaths in the ipilimumab group were attributed to study drug toxicity (marrow aplasia in one patient and colitis in one patient); no further treatment-related deaths were reported. INTERPRETATION At a minimum of 4 years' follow-up, nivolumab demonstrated sustained recurrence-free survival benefit versus ipilimumab in resected stage IIIB-C or IV melanoma indicating a long-term treatment benefit with nivolumab. With fewer deaths than anticipated, overall survival was similar in both groups. Nivolumab remains an efficacious adjuvant treatment for patients with resected high-risk melanoma, with a safety profile that is more tolerable than that of ipilimumab. FUNDING Bristol Myers Squibb and Ono Pharmaceutical.
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Affiliation(s)
- Paolo A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy.
| | | | | | - Helen Gogas
- National and Kapodistrian University of Athens, Athens, Greece
| | - Ana M Arance
- Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain
| | | | - C Lance Cowey
- Texas Oncology-Baylor Charles A Sammons Cancer Center, Dallas, TX, USA
| | | | - Jean-Jacques Grob
- Department of Dermatology, Aix-Marseille University, Hôpital de la Timone, Marseille, France
| | | | - Iván Márquez-Rodas
- Department of Medical Oncology, General University Hospital Gregorio Marañón and CIBERONC, Madrid, Spain
| | - Marcus O Butler
- Department of Immuno-oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michele Maio
- Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | | | | | - Petr Arenberger
- Department of Dermatology, Charles University Third Faculty of Medicine and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Victoria Atkinson
- Division of Cancer Services, Gallipoli Medical Research Foundation, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Hill
- Department of Medical Oncology, Tasman Health Care, Southport, QLD, Australia
| | - Leslie A Fecher
- Department of Medical Oncology, Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Michael Millward
- Department of Internal Medicine, University of Western Australia and Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Maurice Lobo
- Oncology Clinical Development, Bristol Myers Squibb, Princeton, NJ, USA
| | - Veerle de Pril
- Department of Global Regulatory and Safety Sciences, Bristol Myers Squibb, Princeton, NJ, USA
| | - John Loffredo
- Clinical Biomarkers, Bristol Myers Squibb, Princeton, NJ, USA
| | - James Larkin
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Jeffrey Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
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26
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Affiliation(s)
- Kelly Z Young
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Sara L Fossum
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Lori Lowe
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan.,Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Tobias Else
- Department of Internal Medicine - Division of Metabolism, Endocrinology and Diabetes, Michigan Medicine, Ann Arbor, Michigan
| | - Leslie A Fecher
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan.,Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, Michigan Medicine, Ann Arbor, Michigan
| | - Kelly B Cha
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
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27
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Abstract
Immune checkpoint inhibition targeted against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1) has shown clinically significant survival benefit when used to treat multiple types of advanced cancer. These drugs have gained approval by the US Food and Drug Administration and their indications continue to increase. Checkpoint inhibitor therapy is associated with a unique side-effect profile characterized as immune-related adverse events (irAEs), which can result in significant morbidity and rarely mortality. Hepatotoxicity from checkpoint inhibitors is a less common irAE and often mild, while its incidence and severity vary based on the class and dose of checkpoint inhibitor, monotherapy versus combination therapy, and the type of cancer. Histological assessment of suspected irAEs is nonspecific and can show a variety of features. Hepatic irAEs can require discontinuation of checkpoint inhibitor therapy and treatment with immunosuppressive agents.
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Affiliation(s)
- Brian A Nadeau
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Leslie A Fecher
- Department of Internal Medicine and Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Scott R Owens
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Nataliya Razumilava
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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28
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Rizzo JM, Fecher LA, Chan MP, Durham AB. Metastatic melanoma with diffuse melanosis histologically after stable response to talimogene laherparepvec therapy. JAAD Case Rep 2018; 4:379-381. [PMID: 29693076 PMCID: PMC5911974 DOI: 10.1016/j.jdcr.2018.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Jason M Rizzo
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leslie A Fecher
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan.,Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - May P Chan
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Alison B Durham
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
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29
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Lin H, Wei S, Hurt EM, Green MD, Zhao L, Vatan L, Szeliga W, Herbst R, Harms PW, Fecher LA, Vats P, Chinnaiyan AM, Lao CD, Lawrence TS, Wicha M, Hamanishi J, Mandai M, Kryczek I, Zou W. Host expression of PD-L1 determines efficacy of PD-L1 pathway blockade-mediated tumor regression. J Clin Invest 2018; 128:1708. [PMID: 29608143 DOI: 10.1172/jci120803] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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30
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Lin H, Wei S, Hurt EM, Green MD, Zhao L, Vatan L, Szeliga W, Herbst R, Harms PW, Fecher LA, Vats P, Chinnaiyan AM, Lao CD, Lawrence TS, Wicha M, Hamanishi J, Mandai M, Kryczek I, Zou W. Host expression of PD-L1 determines efficacy of PD-L1 pathway blockade-mediated tumor regression. J Clin Invest 2018. [PMID: 29337305 DOI: 10.1172/jci96113] [] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Programmed death-1 receptor (PD-L1, B7-H1) and programmed cell death protein 1 (PD-1) pathway blockade is a promising therapy for treating cancer. However, the mechanistic contribution of host and tumor PD-L1 and PD-1 signaling to the therapeutic efficacy of PD-L1 and PD-1 blockade remains elusive. Here, we evaluated 3 tumor-bearing mouse models that differ in their sensitivity to PD-L1 blockade and demonstrated a loss of therapeutic efficacy of PD-L1 blockade in immunodeficient mice and in PD-L1- and PD-1-deficient mice. In contrast, neither knockout nor overexpression of PD-L1 in tumor cells had an effect on PD-L1 blockade efficacy. Human and murine studies showed high levels of functional PD-L1 expression in dendritic cells and macrophages in the tumor microenvironments and draining lymph nodes. Additionally, expression of PD-L1 on dendritic cells and macrophages in ovarian cancer and melanoma patients correlated with the efficacy of treatment with either anti-PD-1 alone or in combination with anti-CTLA-4. Thus, PD-L1-expressing dendritic cells and macrophages may mechanistically shape and therapeutically predict clinical efficacy of PD-L1/PD-1 blockade.
