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Jansen SN, McCarty SL, Landrum LM. Sertoli-Leydig cell tumor with DICER1 mutation. Gynecol Oncol Rep 2024; 52:101353. [PMID: 38571566 PMCID: PMC10988476 DOI: 10.1016/j.gore.2024.101353] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 04/05/2024] Open
Abstract
Sertoli-Leydig cell tumors (SLCT) are a rare form of sex cord stromal tumors. DICER1 germline mutations have been identified in a portion of these cases. We report a 15-year-old individual who presented to a well-child visit with secondary amenorrhea and subjective observations of a deepening voice and broadening shoulders. Elevations were noted in serum testosterone, inhibin B, androstenedione, and DHEA. Pelvic ultrasound and magnetic resonance imaging (MRI) revealed a left ovarian complex lesion measuring 5.8 x 5.5 x 4.6 cm. A laparoscopic unilateral salpingo-oophorectomy was performed with negative pelvic washings and a diagnosis of stage 1A, poorly differentiated/grade 3 SLCT of the ovary. Somatic and germline testing both demonstrated DICER1 pathologic variations. Adjuvant chemotherapy with cisplatin/etoposide/ifosfamide (PEI) was completed under the care of pediatric oncology, and this patient is now undergoing surveillance with no signs of recurrence. DICER1 Syndrome is associated with multiple tumors, including SLCT, pleuropulmonary blastoma (PPB), cystic sarcomas, and Wilms tumor among others. Patients with SLCT found to have a DICER1 mutation should undergo genetic testing and cancer screening, which may help to identify neoplasms associated with the DICER1 mutation at an early stage. This case will serve as a useful addition to the literature and review suggested pre-operative, operative, and surveillance guidelines.
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Affiliation(s)
- Shae N. Jansen
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Lisa M. Landrum
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Indianapolis, IN, USA
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Minalt N, Caldwell A, Yedlicka GM, Joseph S, Robertson SE, Landrum LM, Peipert JF. Association between intrauterine device use and endometrial, cervical, and ovarian cancer: an expert review. Am J Obstet Gynecol 2023; 229:93-100. [PMID: 37001577 DOI: 10.1016/j.ajog.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023]
Abstract
The intrauterine device is one of the most effective forms of contraception. Use of the intrauterine device has increased in the United States over the last 2 decades. Two formulations are commercially available in the United States: the levonorgestrel-releasing intrauterine device and the copper intrauterine device. The levonorgestrel intrauterine device releases progestin, causing endometrial suppression and cervical mucus thickening, whereas the primary mechanism of action of the copper intrauterine device is to create a local inflammatory response to prevent fertilization. Whereas the protective effects of combined hormonal contraception against ovarian and endometrial cancer, and of tubal sterilization against ovarian cancer are generally accepted, less is known about the effects of modern intrauterine devices on the development of gynecologic malignancies. The best evidence for a protective effect of intrauterine device use against cancer incidence pertains to levonorgestrel intrauterine devices and endometrial cancer, although studies suggest that both copper intrauterine devices and levonorgestrel intrauterine devices reduce endometrial cancer risk. This is supported by the proposed dual mechanisms of action including both endometrial suppression and a local inflammatory response. Studies on the relationship between intrauterine device use and ovarian cancer risk show conflicting results, although most data suggest reduced risk of ovarian cancer in intrauterine device users. The proposed biological mechanisms of ovarian cancer reduction (foreign-body inflammatory response, increased pH, antiestrogenic effect, ovulation suppression) vary by type of intrauterine device. Whereas it has been well established that use of copper intrauterine devices confers a lower risk of cervical intraepithelial neoplasms, the effect of levonorgestrel intrauterine device use on cervical cancer remains unclear. Older studies have linked its use to a higher incidence of cervical dysplasia, but more recent literature has found a decrease in cervical cancer with intrauterine device use. Various mechanisms of protection are postulated, including device-related inflammatory response in the endocervical canal and prostaglandin-mediated immunosurveillance. Overall, the available evidence suggests that both levonorgestrel intrauterine devices and copper intrauterine devices reduce gynecologic cancer risk. Whereas there is support for the reduction of endometrial cancer risk with hormonal and copper intrauterine device use, and reduction of cervical cancer risk with copper intrauterine device use, evidence in support of risk reduction with levonorgestrel intrauterine device use for cervical and ovarian cancers is less consistent.
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Affiliation(s)
- Nicole Minalt
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Amy Caldwell
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Grace M Yedlicka
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Sophia Joseph
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Sharon E Robertson
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Lisa M Landrum
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Jeffrey F Peipert
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN.
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Mirza MR, Chase DM, Slomovitz BM, dePont Christensen R, Novák Z, Black D, Gilbert L, Sharma S, Valabrega G, Landrum LM, Hanker LC, Stuckey A, Boere I, Gold MA, Auranen A, Pothuri B, Cibula D, McCourt C, Raspagliesi F, Shahin MS, Gill SE, Monk BJ, Buscema J, Herzog TJ, Copeland LJ, Tian M, He Z, Stevens S, Zografos E, Coleman RL, Powell MA. Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer. N Engl J Med 2023; 388:2145-2158. [PMID: 36972026 DOI: 10.1056/nejmoa2216334] [Citation(s) in RCA: 132] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
BACKGROUND Dostarlimab is an immune-checkpoint inhibitor that targets the programmed cell death 1 receptor. The combination of chemotherapy and immunotherapy may have synergistic effects in the treatment of endometrial cancer. METHODS We conducted a phase 3, global, double-blind, randomized, placebo-controlled trial. Eligible patients with primary advanced stage III or IV or first recurrent endometrial cancer were randomly assigned in a 1:1 ratio to receive either dostarlimab (500 mg) or placebo, plus carboplatin (area under the concentration-time curve, 5 mg per milliliter per minute) and paclitaxel (175 mg per square meter of body-surface area), every 3 weeks (six cycles), followed by dostarlimab (1000 mg) or placebo every 6 weeks for up to 3 years. The primary end points were progression-free survival as assessed by the investigator according to Response Evaluation Criteria in Solid Tumors (RECIST), version 1.1, and overall survival. Safety was also assessed. RESULTS Of the 494 patients who underwent randomization, 118 (23.9%) had mismatch repair-deficient (dMMR), microsatellite instability-high (MSI-H) tumors. In the dMMR-MSI-H population, estimated progression-free survival at 24 months was 61.4% (95% confidence interval [CI], 46.3 to 73.4) in the dostarlimab group and 15.7% (95% CI, 7.2 to 27.0) in the placebo group (hazard ratio for progression or death, 0.28; 95% CI, 0.16 to 0.50; P<0.001). In the overall population, progression-free survival at 24 months was 36.1% (95% CI, 29.3 to 42.9) in the dostarlimab group and 18.1% (95% CI, 13.0 to 23.9) in the placebo group (hazard ratio, 0.64; 95% CI, 0.51 to 0.80; P<0.001). Overall survival at 24 months was 71.3% (95% CI, 64.5 to 77.1) with dostarlimab and 56.0% (95% CI, 48.9 to 62.5) with placebo (hazard ratio for death, 0.64; 95% CI, 0.46 to 0.87). The most common adverse events that occurred or worsened during treatment were nausea (53.9% of the patients in the dostarlimab group and 45.9% of those in the placebo group), alopecia (53.5% and 50.0%), and fatigue (51.9% and 54.5%). Severe and serious adverse events were more frequent in the dostarlimab group than in the placebo group. CONCLUSIONS Dostarlimab plus carboplatin-paclitaxel significantly increased progression-free survival among patients with primary advanced or recurrent endometrial cancer, with a substantial benefit in the dMMR-MSI-H population. (Funded by GSK; RUBY ClinicalTrials.gov number, NCT03981796.).