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Affiliation(s)
- Heng Lin
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Shuang Wei
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Elaine M Hurt
- Oncology Research, MedImmune LLC, One MedImmune Way, Gaithersburg, Maryland, USA
| | | | | | - Linda Vatan
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Wojciech Szeliga
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Ronald Herbst
- Oncology Research, MedImmune LLC, One MedImmune Way, Gaithersburg, Maryland, USA
| | - Paul W Harms
- Department of Pathology.,Department of Dermatology, and
| | | | - Pankaj Vats
- Department of Pathology.,Michigan Center for Translational Pathology
| | - Arul M Chinnaiyan
- Department of Pathology.,Michigan Center for Translational Pathology.,Howard Hughes Medical Institute, and.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Theodore S Lawrence
- Department of Radiation Oncology.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Max Wicha
- Department of Medicine.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ilona Kryczek
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Weiping Zou
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.,Department of Pathology.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.,Graduate Programs in Immunology and Cancer Biology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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31
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Lin H, Wei S, Hurt EM, Green MD, Zhao L, Vatan L, Szeliga W, Herbst R, Harms PW, Fecher LA, Vats P, Chinnaiyan AM, Lao CD, Lawrence TS, Wicha M, Hamanishi J, Mandai M, Kryczek I, Zou W. Host expression of PD-L1 determines efficacy of PD-L1 pathway blockade-mediated tumor regression. J Clin Invest 2018; 128:805-815. [PMID: 29337305 DOI: 10.1172/jci96113] [Citation(s) in RCA: 351] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Programmed death-1 receptor (PD-L1, B7-H1) and programmed cell death protein 1 (PD-1) pathway blockade is a promising therapy for treating cancer. However, the mechanistic contribution of host and tumor PD-L1 and PD-1 signaling to the therapeutic efficacy of PD-L1 and PD-1 blockade remains elusive. Here, we evaluated 3 tumor-bearing mouse models that differ in their sensitivity to PD-L1 blockade and demonstrated a loss of therapeutic efficacy of PD-L1 blockade in immunodeficient mice and in PD-L1- and PD-1-deficient mice. In contrast, neither knockout nor overexpression of PD-L1 in tumor cells had an effect on PD-L1 blockade efficacy. Human and murine studies showed high levels of functional PD-L1 expression in dendritic cells and macrophages in the tumor microenvironments and draining lymph nodes. Additionally, expression of PD-L1 on dendritic cells and macrophages in ovarian cancer and melanoma patients correlated with the efficacy of treatment with either anti-PD-1 alone or in combination with anti-CTLA-4. Thus, PD-L1-expressing dendritic cells and macrophages may mechanistically shape and therapeutically predict clinical efficacy of PD-L1/PD-1 blockade.
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Affiliation(s)
- Heng Lin
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Shuang Wei
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Elaine M Hurt
- Oncology Research, MedImmune LLC, One MedImmune Way, Gaithersburg, Maryland, USA
| | | | | | - Linda Vatan
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Wojciech Szeliga
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Ronald Herbst
- Oncology Research, MedImmune LLC, One MedImmune Way, Gaithersburg, Maryland, USA
| | - Paul W Harms
- Department of Pathology.,Department of Dermatology, and
| | | | - Pankaj Vats
- Department of Pathology.,Michigan Center for Translational Pathology
| | - Arul M Chinnaiyan
- Department of Pathology.,Michigan Center for Translational Pathology.,Howard Hughes Medical Institute, and.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Theodore S Lawrence
- Department of Radiation Oncology.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Max Wicha
- Department of Medicine.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ilona Kryczek
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Weiping Zou
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.,Department of Pathology.,University of Michigan Comprehensive Cancer Center, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.,Graduate Programs in Immunology and Cancer Biology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
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32
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Walocko FM, Scheier BY, Harms PW, Fecher LA, Lao CD. Erratum to: Metastatic Merkel cell carcinoma response to nivolumab. J Immunother Cancer 2017; 5:27. [PMID: 28286652 PMCID: PMC5340072 DOI: 10.1186/s40425-017-0221-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/12/2023] Open
Abstract
[This corrects the article DOI: 10.1186/s40425-016-0186-1.].
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Affiliation(s)
| | - Benjamin Y Scheier
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, C451 Med Inn, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI USA.,Department of Dermatology, University of Michigan, Ann Arbor, MI USA
| | - Leslie A Fecher
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, C451 Med Inn, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Christopher D Lao
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, C451 Med Inn, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
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33
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Walocko FM, Scheier BY, Harms PW, Fecher LA, Lao CD. Metastatic Merkel cell carcinoma response to nivolumab. J Immunother Cancer 2016; 4:79. [PMID: 27879975 PMCID: PMC5109712 DOI: 10.1186/s40425-016-0186-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
Background Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy with limited treatment options. Several lines of evidence support the programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) axis as a likely contributor to immune evasion in MCC. Case presentation We report a case of a patient with metastatic MCC with a significant and durable response to nivolumab, a humanized IgG4 monoclonal anti-PD-1 antibody. Conclusion Immunotherapy with PD-1/PD-L1 inhibitors has become a rational and promising treatment option for MCC in the advanced or metastatic disease. Clinical trials are currently in progress to further evaluate these novel therapeutic agents.
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Affiliation(s)
| | - Benjamin Y Scheier
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, C451 Med Inn, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI USA ; Department of Dermatology, University of Michigan, Ann Arbor, MI USA
| | - Leslie A Fecher
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, C451 Med Inn, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Christopher D Lao
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, C451 Med Inn, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
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34
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Wilson MA, Guld K, Galetta S, Walsh RD, Kharlip J, Tamhankar M, McGettigan S, Schuchter LM, Fecher LA. Acute visual loss after ipilimumab treatment for metastatic melanoma. J Immunother Cancer 2016; 4:66. [PMID: 27777775 PMCID: PMC5067900 DOI: 10.1186/s40425-016-0170-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 03/24/2016] [Accepted: 09/29/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Ipilimumab, a humanized CLTA-4 antibody is a standard therapy in the treatment of advanced melanoma. While ipilimumab provides an overall survival benefit to patients, it can be associated with immune related adverse events (IrAEs). CASE PRESENTATION Here we describe a patient treated with ipilimumab who experienced known IrAEs, including hypophysitis, as well as a profound vision loss due to optic neuritis. There are rare reports of optic neuritis occurring as an adverse event associated with ipilimumab treatment. Furthermore, the patient experienced multiple complications from high dose steroids used to manage his IrAEs. CONCLUSIONS This case highlights the need for recognition of atypical immune mediated processes associated with newer checkpoint inhibitor therapies including ipilimumab.
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Affiliation(s)
- Melissa A Wilson
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA USA ; Present address: Division of Hematology and Medical Oncology, Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY USA
| | - Kelly Guld
- Department of Medicine, University of Pennsylvania, Philadelphia, PA USA ; Present address: Department of Cardiology, UCSF Medical Center, San Francisco, CA USA
| | - Steven Galetta
- Department of Neurology, NYU Langone Medical Center, New York, NY USA
| | - Ryan D Walsh
- Departments of Ophthalmology and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Julia Kharlip
- Division of Endocrinology, Department of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Madhura Tamhankar
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania Health System, Philadelphia, PA USA
| | - Suzanne McGettigan
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Lynn M Schuchter
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Leslie A Fecher
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, PA USA ; Present address: Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, C366 MIB 1500 E. Medical Center Drive, SPC5848, Ann Arbor, MI 48109 USA
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35
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Abstract
Cutaneous basal cell carcinoma (BCC) is the most common human cancer and its incidence is rising worldwide. Ultraviolet radiation exposure, including tanning bed use, as well as host factors play a role in its development. The majority of cases are treated and cured with local therapies including surgery. Yet, the health care costs of diagnosis and treatment of BCCs in the US is substantial. In the United States, the cost of nonmelanoma skin cancer care in the Medicare population is estimated to be US$426 million per year. While rare, locally advanced BCCs that can no longer be controlled with surgery and/or radiation, and metastatic BCCs do occur and can be associated with significant morbidity and mortality. Vismodegib (GDC-0449), a smoothened inhibitor targeted at the hedgehog pathway, is the first US Food and Drug Association (FDA)-approved agent in the treatment of locally advanced, unresectable, and metastatic BCCs. This class of agents appears to be changing the survival rates in advanced BCC patients, but appropriate patient selection and monitoring are important. Multidisciplinary assessments are essential for the optimal care and management of these patients. For some patients with locally advanced BCC, treatment with a hedgehog inhibitor may eliminate the need for an excessively disfiguring or morbid surgery.
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Affiliation(s)
- Leslie A Fecher
- Department of Internal Medicine and Dermatology, Indiana University Health Simon Cancer Center, Indianapolis, IN, USA
- Department of Internal Medicine and Dermatology, University of Michigan, MI, USA
| | - William H Sharfman
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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36
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Bettegowda C, Sausen M, Leary RJ, Kinde I, Wang Y, Agrawal N, Bartlett BR, Wang H, Luber B, Alani RM, Antonarakis ES, Azad NS, Bardelli A, Brem H, Cameron JL, Lee CC, Fecher LA, Gallia GL, Gibbs P, Le D, Giuntoli RL, Goggins M, Hogarty MD, Holdhoff M, Hong SM, Jiao Y, Juhl HH, Kim JJ, Siravegna G, Laheru DA, Lauricella C, Lim M, Lipson EJ, Marie SKN, Netto GJ, Oliner KS, Olivi A, Olsson L, Riggins GJ, Sartore-Bianchi A, Schmidt K, Shih LM, Oba-Shinjo SM, Siena S, Theodorescu D, Tie J, Harkins TT, Veronese S, Wang TL, Weingart JD, Wolfgang CL, Wood LD, Xing D, Hruban RH, Wu J, Allen PJ, Schmidt CM, Choti MA, Velculescu VE, Kinzler KW, Vogelstein B, Papadopoulos N, Diaz LA. Detection of circulating tumor DNA in early- and late-stage human malignancies. Sci Transl Med 2014; 6:224ra24. [PMID: 24553385 DOI: 10.1126/scitranslmed.3007094] [Citation(s) in RCA: 3117] [Impact Index Per Article: 311.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of noninvasive methods to detect and monitor tumors continues to be a major challenge in oncology. We used digital polymerase chain reaction-based technologies to evaluate the ability of circulating tumor DNA (ctDNA) to detect tumors in 640 patients with various cancer types. We found that ctDNA was detectable in >75% of patients with advanced pancreatic, ovarian, colorectal, bladder, gastroesophageal, breast, melanoma, hepatocellular, and head and neck cancers, but in less than 50% of primary brain, renal, prostate, or thyroid cancers. In patients with localized tumors, ctDNA was detected in 73, 57, 48, and 50% of patients with colorectal cancer, gastroesophageal cancer, pancreatic cancer, and breast adenocarcinoma, respectively. ctDNA was often present in patients without detectable circulating tumor cells, suggesting that these two biomarkers are distinct entities. In a separate panel of 206 patients with metastatic colorectal cancers, we showed that the sensitivity of ctDNA for detection of clinically relevant KRAS gene mutations was 87.2% and its specificity was 99.2%. Finally, we assessed whether ctDNA could provide clues into the mechanisms underlying resistance to epidermal growth factor receptor blockade in 24 patients who objectively responded to therapy but subsequently relapsed. Twenty-three (96%) of these patients developed one or more mutations in genes involved in the mitogen-activated protein kinase pathway. Together, these data suggest that ctDNA is a broadly applicable, sensitive, and specific biomarker that can be used for a variety of clinical and research purposes in patients with multiple different types of cancer.