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Affiliation(s)
- Mansoor R Mirza
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Dana M Chase
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Brian M Slomovitz
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - René dePont Christensen
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Zoltán Novák
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Destin Black
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Lucy Gilbert
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Sudarshan Sharma
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Giorgio Valabrega
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Lisa M Landrum
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Lars C Hanker
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Ashley Stuckey
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Ingrid Boere
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Michael A Gold
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Annika Auranen
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Bhavana Pothuri
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - David Cibula
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Carolyn McCourt
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Francesco Raspagliesi
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Mark S Shahin
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Sarah E Gill
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Bradley J Monk
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Joseph Buscema
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Thomas J Herzog
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Larry J Copeland
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Min Tian
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Zangdong He
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Shadi Stevens
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Eleftherios Zografos
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Robert L Coleman
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
| | - Matthew A Powell
- From the Department of Oncology, Rigshospitalet, Copenhagen University Hospital, and the Nordic Society of Gynaecological Oncology-Clinical Trial Unit, Copenhagen (M.R.M.), and the Research Unit for General Practice, University of Southern Denmark, Institute of Public Health, Odense (R.C.) - all in Denmark; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.M.C.); the Department of Gynecologic Oncology, Mount Sinai Medical Center, and the Department of Obstetrics and Gynecology, Florida International University, Miami Beach (B.M.S.); the Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary (Z.N.); the Department of Obstetrics and Gynecology, Louisiana State University Health Shreveport, and Willis-Knighton Physician Network, Shreveport (D.B.); the Division of Gynecologic Oncology, McGill University Health Centre, Montreal (L.G.); the Department of Obstetrics and Gynecology, AMITA Adventist Hinsdale Hospital, Hinsdale, IL (S.S.); the University of Turin, A.O. Ordine Mauriziano, Turin (G.V.), and the Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori-Milano, University of Milan, Milan (F.R.) - both in Italy; Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany (L.C.H.); Women and Infants Hospital, Providence, RI (A.S.); the Department of Medical Oncology, Erasmus MC Cancer Center, Rotterdam, the Netherlands (I.B.); Oklahoma Cancer Specialists and Research Institute, Tulsa (M.A.G.); Tays Cancer Center and FICAN Mid, Tampere University and Tampere University Hospital, Tampere, Finland (A.A.); New York University Langone Health, New York (B.P.); the Department of Obstetrics and Gynecology, General University Hospital in Prague, First Faculty of Medicine, Charles University, Prague, Czech Republic (D.C.); the Division of Gynecologic Oncology (C.M.) and National Cancer Institute-sponsored NRG Oncology (M.A.P.), Washington University School of Medicine, St. Louis; Hanjani Institute for Gynecologic Oncology, Abington Hospital-Jefferson Health, Asplundh Cancer Pavilion, Sidney Kimmel Medical College, Thomas Jefferson University, Willow Grove (M.S.S.), and GSK, Collegeville (M.T., Z.H.) - both in Pennsylvania; the Division of Gynecologic Oncology, Nancy N. and J.C. Lewis Cancer and Research Pavilion, Savannah, GA (S.E.G.); HonorHealth Research Institute, University of Arizona College of Medicine, and Creighton University School of Medicine, Phoenix (B.J.M.), and the Department of Gynecologic Oncology, Arizona Oncology, Tucson (J.B.); the Department of Obstetrics and Gynecology, University of Cincinnati Cancer Center, Cincinnati (T.J.H.), and Ohio State University Comprehensive Cancer Center, Hillard (L.J.C.); GSK, London (S.S., E.Z.); and US Oncology Research, the Woodlands, TX (R.L.C.)
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Eskander RN, Sill MW, Beffa L, Moore RG, Hope JM, Musa FB, Mannel R, Shahin MS, Cantuaria GH, Girda E, Mathews C, Kavecansky J, Leath CA, Gien LT, Hinchcliff EM, Lele SB, Landrum LM, Backes F, O'Cearbhaill RE, Al Baghdadi T, Hill EK, Thaker PH, John VS, Welch S, Fader AN, Powell MA, Aghajanian C. Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer. N Engl J Med 2023; 388:2159-2170. [PMID: 36972022 PMCID: PMC10351614 DOI: 10.1056/nejmoa2302312] [Citation(s) in RCA: 109] [Impact Index Per Article: 109.0] [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: 03/29/2023]
Abstract
BACKGROUND Standard first-line chemotherapy for endometrial cancer is paclitaxel plus carboplatin. The benefit of adding pembrolizumab to chemotherapy remains unclear. METHODS In this double-blind, placebo-controlled, randomized, phase 3 trial, we assigned 816 patients with measurable disease (stage III or IVA) or stage IVB or recurrent endometrial cancer in a 1:1 ratio to receive pembrolizumab or placebo along with combination therapy with paclitaxel plus carboplatin. The administration of pembrolizumab or placebo was planned in 6 cycles every 3 weeks, followed by up to 14 maintenance cycles every 6 weeks. The patients were stratified into two cohorts according to whether they had mismatch repair-deficient (dMMR) or mismatch repair-proficient (pMMR) disease. Previous adjuvant chemotherapy was permitted if the treatment-free interval was at least 12 months. The primary outcome was progression-free survival in the two cohorts. Interim analyses were scheduled to be triggered after the occurrence of at least 84 events of death or progression in the dMMR cohort and at least 196 events in the pMMR cohort. RESULTS In the 12-month analysis, Kaplan-Meier estimates of progression-free survival in the dMMR cohort were 74% in the pembrolizumab group and 38% in the placebo group (hazard ratio for progression or death, 0.30; 95% confidence interval [CI], 0.19 to 0.48; P<0.001), a 70% difference in relative risk. In the pMMR cohort, median progression-free survival was 13.1 months with pembrolizumab and 8.7 months with placebo (hazard ratio, 0.54; 95% CI, 0.41 to 0.71; P<0.001). Adverse events were as expected for pembrolizumab and combination chemotherapy. CONCLUSIONS In patients with advanced or recurrent endometrial cancer, the addition of pembrolizumab to standard chemotherapy resulted in significantly longer progression-free survival than with chemotherapy alone. (Funded by the National Cancer Institute and others; NRG-GY018 ClinicalTrials.gov number, NCT03914612.).
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Affiliation(s)
- Ramez N Eskander
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Michael W Sill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lindsey Beffa
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Richard G Moore
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Joanie M Hope
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Fernanda B Musa
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Robert Mannel
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Mark S Shahin
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Guilherme H Cantuaria
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Eugenia Girda
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Cara Mathews
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Juraj Kavecansky
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Charles A Leath
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lilian T Gien
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Emily M Hinchcliff
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Shashikant B Lele
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Lisa M Landrum
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Floor Backes
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Roisin E O'Cearbhaill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Tareq Al Baghdadi
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Emily K Hill
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Premal H Thaker
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Veena S John
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Stephen Welch
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Amanda N Fader
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Matthew A Powell
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
| | - Carol Aghajanian
- From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, Rebecca and John Moores Cancer Center, La Jolla (R.N.E.), and the Kaiser Permanente National Cancer Institute Community Oncology Research Program (NCORP), Antioch Medical Center, Antioch (J.K.) - both in California; the Clinical Trial Development Division, Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo (M.W.S., S.B.L.), the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester (R.G.M.), the Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, and the Department of Medicine, Weill Cornell Medical College, New York (R.E.O., C.A.), and the Northwell Health Cancer Institute, New Hyde Park (V.S.J.) - all in New York; the Case Comprehensive Cancer Center, Cleveland Clinic Foundation, Cleveland (L.B.), and Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus (F.B.); the Pacific Cancer Research Consortium, NCORP, Alaska Women's Cancer Care, and Providence Alaska Cancer Center, Anchorage (J.M.H.); the Pacific Cancer Research Consortium, NCORP, Swedish Medical Center-First Hill, Seattle (F.B.M.); the University of Oklahoma Health Sciences Center, Oklahoma City (R.M.); Jefferson Abington Hospital, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA (M.S.S.); Georgia NCORP, Atlanta (G.H.C.); Rutgers Cancer Institute of New Jersey, New Brunswick (E.G.); Women and Infants Hospital, Legoretta Cancer Center, Alpert Medical School, Brown University, Providence, RI (C.M.); the University of Alabama at Birmingham-Deep South Research Consortium, O'Neal Comprehensive Cancer Center, University of Alabama Hospital, Birmingham (C.A.L.); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (L.T.G.), and the London Regional Cancer Program, London, ON (S.W.) - both in Canada; Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago (E.M.H.); the Indiana University Health Simon Cancer Center, Indianapolis (L.M.L.); the Michigan Cancer Research Consortium, NCORP, Trinity Health IHA Medical Group, Ypsilanti (T.A.B.); the University of Iowa Hospitals and Clinics, Iowa City (E.K.H.); the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis (P.H.T., M.A.P.); and the Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore (A.N.F.)
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5
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Tewari KS, Sill MW, Birrer MJ, Penson RT, Huang H, Moore DH, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, Monk BJ. Final survival analysis of topotecan and paclitaxel for first-line treatment of advanced cervical cancer: An NRG oncology randomized study. Gynecol Oncol 2023; 171:141-150. [PMID: 36898292 PMCID: PMC10286827 DOI: 10.1016/j.ygyno.2023.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 10/18/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To determine whether a non‑platinum chemotherapy doublet improves overall survival (OS) among patients with recurrent/metastatic cervical carcinoma. METHODS Gynecologic Oncology Group protocol 240 is a phase 3, randomized, open-label, clinical trial that studied the efficacy of paclitaxel 175 mg/m2 plus topotecan 0.75 mg/m2 days 1-3 (n = 223) vs cisplatin 50 mg/m2 plus paclitaxel 135 or 175 mg/m2 (n = 229), in 452 patients with recurrent/metastatic cervical cancer. Each chemotherapy doublet was also studied with and without bevacizumab (15 mg/kg). Cycles were repeated every 21 days until progression, unacceptable toxicity, or complete response. The primary endpoints were OS and the frequency and severity of adverse effects. We report the final analysis of OS. RESULTS At the protocol-specified final analysis, median OS was 16.3 (cisplatin-paclitaxel backbone) and 13.8 months (topotecan-paclitaxel backbone) (HR 1.12; 95% CI, 0.91-1.38; p = 0.28). Median OS for cisplatin-paclitaxel and topotecan-paclitaxel was 15 vs 12 months, respectively (HR 1.10; 95% CI,0.82-1.48; p = 0.52), and for cisplatin-paclitaxel-bevacizumab and topotecan-paclitaxel-bevacizumab was 17.5 vs 16.2 months, respectively (HR 1.16; 95% CI, 0.86-1.56; p = 0.34). Among the 75% of patients in the study population previously exposed to platinum, median OS was 14.6 (cisplatin-paclitaxel backbone) vs 12.9 months (topotecan-paclitaxel backbone), respectively (HR 1.09; 95% CI, 0.86-1.38;p = 0.48). Post-progression survival was 7.9 (cisplatin-paclitaxel backbone) vs 8.1 months (topotecan-paclitaxel backbone) (HR 0.95; 95% CI, 0.75-1.19). Grade 4 hematologic toxicity was similar between chemotherapy backbones. CONCLUSIONS Topotecan plus paclitaxel does not confer a survival benefit to women with recurrent/metastatic cervical cancer, even among platinum-exposed patients. Topotecan-paclitaxel should not be routinely recommended in this population. NCT00803062.