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Affiliation(s)
- Chetan Bettegowda
- Ludwig Center for Cancer Genetics and Therapeutics, Howard Hughes Medical Institute and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231, USA
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37
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Rangwala R, Leone R, Chang YC, Fecher LA, Schuchter LM, Kramer A, Tan KS, Heitjan DF, Rodgers G, Gallagher M, Piao S, Troxel AB, Evans TL, DeMichele AM, Nathanson KL, O'Dwyer PJ, Kaiser J, Pontiggia L, Davis LE, Amaravadi RK. Phase I trial of hydroxychloroquine with dose-intense temozolomide in patients with advanced solid tumors and melanoma. Autophagy 2014; 10:1369-79. [PMID: 24991839 PMCID: PMC4203514 DOI: 10.4161/auto.29118] [Citation(s) in RCA: 270] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Blocking autophagy with hydroxychloroquine (HCQ) augments cell death associated with alkylating chemotherapy in preclinical models. This phase I study evaluated the maximum tolerated dose (MTD), safety, preliminary activity, pharmacokinetics, and pharmacodynamics of HCQ in combination with dose-intense temozolomide (TMZ) in patients with advanced solid malignancies. Forty patients (73% metastatic melanoma) were treated with oral HCQ 200 to 1200 mg daily with dose-intense oral TMZ 150 mg/m2 daily for 7/14 d. This combination was well tolerated with no recurrent dose-limiting toxicities observed. An MTD was not reached for HCQ and the recommended phase II dose was HCQ 600 mg twice daily combined with dose-intense TMZ. Common toxicities included grade 2 fatigue (55%), anorexia (28%), nausea (48%), constipation (20%), and diarrhea (20%). Partial responses and stable disease were observed in 3/22 (14%) and 6/22 (27%) patients with metastatic melanoma. In the final dose cohort 2/6 patients with refractory BRAF wild-type melanoma had a near complete response, and prolonged stable disease, respectively. A significant accumulation in autophagic vacuoles (AV) in peripheral blood mononuclear cells was observed in response to combined therapy. Population pharmacokinetics (PK) modeling, individual PK simulations, and PK-pharmacodynamics (PD) analysis identified a threshold HCQ peak concentration that predicts therapy-associated AV accumulation. This study indicates that the combination of high-dose HCQ and dose-intense TMZ is safe and tolerable, and is associated with autophagy modulation in patients. Prolonged stable disease and responses suggest antitumor activity in melanoma patients, warranting further studies of this combination, or combinations of more potent autophagy inhibitors and chemotherapy in melanoma.
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Affiliation(s)
- Reshma Rangwala
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Robert Leone
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Yunyoung C Chang
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Leslie A Fecher
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Lynn M Schuchter
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Amy Kramer
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Kay-See Tan
- Center for Clinical Epidemiology and Biostatistics; University of Pennsylvania; Philadelphia, PA USA
| | - Daniel F Heitjan
- Center for Clinical Epidemiology and Biostatistics; University of Pennsylvania; Philadelphia, PA USA
| | - Glenda Rodgers
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Maryann Gallagher
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Shengfu Piao
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics; University of Pennsylvania; Philadelphia, PA USA
| | - Tracey L Evans
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Angela M DeMichele
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Katherine L Nathanson
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Peter J O'Dwyer
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
| | - Jonathon Kaiser
- Philadelphia College of Pharmacy; University of the Sciences; Philadelphia, PA USA
| | - Laura Pontiggia
- Department of Mathematics, Physics and Statistics; University of the Sciences; Philadelphia, PA USA
| | - Lisa E Davis
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA; Philadelphia College of Pharmacy; University of the Sciences; Philadelphia, PA USA
| | - Ravi K Amaravadi
- Department of Medicine and Abramson Cancer Center; University of Pennsylvania; Philadelphia, PA USA
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38
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Rangwala R, Chang YC, Hu J, Algazy KM, Evans TL, Fecher LA, Schuchter LM, Torigian DA, Panosian JT, Troxel AB, Tan KS, Heitjan DF, DeMichele AM, Vaughn DJ, Redlinger M, Alavi A, Kaiser J, Pontiggia L, Davis LE, O'Dwyer PJ, Amaravadi RK. Combined MTOR and autophagy inhibition: phase I trial of hydroxychloroquine and temsirolimus in patients with advanced solid tumors and melanoma. Autophagy 2014; 10:1391-402. [PMID: 24991838 PMCID: PMC4203516 DOI: 10.4161/auto.29119] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [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] [Indexed: 02/07/2023] Open
Abstract
The combination of temsirolimus (TEM), an MTOR inhibitor, and hydroxychloroquine (HCQ), an autophagy inhibitor, augments cell death in preclinical models. This phase 1 dose-escalation study evaluated the maximum tolerated dose (MTD), safety, preliminary activity, pharmacokinetics, and pharmacodynamics of HCQ in combination with TEM in cancer patients. In the dose escalation portion, 27 patients with advanced solid malignancies were enrolled, followed by a cohort expansion at the top dose level in 12 patients with metastatic melanoma. The combination of HCQ and TEM was well tolerated, and grade 3 or 4 toxicity was limited to anorexia (7%), fatigue (7%), and nausea (7%). An MTD was not reached for HCQ, and the recommended phase II dose was HCQ 600 mg twice daily in combination with TEM 25 mg weekly. Other common grade 1 or 2 toxicities included fatigue, anorexia, nausea, stomatitis, rash, and weight loss. No responses were observed; however, 14/21 (67%) patients in the dose escalation and 14/19 (74%) patients with melanoma achieved stable disease. The median progression-free survival in 13 melanoma patients treated with HCQ 1200mg/d in combination with TEM was 3.5 mo. Novel 18-fluorodeoxyglucose positron emission tomography (FDG-PET) measurements predicted clinical outcome and provided further evidence that the addition of HCQ to TEM produced metabolic stress on tumors in patients that experienced clinical benefit. Pharmacodynamic evidence of autophagy inhibition was evident in serial PBMC and tumor biopsies only in patients treated with 1200 mg daily HCQ. This study indicates that TEM and HCQ is safe and tolerable, modulates autophagy in patients, and has significant antitumor activity. Further studies combining MTOR and autophagy inhibitors in cancer patients are warranted.