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Affiliation(s)
| | - Michael W Sill
- Roswell Park Comprehensive Cancer Center, State University of New York at Buffalo, NY, USA.
| | - Michael J Birrer
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | - Helen Huang
- Roswell Park Comprehensive Cancer Center, State University of New York at Buffalo, NY, USA.
| | - David H Moore
- Franciscan S. Francis Health, Indianapolis, IN, USA.
| | | | | | - Ana Oaknin
- Gynaecologic Cancer Programme, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
| | - Thomas J Reid
- University of Cincinnati College of Medicine Kettering, OH, USA.
| | - Mario M Leitao
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Helen E Michael
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Jackson CG, Moore KN, Cantrell L, Erickson BK, Duska LR, Richardson DL, Landrum LM, Holman LL, Walker JL, Mannel RS, Moxley KM, Queimado L, Cohoon A, Ding K, Dockery LE. A phase II trial of bevacizumab and rucaparib in recurrent carcinoma of the cervix or endometrium. Gynecol Oncol 2022; 166:44-49. [PMID: 35491267 PMCID: PMC10428664 DOI: 10.1016/j.ygyno.2022.04.016] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the tolerability and efficacy of combination bevacizumab rucaparib therapy in patients with recurrent cervical or endometrial cancer. PATIENTS & METHODS Thirty-three patients with recurrent cervical or endometrial cancer were enrolled. Patients were required to have tumor progression after first line treatment for metastatic, or recurrent disease. Rucaparib was given at 600 mg BID twice daily for each 21-day cycle. Bevacizumab was given at 15 mg/kg on day 1 of each 21-day cycle. The primary endpoint was efficacy as determined by objective response rate or 6-month progression free survival. RESULTS Of the 33 patients enrolled, 28 were evaluable. Patients with endometrial cancer had a response rate of 17% while patients with cervical cancer had a response rate of 14%. Median progression free survival was 3.8 months (95% C·I 2.5 to 5.7 months), and median overall survival was 10.1 months (95% C·I 7.0 to 15.1 months). Patients with ARID1A mutations displayed a better response rate (33%) and 6-month progression free survival (PFS6) rate (67%) than the entire study population. Observed toxicity was similar to that of previous studies with bevacizumab and rucaparib. CONCLUSIONS The combination of bevacizumab with rucaparib did not show significantly increased anti-tumor activity in all patients with recurrent cervical or endometrial cancer. However, patients with ARID1A mutations had a higher response rate and PFS6 suggesting this subgroup may benefit from the combination of bevacizumab and rucaparib. Further study is needed to confirm this observation. No new safety signals were seen.
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Affiliation(s)
- C G Jackson
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K N Moore
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L Cantrell
- Division of Gynecologic Oncology, University of Virginia, Department of Obstetrics and Gynecology; Charlottesville, VA, USA
| | - B K Erickson
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota; Minneapolis, MN, USA
| | - L R Duska
- Division of Gynecologic Oncology, University of Virginia, Department of Obstetrics and Gynecology; Charlottesville, VA, USA
| | - D L Richardson
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L M Landrum
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L L Holman
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - J L Walker
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - R S Mannel
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K M Moxley
- Stephenson Cancer Center Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L Queimado
- Department of Otolaryngology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - A Cohoon
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - K Ding
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center; Oklahoma City, OK, USA
| | - L E Dockery
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina; Chapel Hill, NC, USA.
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7
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Donovan HS, Sereika SM, Wenzel LB, Edwards RP, Knapp JE, Hughes SH, Roberge MC, Thomas TH, Klein SJ, Spring MB, Nolte S, Landrum LM, Casey AC, Mutch DG, DeBernardo RL, Muller CY, Sullivan SA, Ward SE. Effects of the WRITE Symptoms Interventions on Symptoms and Quality of Life Among Patients With Recurrent Ovarian Cancers: An NRG Oncology/GOG Study (GOG-0259). J Clin Oncol 2022; 40:1464-1473. [PMID: 35130043 PMCID: PMC9061156 DOI: 10.1200/jco.21.00656] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/10/2021] [Revised: 11/21/2021] [Accepted: 01/05/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE GOG-259 was a 3-arm randomized controlled trial of two web-based symptom management interventions for patients with recurrent ovarian cancer. Primary aims were to compare the efficacy of the nurse-guided (Nurse-WRITE) and self-directed (SD-WRITE) interventions to Enhanced Usual Care (EUC) in improving symptoms (burden and controllability) and quality of life (QOL). METHODS Patients with recurrent or persistent ovarian, fallopian, or primary peritoneal cancer with 3+ symptoms were eligible for the study. Participants completed baseline (BL) surveys (symptom burden and controllability and QOL) before random assignment. WRITE interventions lasted 8 weeks to develop symptom management plans for three target symptoms. All women received EUC: monthly online symptom assessment with provider reports; online resources; and every 2-week e-mails. Outcomes were evaluated at 8 and 12 weeks after BL. Repeated-measures modeling with linear contrasts evaluated group by time effects on symptom burden, controllability, and QOL, controlling for key covariates. RESULTS Participants (N = 497) reported mean age of 59.3 ± 9.2 years. At BL, 84% were receiving chemotherapy and reported a mean of 14.2 ± 4.9 concurrent symptoms, most commonly fatigue, constipation, and peripheral neuropathy. Symptom burden and QOL improved significantly over time (P < .001) for all three groups. A group by time interaction (P < .001) for symptom controllability was noted whereby both WRITE intervention groups had similar improvements from BL to 8 and 12 weeks, whereas EUC did not improve over time. CONCLUSION Both WRITE Intervention groups showed significantly greater improvements in symptom controllability from BL to 8 and BL to 12 weeks compared with EUC. There were no significant differences between Nurse-WRITE and SD-WRITE. SD-WRITE has potential as a scalable intervention for a future implementation study.
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Affiliation(s)
- Heidi S. Donovan
- University of Pittsburgh School of Nursing, Pittsburgh, PA
- Magee Womens Hospital of UPMC Hillman Cancer Center, Pittsburgh, PA
| | | | - Lari B. Wenzel
- Medicine and Public Health, University of California, Irvine, CA
| | | | | | | | | | | | - Sara Jo Klein
- University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Michael B. Spring
- University of Pittsburgh School of Computing and Information, Pittsburgh, PA
| | - Susan Nolte
- Abington Memorial Hospital, Gynecologic Oncology Institute, Abington, PA
| | - Lisa M. Landrum
- Stephenson Cancer Center Gynecologic Cancers Clinic, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | - David G. Mutch
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | | | - Carolyn Y. Muller
- Gynecologic Oncology, UNM School of Medicine, University of New Mexico Albuquerque, NM
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Castellano T, John Maxwell IV, Adam Walter J, Thompson S, McMeekin DS, Landrum LM. Phase II trial of vaginal cuff brachytherapy followed by dose-dense chemotherapy in early stage endometrial cancer patients with enriched, high-intermediate risk factors for recurrence. Gynecol Oncol 2020; 160:669-673. [PMID: 33358492 DOI: 10.1016/j.ygyno.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the feasibility of vaginal cuff brachytherapy (VCB) followed by 3 cycles of dose dense paclitaxel and carboplatin chemotherapy (ddTC) in enriched, high-intermediate risk (H-IR) patients with early stage endometrial cancer following hysterectomy. METHODS A phase II trial of early stage endometrial cancer patients treated with VCB (2100 cGy) followed by three cycles of carboplatin (AUC 6) and dose dense paclitaxel (80 mg/m2) weekly within 12-weeks of surgery was conducted. The primary endpoint was the proportion of patients completing both VCB and ddTC. Secondary outcomes include short and long-term toxicities, recurrence rate and sites, and progression free survival. Toxicity assessments were patient reported as well as those resulting in delays or dose modifications. RESULTS A total of 32 evaluable patients with median age of 64.5 years were included. Most patients were endometrioid histology (18/32, 56.3%) and fully staged (21/32, 65.6%) to stage Ib (18/32, 56.3%). In total, 27/32 (84.4%) patients completed treatment per protocol. Protocol non-completion included renal insufficiency, paclitaxel reaction, and treatment refusal. Median time to VCB completion was 11 days with all patients completing three fractions of VCB. Acute toxicities with VCB included grade 1 and 2 gastrointestinal, genitourinary and fatigue symptoms. Acute toxicities associated with ddTC included infusion reaction and neutropenia. Most reported long-term toxicities were grade 1 or 2 and resolved with time. CONCLUSIONS Treatment with VCB followed by three cycles of ddTC is well-tolerated with promising utility for treatment in enriched high-intermediate risk endometrial cancer patients. Recurrence-free and overall survival outcomes are not yet mature.
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Affiliation(s)
- Tara Castellano
- Section of Gynecology Oncology at the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - I V John Maxwell
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - J Adam Walter
- Section of Gynecology Oncology at the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Spencer Thompson
- Department of Radiation Oncology at the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - D Scott McMeekin
- Section of Gynecology Oncology at the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Lisa M Landrum
- Section of Gynecology Oncology at the Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Abstract
•During the COVID-19 pandemic, the primary clinical emphasis has shifted to optimizing community health. •Scarce resources should be allocated to maximize benefit without unfairly affecting any group. •Healthcare systems should consider adopting a formal, tier-based response to COVID-19 related demand on resources. •Clinicians should use principles of high-stakes communication to guide care planning during the pandemic.
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Affiliation(s)
- David I Shalowitz
- Section on Gynecologic Oncology, Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.
| | - Carolyn Lefkowits
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, United States of America
| | - Lisa M Landrum
- Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States of America
| | - Vivian E von Gruenigen
- Division of Gynecologic Oncology, University Hospitals Medical Center, Beachwood, OH, United States of America
| | - Monique A Spillman
- Division of Gynecologic Oncology, Texas Oncology, Baylor University Medical Center, Dallas, TX, United States of America
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10
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Tewari KS, Sill MW, Monk BJ, Penson RT, Moore DH, Lankes HA, Ramondetta LM, Landrum LM, Randall LM, Oaknin A, Leitao MM, Eisenhauer EL, DiSilvestro P, Van Le L, Pearl ML, Burke JJ, Salani R, Richardson DL, Michael HE, Kindelberger DW, Birrer MJ. Circulating Tumor Cells In Advanced Cervical Cancer: NRG Oncology-Gynecologic Oncology Group Study 240 (NCT 00803062). Mol Cancer Ther 2020; 19:2363-2370. [PMID: 32847980 DOI: 10.1158/1535-7163.mct-20-0276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/04/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022]
Abstract
To isolate circulating tumor cells (CTC) from women with advanced cervical cancer and estimate the impact of CTCs and treatment on overall survival and progression-free survival (PFS). A total of 7.5 mL of whole blood was drawn pre-cycle 1 and 36 days post-cycle 1 from patients enrolled on Gynecologic Oncology Group 0240, the phase III randomized trial that led directly to regulatory approval of the antiangiogenesis drug, bevacizumab, in women with recurrent/metastatic cervical cancer. CTCs (defined as anti-cytokeratin+/anti-CD45- cells) were isolated from the buffy coat layer using an anti-EpCAM antibody-conjugated ferrofluid and rare earth magnet, and counted using a semiautomated fluorescence microscope. The median pre-cycle 1 CTC count was 7 CTCs/7.5 mL whole blood (range, 0-18) and, at 36 days posttreatment, was 4 (range, 0-17). The greater the declination in CTCs between time points studied, the lower the risk of death [HR, 0.87; 95% confidence interval (CI), 0.79-0.95)]. Among patients with high (≥ median) pretreatment CTCs, bevacizumab treatment was associated with a reduction in the hazard of death (HR, 0.57; 95% CI, 0.32-1.03) and PFS (HR, 0.59; 95% CI, 0.36-0.96). This effect was not observed with low (< median) CTCs. CTCs can be isolated from women with advanced cervical cancer and may have prognostic significance. A survival benefit conferred by bevacizumab among patients with high pretreatment CTCs may reflect increased tumor neovascularization and concomitant vulnerability to VEGF inhibition. These data support studying CTC capture as a potential predictive biomarker.