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Affiliation(s)
- Reshma Rangwala
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Yunyoung C Chang
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Janice Hu
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Kenneth M Algazy
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Tracey L Evans
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Leslie A Fecher
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Lynn M Schuchter
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Drew A Torigian
- Department of Radiology Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Jeffrey T Panosian
- Department of Radiology Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Andrea B Troxel
- Center for Biostatistics and Epidemiology; University of Pennsylvania; Philadelphia, PA USA
| | - Kay-See Tan
- Center for Biostatistics and Epidemiology; University of Pennsylvania; Philadelphia, PA USA
| | - Daniel F Heitjan
- Center for Biostatistics and Epidemiology; University of Pennsylvania; Philadelphia, PA USA
| | - Angela M DeMichele
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - David J Vaughn
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Maryann Redlinger
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Abass Alavi
- Department of Radiology Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Jonathon Kaiser
- Department of Pharmacy Practice and Pharmacy Administration; Philadelphia College of Pharmacy; University of the Sciences; Philadelphia, PA USA
| | - Laura Pontiggia
- Department of Mathematics, Physics, and Statistics; University of the Sciences; Philadelphia, PA USA
| | - Lisa E Davis
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA; Department of Pharmacy Practice and Pharmacy Administration; Philadelphia College of Pharmacy; University of the Sciences; Philadelphia, PA USA
| | - Peter J O'Dwyer
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
| | - Ravi K Amaravadi
- Department of Medicine and the Abramson Cancer Center; Perelman School of Medicine; University of Pennsylvania; Philadelphia, PA USA
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Abstract
The treatment for metastatic melanoma has evolved significantly in the past few years. Ipilimumab, an immunotherapy, is now in mainstream oncology practice given that it has shown improved overall survival in randomized clinical trials. Other immune modulating agents, such as programmed death receptor-1 and programmed death receptor ligand-1 antibodies, are showing promise in early clinical trials. This manuscript will review ipilimumab and its most common side effects. Immune-related adverse events (irAEs) are important to recognize early, and their presentation, timing of onset, and general recommendations for workup and management will be reviewed. Assembling a multidisciplinary team, as well as thorough education of the patient, is recommended to optimize patient care.
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Affiliation(s)
- Leslie A Fecher
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania, USA.
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Kim KB, Kefford R, Pavlick AC, Infante JR, Ribas A, Sosman JA, Fecher LA, Millward M, McArthur GA, Hwu P, Gonzalez R, Ott PA, Long GV, Gardner OS, Ouellet D, Xu Y, DeMarini DJ, Le NT, Patel K, Lewis KD. Phase II study of the MEK1/MEK2 inhibitor Trametinib in patients with metastatic BRAF-mutant cutaneous melanoma previously treated with or without a BRAF inhibitor. J Clin Oncol 2012; 31:482-9. [PMID: 23248257 DOI: 10.1200/jco.2012.43.5966] [Citation(s) in RCA: 355] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE BRAF mutations promote melanoma cell proliferation and survival primarily through activation of MEK. The purpose of this study was to determine the response rate (RR) for the selective, allosteric MEK1/MEK2 inhibitor trametinib (GSK1120212), in patients with metastatic BRAF-mutant melanoma. PATIENTS AND METHODS This was an open-label, two-stage, phase II study with two cohorts. Patients with metastatic BRAF-mutant melanoma previously treated with a BRAF inhibitor (cohort A) or treated with chemotherapy and/or immunotherapy (BRAF-inhibitor naive; cohort B) were enrolled. Patients received 2 mg of trametinib orally once daily. RESULTS In cohort A (n = 40), there were no confirmed objective responses and 11 patients (28%) with stable disease (SD); the median progression-free survival (PFS) was 1.8 months. In cohort B (n = 57), there was one (2%) complete response, 13 (23%) partial responses (PRs), and 29 patients (51%) with SD (confirmed RR, 25%); the median PFS was 4.0 months. One patient each with BRAF K601E and BRAF V600R had prolonged PR. The most frequent treatment-related adverse events for all patients were skin-related toxicity, nausea, peripheral edema, diarrhea, pruritis, and fatigue. No cutaneous squamous cell carcinoma was observed. CONCLUSION Trametinib was well tolerated. Significant clinical activity was observed in BRAF-inhibitor-naive patients previously treated with chemotherapy and/or immunotherapy. Minimal clinical activity was observed as sequential therapy in patients previously treated with a BRAF inhibitor. Together, these data suggest that BRAF-inhibitor resistance mechanisms likely confer resistance to MEK-inhibitor monotherapy. These data support further evaluation of trametinib in BRAF-inhibitor-naive BRAF-mutant melanoma, including rarer forms of BRAF-mutant melanoma.
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Affiliation(s)
- Kevin B Kim
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Falchook GS, Lewis KD, Infante JR, Gordon MS, Vogelzang NJ, DeMarini DJ, Sun P, Moy C, Szabo SA, Roadcap LT, Peddareddigari VGR, Lebowitz PF, Le NT, Burris HA, Messersmith WA, O'Dwyer PJ, Kim KB, Flaherty K, Bendell JC, Gonzalez R, Kurzrock R, Fecher LA. Activity of the oral MEK inhibitor trametinib in patients with advanced melanoma: a phase 1 dose-escalation trial. Lancet Oncol 2012; 13:782-9. [PMID: 22805292 DOI: 10.1016/s1470-2045(12)70269-3] [Citation(s) in RCA: 404] [Impact Index Per Article: 33.7] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND MEK is a member of the MAPK signalling cascade that is commonly activated in melanoma. Direct inhibition of MEK blocks cell proliferation and induces apoptosis. We aimed to analyse safety, efficacy, and genotyping data for the oral, small-molecule MEK inhibitor trametinib in patients with melanoma. METHODS We undertook a multicentre, phase 1 three-part study (dose escalation, cohort expansion, and pharmacodynamic assessment). The main results of this study are reported elsewhere; here we present data relating to patients with melanoma. We obtained tumour samples to assess BRAF mutational status, and available tissues underwent exploratory genotyping analysis. Disease response was measured by Response Evaluation Criteria in Solid Tumors, and adverse events were defined by common toxicity criteria. This study is registered with ClinicalTrials.gov, number NCT00687622. FINDINGS 97 patients with melanoma were enrolled, including 81 with cutaneous or unknown primary melanoma (36 BRAF mutant, 39 BRAF wild-type, six BRAF status unknown), and 16 with uveal melanoma. The most common treatment-related adverse events were rash or dermatitis acneiform (n=80; 82%) and diarrhoea (44; 45%), most of which were grade 2 or lower. No cutaneous squamous-cell carcinomas were recorded. Of 36 patients with BRAF mutations, 30 had not received a BRAF inhibitor before; two complete responses (both confirmed) and ten partial responses (eight confirmed) were noted in this subgroup (confirmed response rate, 33%). Median progression-free survival of this subgroup was 5·7 months (95% CI 4·0-7·4). Of the six patients who had received previous BRAF inhibition, one unconfirmed partial response was recorded. Of 39 patients with BRAF wild-type melanoma, four partial responses were confirmed (confirmed response rate, 10%). INTERPRETATION Our data show substantial clinical activity of trametinib in melanoma and suggest that MEK is a valid therapeutic target. Differences in response rates according to mutations indicate the importance of mutational analyses in the future. FUNDING GlaxoSmithKline.
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Affiliation(s)
- Gerald S Falchook
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Chu EY, Wanat KA, Miller CJ, Amaravadi RK, Fecher LA, Brose MS, McGettigan S, Giles LR, Schuchter LM, Seykora JT, Rosenbach M. Diverse cutaneous side effects associated with BRAF inhibitor therapy: a clinicopathologic study. J Am Acad Dermatol 2012; 67:1265-72. [PMID: 22609219 DOI: 10.1016/j.jaad.2012.04.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 04/04/2012] [Accepted: 04/08/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Vemurafenib, a novel selective small molecule inhibitor of BRAF, has recently been shown to be effective in the treatment of melanomas harboring the BRAF V600E mutation. Similar to the broad-spectrum RAF inhibitor sorafenib, vemurafenib induces development of squamous cell carcinomas and keratoacanthomas as a side effect of therapy. OBJECTIVE We sought to detail additional cutaneous adverse effects of vemurafenib and a similar BRAF inhibitor, dabrafenib. METHODS We evaluated the clinical and histologic feature of skin side effects developing on vemurafenib or dabrafenib therapy in 14 patients. RESULTS Eight patients developed one or more squamous cell carcinomas, and 11 patients formed benign verrucous keratoses. Eight patients developed single lesions and/or widespread eruptions with histopathologic findings of acantholytic dyskeratosis, consistent with warty dyskeratomas and Darier- or Grover-like rashes, respectively. One patient developed palmoplantar hyperkeratosis, and darkening of existing nevi and new nevi within 2 months of starting vemurafenib. Side effects presented as early as 1 week after beginning therapy, with a mean time of onset of 12.6 weeks in our cohort. LIMITATIONS This study was limited by the small number of cases, all from a single institution. CONCLUSION Selective BRAF inhibitor therapy is associated with the development of malignant and benign growths, including keratoacanthoma-like squamous cell carcinomas, warty dyskeratomas, and verrucous keratoses, along with widespread eruptions with histologic features of acantholytic dyskeratosis. Given the potential for malignant lesions to develop on treatment, awareness of potential adverse effects of these agents is necessary, and a low threshold for biopsy of new growths is recommended.
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Affiliation(s)
- Emily Y Chu
- Department of Dermatology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Cox DS, Boyle DA, Ouellet D, Infante JR, Fecher LA, Fossler MJ. Abstract 1289: Population pharmacokinetics (PK) of the MEK inhibitor GSK1120212 from the first-time-in-human study in patients with solid tumors or lymphoma. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-1289] [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: GSK1120212 is a reversible, highly selective allosteric inhibitor of MEK1/MEK2. MEK111054, a first-time-in human study (FTIH) is an open-label, multiple-dose, dose escalation trial designed to investigate the safety, PK and pharmacodynamics (PD) of GSK1120212 in patients with solid tumors or lymphoma. A population PK model of GSK1120212 was developed and validated from the dose-escalation part of the FTIH trial.