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Affiliation(s)
| | - Michael W Sill
- NRG Oncology/Gynecologic Oncology Group, SUNY at Buffalo, Buffalo, New York.,Statistics & Data Center, SUNY at Buffalo, Buffalo, New York.,Roswell Park Cancer Institute, SUNY at Buffalo, Buffalo, New York
| | - Bradley J Monk
- University of Arizona Cancer Center and Creighton University at St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - David H Moore
- Franciscan St. Francis Health-Indianapolis, Indianapolis, Indiana
| | - Heather A Lankes
- NRG Oncology/Gynecologic Oncology Group, SUNY at Buffalo, Buffalo, New York.,Statistics & Data Center, SUNY at Buffalo, Buffalo, New York.,Roswell Park Cancer Institute, SUNY at Buffalo, Buffalo, New York
| | | | - Lisa M Landrum
- Oklahoma University Health Science Center, Oklahoma City, Oklahoma
| | | | - Ana Oaknin
- Grupo Espanol de Investigacion en Cancer de Ovario (GEICO), Barcelona, Spain
| | - Mario M Leitao
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | | - Linda Van Le
- University of North Carolina, Chapel Hill, North Carolina
| | - Michael L Pearl
- Stony Brook University Medical Center, Stony Brook, New York
| | - James J Burke
- Southeast Cancer Control Consortium CCOP, Winston-Salem, North Carolina.,Memorial University Medical Center, Savannah, Georgia
| | - Ritu Salani
- The Ohio State University Medical Center, Columbus, Ohio
| | | | - Helen E Michael
- Indiana University School of Medicine, Indianapolis, Indiana
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11
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Huh WK, Brady WE, Fracasso PM, Dizon DS, Powell MA, Monk BJ, Leath CA, Landrum LM, Tanner EJ, Crane EK, Ueda S, McHale MT, Aghajanian C. Phase II study of axalimogene filolisbac (ADXS-HPV) for platinum-refractory cervical carcinoma: An NRG oncology/gynecologic oncology group study. Gynecol Oncol 2020; 158:562-569. [PMID: 32641240 DOI: 10.1016/j.ygyno.2020.06.493] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Women with persistent, recurrent, and/or metastatic cervical cancer have a poor prognosis. Even with the availability of cisplatin plus paclitaxel and bevacizumab, median overall survival (OS) is only 17.0 months, with median post-progression survival of approximately seven months. We studied the therapeutic vaccine, Axalimogene filolisbac (ADXS-HPV), in women who had progressed following at least one prior line of therapy (Gynecologic Oncology Group protocol 265/NCT01266460). METHODS Volunteers ≥18 years with advanced cervical cancer and GOG performance status score of 0 or 1 were eligible for participation in this 2-stage, phase II trial. In stage 1, women received up to three doses of ADXS-HPV (1 × 109 colony-forming units in 250 mL IV over 15 min every 28 days) and were monitored for tumor progression. In stage 2, women were treated until progression, intolerable adverse events (AEs), or voluntary withdrawal of consent. Co-primary endpoints were safety and proportion of volunteers surviving ≥12 months. An estimated, combined (stages 1 + 2) 12-month OS of 35% was calculated from historical GOG cohorts to declare ADXS-HPV sufficiently active in this platinum-pre-treated population. Secondary endpoints were OS and progression-free survival (PFS). RESULTS Among 50 evaluable volunteers, the 12-month OS was 38% (n = 19). Median OS was 6.1 months (95% CI: 4.3-12.1) and median PFS was 2.8 months (95% CI: 2.6-3.0). The most common treatment-related AEs were fatigue, chills, fever, nausea, and anemia. The majority of AEs were grade 1 or 2 and resolved spontaneously or with appropriate treatment. CONCLUSION At the dose and schedule studied, ADXS-HPV immunotherapy was tolerable and met the protocol-specified benchmark for activity required to warrant further investigation in volunteers with cervical carcinoma.
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Affiliation(s)
- Warner K Huh
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - William E Brady
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park, Buffalo, NY 14263, United States of America
| | - Paula M Fracasso
- Department of Medicine, University of Virginia, UVA Cancer Center, Charlottesville, VA 22908, United States of America.
| | - Don S Dizon
- Division of Hematology-Oncology, Lifespan Cancer Institute, Rhode Island Hospital, Department of Medicine, Alpert Medical School of Brown University, Providence, RI 02903, United States of America
| | - Matthew A Powell
- Washington University School of Medicine, Saint Louis, MO 63110, United States of America.
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St. Joseph Hospital, Phoenix, AZ 85016, United States of America.
| | - Charles A Leath
- University of Alabama at Birmingham, Division of Gynecologic Oncology, Birmingham, AL 35249, United States of America.
| | - Lisa M Landrum
- Oklahoma University Health Science Center, OB/GYN, Oklahoma City, OK 73104, United States of America.
| | - Edward J Tanner
- Johns Hopkins Medical Institutions, Baltimore, MD 21287, United States of America.
| | - Erin K Crane
- Department of Gynecologic Oncology, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC 28203, United States of America.
| | - Stefanie Ueda
- University of California, San Francisco, OB/GYN & Reproductive Sciences, Division of Gyn Onc., San Francisco, CA 94115, United States of America.
| | - Michael T McHale
- Moores UCSD Cancer Center, La Jolla, CA 92093, United States of America.
| | - Carol Aghajanian
- Memorial Sloan-Kettering Cancer Center, Dept. of Medical Oncology, New York, NY 10021, United States of America.