Materials and Methods: GSK1120212 single (0.125-10 mg) and repeat (0.125-4 mg) dose plasma concentrations were obtained from MEK111054 that utilized both continuous and loading dose regimens with daily administration of GSK1120212. Plasma GSK1120212 concentrations were determined using a validated analytical method based on liquid-liquid extraction, followed by HPLC-MS/MS analysis. Population PK analysis was performed on 1373 plasma samples from 55 patients ranging in ages from 35 to 77 years. Population PK analysis was performed using a nonlinear mixed effects modeling method (NONMEM, v. 7.1.0). Concentrations were transformed into the log domain and the residual variability was described by an additive error model. The influence of covariates such as gender, age, weight and BMI on PK parameter estimates was assessed. The final model was validated using a visual predictive check (VPC) of the simulated (n=1000) and observed data.
Results: Plasma concentration-time data for GSK1120212 were best described by a two-compartment model with first-order absorption and elimination. The final model also incorporated two sequential absorption rates (KA1 and KA2) with a change point (MTIME) estimated at 0.41 hours post-dose. Final model population mean (%CV) parameter estimates for clearance (CL/F), volume of the central compartment (V2/F), volume of the peripheral compartment (V3/F), and intercompartmental clearance (Q/F) were 6.76 L/hr (7%), 125 L (18%), 746 L (11%), and 114 L, respectively. Interindividual variability ranged from 43 to 88%, interoccassion variability ranged from 8-74%, and the residual variability was 13 ng/mL. Covariates did not influence the pharmacokinetics of GSK1120212. VPC supported the validity of the model and was a good predictor of observed single and repeat dose data in the current study.
Conclusion: The population PK model of GSK1120212 in patients with solid tumors or lymphoma provided a description of PK and an understanding of its variability which aided dose selection decisions. Once daily dosing without a loading dose was selected for future studies in order to maintain concentrations above the preclinical antiproliferation IC90. The established population PK model will aid in the development of future population PK/PD assessments with both tumor response and adverse event data.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1289. doi:10.1158/1538-7445.AM2011-1289
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Affiliation(s)
| | | | | | | | - Leslie A. Fecher
- 4University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
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Fecher LA, Schuchter LM, Evans T, Chang CY, Gallagher M, Kramer A, O'Dwyer PJ, Amaravadi RK. Abstract 2521: Combining chemotherapy with autophagy inhibition: Phase I trial of dose-intense temozolomide and hydroxchloroquine in patients with advanced solid tumors. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-2521] [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: Therapy-induced autophagy is a key resistance mechanism to alkylating chemotherapy. Hydroxychloroquine (HCQ) is an autophagy inhibitor that augments the antitumor efficacy of chemotherapy in preclinical models. To determine the safety and pharmacodynamic (PD) effects of combining an alkylating chemotherapy with an autophagy inhibitor, we conducted a phase I clinical trial of temozolomide (TMZ) and HCQ in patients with advanced solid tumors. Methods: This was a traditional 3+3 dose escalation study in which patients were treated with 2 weeks daily HCQ followed by combined treatment with TMZ 150 mg/m2 po qd for 7/ 14 days and continuous HCQ. Patients with solid tumors with any number of prior therapies were eligible. Because both drugs cross the blood brain barrier, patients with brain metastases were included. The primary objective was to determine the maximal tolerated dose (MTD) of HCQ in this combination. Secondary objectives included toxicity rate, response rate, and measurement of therapy-induced accumulation of autophagic vesicles (AV) in serial peripheral blood mononuclear cells (PBMC) and tumor tissue. Results: 27 patients including 10 with brain metastases were enrolled with 19 evaluable for toxicity and response. HCQ was successfully dose escalated from 200 mg daily to 600 mg bid in 5 cohorts. There was one dose limiting toxicity at 400 mg bid HCQ of grade 4 neutropenia >7 days which lead to dose expansion. The 400 mg bid cohort was further expanded due to complete heart block in one patient that was thought to be unrelated to study drug. A grade 3 rash lead to dose expansion at 1000 mg daily. Anorexia, nausea, and fatigue were common grade 2 toxicities. In 12 patients with melanoma, partial response and stable disease was achieved in 2, and 3 patients respectively, including complete regression of multiple large extra-cranial tumors in a patient with brain metastases. One patient with 7 prior treatments for metastatic breast cancer with brain metastases had stable disease for 8 months. PD evidence of autophagy inhibition was observed by electron microscopy (EM) in PBMCs in individual patients but not across cohorts. In one patient with advanced melanoma, a post-progression FDG-PET scan demonstrated metabolic compromise and necrosis in the center of tumors, recapitulating preclinical models of autophagy inhibition. Conclusions: Dose- intense TMZ and HCQ demonstrated clinical activity, and a manageable safety profile in a population of patients enriched for brain metastases. Inconsistent evidence of autophagy inhibition in PBMC may reflect limited induction of autophagy by single agent temozolomide in surrogate tissues. Central metabolic compromise of tumor suggests FDG-PET can capture on-target effects of HCQ. The recommended phase II dose, final response rate and EM analysis of serial tumor biopsies will be presented.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2521. doi:10.1158/1538-7445.AM2011-2521
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Affiliation(s)
| | | | | | | | | | - Amy Kramer
- 1University of Pennsylvania, Philadelphia, PA
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45
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Abstract
Melanoma continues to be one of the most aggressive and morbid malignancies once metastatic. Overall survival for advanced unresectable melanoma has not changed over the past several decades. However, the presence of some long-term survivors of metastatic melanoma highlights the heterogeneity of this disease and the potential for improved outcomes. Current research is uncovering the molecular and genetic scaffolding of normal and aberrant cell function. The known oncogenic pathways in melanoma and the attempts to develop therapy for them are discussed. The targeting of certain cellular processes, downstream of the common genetic alterations, for which the issues of target and drug validation are somewhat distinct, are also highlighted.