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12
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Chase D, Huang HQ, Monk BJ, Ramondetta LM, Penson RT, Gil K, Landrum LM, Leitao M, Oaknin A, Huh WK, Pulaski HL, Robison K, Guntupalli SR, Richardson D, Salani R, Sill MW, Wenzel LB, Tewari KS. Patient-reported outcomes at discontinuation of anti-angiogenesis therapy in the randomized trial of chemotherapy with bevacizumab for advanced cervical cancer: an NRG Oncology Group study. Int J Gynecol Cancer 2020; 30:596-601. [PMID: 32114513 DOI: 10.1136/ijgc-2019-000869] [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: 10/04/2019] [Revised: 01/18/2020] [Accepted: 02/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION To describe patient-reported outcomes and toxicities at time of treatment discontinuation secondary to progression or toxicities in advanced/recurrent cervical cancer patients receiving chemotherapy with bevacizumab. METHODS Summarize toxicity, grade, and health-related quality of life within 1 month of treatment discontinuation for women receiving chemotherapy with bevacizumab in GOG240. RESULTS Of the 227 patients who received chemotherapy with bevacizumab, 148 discontinued study protocol treatment (90 for disease progression and 58 for toxicity). The median survival time from treatment discontinuation to death was 7.9 months (95% CI 5.0 to 9.0) for those who progressed versus 12.1 months (95% CI 8.9 to 23.2) for those who discontinued therapy due to toxicities. The most common grade 3 or higher toxicities included hematologic, gastrointestinal, and pain. Some 57% (84/148) of patients completed quality of life assessment within 1 month of treatment discontinuation. Those patients who discontinued treatment due to progression had a mean decline in the FACT-Cx TOI of 3.2 points versus 2.2 in patients who discontinued therapy due to toxicity. This was a 9.9 point greater decline in the FACT-Cx TOI scores than those who discontinued treatment due to progression (95% CI 2.8 to 17.0, p=0.007). The decline in quality of life was due to worsening physical and functional well-being. Those who discontinued treatment due to toxicities had worse neurotoxicity and pain. DISCUSSION Patients who discontinued chemotherapy with bevacizumab for toxicity experienced longer post-protocol survival but significantly greater declination in quality of life than those with progression. Future trial design should include supportive care interventions that optimize physiologic function and performance status for salvage therapies.
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Affiliation(s)
- Dana Chase
- Arizona Oncology, Paradise Valley, California, USA
| | - Helen Q Huang
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bradley J Monk
- Ob Gyn/Gyn Onc, Creighton University School of Medicine at St Josephs Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - Richard T Penson
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Gil
- Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lisa M Landrum
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mario Leitao
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Ana Oaknin
- Vall d' Hebron Institute of Oncology, University Hospital, Barcelona, Spain
| | - Warner K Huh
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Heather L Pulaski
- Gynecological Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Katina Robison
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
| | - Saketh R Guntupalli
- Gynecologic Oncology, University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Ritu Salani
- Ob/Gyn, Ohio State University, Columbus, Ohio, USA
| | - Michael W Sill
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Lari B Wenzel
- University of California Irvine School of Medicine, Irvine, California, USA
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13
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Richardson DL, Sill MW, Coleman RL, Sood AK, Pearl ML, Kehoe SM, Carney ME, Hanjani P, Van Le L, Zhou XC, Alvarez Secord A, Gray HJ, Landrum LM, Lankes HA, Hu W, Aghajanian C. Paclitaxel With and Without Pazopanib for Persistent or Recurrent Ovarian Cancer: A Randomized Clinical Trial. JAMA Oncol 2019; 4:196-202. [PMID: 29242937 DOI: 10.1001/jamaoncol.2017.4218] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Ovarian cancer is the leading cause of gynecologic cancer deaths in the United States. Pazopanib is an oral, multitarget kinase inhibitor of vascular endothelial growth factor receptors 1, 2, and 3; platelet-derived growth factor receptors α and β; and proto-oncogene receptor tyrosine kinase (c-KIT). Objective To estimate the progression-free survival (PFS) hazard ratio (HR) of weekly paclitaxel and pazopanib compared with weekly paclitaxel and placebo in women with recurrent ovarian cancer. Secondary objectives included frequency and severity of adverse events, proportion responding, and overall survival (OS) in each arm. Translational research objectives included exploring the association between possible biomarkers and single-nucleotide polymorphisms in vascular endothelial growth factor A, interleukin 8, and hypoxia-inducible factor 1α; and PFS, OS, and proportion responding. Design, Setting, and Participants A randomized, placebo-controlled, double-blind phase 2 study was conducted at 26 participating institutions. Patients were enrolled between December 12, 2011, and April 22, 2013. Data were frozen on August 11, 2014. Participants were patients with persistent or recurrent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma with 1 to 3 prior regimens and performance status of 0 to 2. One hundred six patients enrolled; 100 were evaluable for toxic effects. Interventions All patients received paclitaxel 80 mg/m2 intravenously on days 1, 8, and 15 every 28 days and were randomized 1:1 to pazopanib 800 mg orally daily or placebo. Main Outcomes and Measures The primary end point was PFS. The study was designed to detect a 37.5% reduction in the hazard with 80% power (α = 10%). Results A total of 106 women (median age [range], 61 [35-87] years; 88 [83%] white) were enrolled. Study arms were well balanced for age, performance status, measurable disease, and prior bevacizumab. Proportion responding was 14 of 44 (31.8%) vs 10 of 44 (22.7%) for pazopanib plus paclitaxel vs paclitaxel alone. Median PFS was 7.5 vs 6.2 months for pazopanib plus paclitaxel vs paclitaxel alone, respectively (HR, 0.84; 90% CI, 0.57-1.22; P = .20). Median OS was 20.7 vs 23.3 months for pazopanib plus paclitaxel vs paclitaxel alone (HR, 1.04; 90% CI, 0.60-1.79; P = .90). Severe hypertension was more common on the pazopanib plus paclitaxel arm (relative risk, 12.0; 95% CI, 1.62-88.84). More patients discontinued treatment on the paclitaxel arm for disease progression (34 of 52 [65.4%] vs 17 of 54 [31.5%]), and more on the pazopanib plus paclitaxel arm for adverse events (20 of 54 [37%] vs 5 of 52 [9.6%]). No association was found between single-nucleotide polymorphisms (interleukin 8 and hypoxia-inducible factor 1α) and OS and proportion responding. Patients with VEGFA CC genotype may be more resistant to weekly paclitaxel than those with the AC or AA genotype, with 1 of 14 (7%), 3 of 15 (20%), and 4 of 8 (50%) responding, respectively. Conclusions and Relevance The combination of pazopanib plus paclitaxel is not superior to paclitaxel in women with recurrent ovarian cancer. Trial Registration clinicaltrials.gov Identifier: NCT01468909.