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Affiliation(s)
- Leslie A Fecher
- Department of Medicine, Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, 3400 Spruce Street, 16 Penn Tower, Philadelphia, PA 19104, USA.
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Carpenter EL, Mick R, Rech AJ, Beatty GL, Colligon TA, Rosenfeld MR, Kaplan DE, Chang KM, Domchek SM, Kanetsky PA, Fecher LA, Flaherty KT, Schuchter LM, Vonderheide RH. Collapse of the CD27+ B-cell compartment associated with systemic plasmacytosis in patients with advanced melanoma and other cancers. Clin Cancer Res 2009; 15:4277-87. [PMID: 19549767 PMCID: PMC2896505 DOI: 10.1158/1078-0432.ccr-09-0537] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Disturbed peripheral blood B-cell homeostasis complicates certain infections and autoimmune diseases, such as HIV and systemic lupus erythematosus, but has not been reported in cancer. This study aimed to investigate whether B-cell physiology was altered in the presence of melanoma and other cancers. EXPERIMENTAL DESIGN Flow cytometry was used to identify phenotypic differences in B cells from patients with melanoma and normal donors. In vitro stimulated B cells were assessed for responsiveness and also used as stimulators of allogeneic T cells in mixed lymphocyte reactions. RESULTS We show B-cell dysregulation in patients with advanced melanoma (n = 26) and other solid tumors (n = 13), marked by a relative and absolute loss of CD27+ (memory) B cells and associated with an aberrant systemic plasmacytosis. Functionally, B cells from patients with melanoma inefficiently up-regulated immunoregulatory molecules and weakly secreted cytokines in response to CD40 and toll-like receptor 9 agonists. Stimulated B cells from patients induced proliferation of alloreactive CD4+ T cells, but these T cells poorly secreted IFNgamma and interleukin-2. These effects were recapitulated by using purified normal donor CD27(neg) B cells in these same assays, linking the predominance of CD27(neg) B cells in patients with the observed functional hyporesponsiveness. Indeed, B-cell dysfunction in patients strongly correlated with the extent of loss of CD27+ B cells in peripheral blood. CONCLUSIONS Disturbed B-cell homeostasis is a previously unrecognized feature of patients with advanced melanoma and other cancers and may represent an unanticipated mechanism of immune incompetence in cancer.
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Affiliation(s)
- Erica L. Carpenter
- Abramson Family Cancer Research Institute; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Rosemarie Mick
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Andrew J. Rech
- Abramson Family Cancer Research Institute; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Gregory L. Beatty
- Abramson Family Cancer Research Institute; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Hematology-Oncology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Theresa A. Colligon
- Abramson Family Cancer Research Institute; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Myrna R. Rosenfeld
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Neuro-oncology, Department of Neurology; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - David E. Kaplan
- Gastroenterology Section, Philadelphia Veterans Affairs Medical Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Gastroenterology, Department of Medicine; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Kyong-Mi Chang
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Gastroenterology Section, Philadelphia Veterans Affairs Medical Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Gastroenterology, Department of Medicine; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Susan M. Domchek
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Hematology-Oncology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Peter A. Kanetsky
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Leslie A. Fecher
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Hematology-Oncology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Keith T. Flaherty
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Hematology-Oncology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Lynn M. Schuchter
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Hematology-Oncology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
| | - Robert H. Vonderheide
- Abramson Family Cancer Research Institute; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Abramson Cancer Center; University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
- Division of Hematology-Oncology, University of Pennsylvania School of Medicine; Philadelphia, PA 19104, USA
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Fecher LA, Flaherty KT. Where are we with adjuvant therapy of stage III and IV melanoma in 2009? J Natl Compr Canc Netw 2009; 7:295-304. [PMID: 19401062 DOI: 10.6004/jnccn.2009.0022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Accepted: 11/12/2008] [Indexed: 11/17/2022]
Abstract
Adjuvant therapy options for advanced melanoma in 2009 remain active observation, high-dose interferon, or clinical trial participation. Close observation is currently the only required adjuvant management, with the purpose of detecting the emergence of regional or metastatic disease early, when surgical management may still be possible. The National Comprehensive Cancer Network guidelines for the workup and follow-up of all stages of melanoma must be tailored to specific patients by the treating physician. This article explores the factors to consider when individualizing care within the scope of these guidelines.
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Affiliation(s)
- Leslie A Fecher
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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49
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Abstract
The incidence of melanoma is increasing at one of the highest rates of any form of cancer in the United States, with the current lifetime risk being one in 68. At present, there are limited systemic therapies to treat advanced stages of melanoma, and the key to improved survival remains early detection. Recent discoveries have allowed for a clearer picture of the molecular events leading to melanoma development and progression. Since identifying prevalent activating mutations of the BRAF kinase in melanomas, there has been a flood of additional molecular studies to further clarify the role of this pathway and others in melanomagenesis. In particular, recent genetic studies have demonstrated specific genotype-phenotype correlations that provide the first major insights into the molecular subclassification of melanoma and the heterogeneous nature of this malignancy. In this article, we review the most up-to-date molecular discoveries in melanoma biology and provide a framework for understanding their significance in melanoma development and progression. We also provide details on the development of novel therapies based on these recent molecular discoveries and insight into current and planned clinical trials. It is expected that these latest studies in melanoma will help define the critical molecular events involved in disease onset and progression and allow us to move rapidly toward a true molecular classification. We eagerly anticipate rationally designed melanoma therapies based on such a classification scheme and the associated improvements in patient outcomes.
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Affiliation(s)
- Leslie A Fecher
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, USA
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