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Affiliation(s)
- Debra L Richardson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Michael W Sill
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Anil K Sood
- University of Texas, MD Anderson Cancer Center, Houston
| | - Michael L Pearl
- Division of Gynecological Oncology, Stony Brook University Hospital, Health Sciences Center T9, Stony Brook, New York
| | - Siobhan M Kehoe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | | | - Parviz Hanjani
- Hanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington, Pennsylvania
| | - Linda Van Le
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Xun C Zhou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Hospital of Central Connecticut, New Britain
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Heidi J Gray
- University of Washington Medical Center, Seattle
| | - Lisa M Landrum
- Department of Obstetrics and Gynecology, Oklahoma University Health Science Center, Oklahoma City
| | - Heather A Lankes
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, New York
| | - Wei Hu
- University of Texas, MD Anderson Cancer Center, Houston
| | - Carol Aghajanian
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
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14
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Richardson DL, Sill MW, Coleman RL, Sood AK, Pearl ML, Kehoe SM, Carney ME, Hanjani P, Van Le L, Zhou XC, Alvarez Secord A, Gray HJ, Landrum LM, Lankes HA, Hu W, Aghajanian C. Paclitaxel With and Without Pazopanib for Persistent or Recurrent Ovarian Cancer: A Randomized Clinical Trial. JAMA Oncol 2018. [PMID: 29242937 DOI: 10.1001/jamaoncol.2017.4218] [] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Ovarian cancer is the leading cause of gynecologic cancer deaths in the United States. Pazopanib is an oral, multitarget kinase inhibitor of vascular endothelial growth factor receptors 1, 2, and 3; platelet-derived growth factor receptors α and β; and proto-oncogene receptor tyrosine kinase (c-KIT). Objective To estimate the progression-free survival (PFS) hazard ratio (HR) of weekly paclitaxel and pazopanib compared with weekly paclitaxel and placebo in women with recurrent ovarian cancer. Secondary objectives included frequency and severity of adverse events, proportion responding, and overall survival (OS) in each arm. Translational research objectives included exploring the association between possible biomarkers and single-nucleotide polymorphisms in vascular endothelial growth factor A, interleukin 8, and hypoxia-inducible factor 1α; and PFS, OS, and proportion responding. Design, Setting, and Participants A randomized, placebo-controlled, double-blind phase 2 study was conducted at 26 participating institutions. Patients were enrolled between December 12, 2011, and April 22, 2013. Data were frozen on August 11, 2014. Participants were patients with persistent or recurrent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma with 1 to 3 prior regimens and performance status of 0 to 2. One hundred six patients enrolled; 100 were evaluable for toxic effects. Interventions All patients received paclitaxel 80 mg/m2 intravenously on days 1, 8, and 15 every 28 days and were randomized 1:1 to pazopanib 800 mg orally daily or placebo. Main Outcomes and Measures The primary end point was PFS. The study was designed to detect a 37.5% reduction in the hazard with 80% power (α = 10%). Results A total of 106 women (median age [range], 61 [35-87] years; 88 [83%] white) were enrolled. Study arms were well balanced for age, performance status, measurable disease, and prior bevacizumab. Proportion responding was 14 of 44 (31.8%) vs 10 of 44 (22.7%) for pazopanib plus paclitaxel vs paclitaxel alone. Median PFS was 7.5 vs 6.2 months for pazopanib plus paclitaxel vs paclitaxel alone, respectively (HR, 0.84; 90% CI, 0.57-1.22; P = .20). Median OS was 20.7 vs 23.3 months for pazopanib plus paclitaxel vs paclitaxel alone (HR, 1.04; 90% CI, 0.60-1.79; P = .90). Severe hypertension was more common on the pazopanib plus paclitaxel arm (relative risk, 12.0; 95% CI, 1.62-88.84). More patients discontinued treatment on the paclitaxel arm for disease progression (34 of 52 [65.4%] vs 17 of 54 [31.5%]), and more on the pazopanib plus paclitaxel arm for adverse events (20 of 54 [37%] vs 5 of 52 [9.6%]). No association was found between single-nucleotide polymorphisms (interleukin 8 and hypoxia-inducible factor 1α) and OS and proportion responding. Patients with VEGFA CC genotype may be more resistant to weekly paclitaxel than those with the AC or AA genotype, with 1 of 14 (7%), 3 of 15 (20%), and 4 of 8 (50%) responding, respectively. Conclusions and Relevance The combination of pazopanib plus paclitaxel is not superior to paclitaxel in women with recurrent ovarian cancer. Trial Registration clinicaltrials.gov Identifier: NCT01468909.
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Affiliation(s)
- Debra L Richardson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Michael W Sill
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Anil K Sood
- University of Texas, MD Anderson Cancer Center, Houston
| | - Michael L Pearl
- Division of Gynecological Oncology, Stony Brook University Hospital, Health Sciences Center T9, Stony Brook, New York
| | - Siobhan M Kehoe
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | | | - Parviz Hanjani
- Hanjani Institute for Gynecologic Oncology, Abington Memorial Hospital, Abington, Pennsylvania
| | - Linda Van Le
- Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Xun C Zhou
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Hospital of Central Connecticut, New Britain
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Heidi J Gray
- University of Washington Medical Center, Seattle
| | - Lisa M Landrum
- Department of Obstetrics and Gynecology, Oklahoma University Health Science Center, Oklahoma City
| | - Heather A Lankes
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, New York
| | - Wei Hu
- University of Texas, MD Anderson Cancer Center, Houston
| | - Carol Aghajanian
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
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15
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Cosgrove CM, Tritchler DL, Cohn DE, Mutch DG, Rush CM, Lankes HA, Creasman WT, Miller DS, Ramirez NC, Geller MA, Powell MA, Backes FJ, Landrum LM, Timmers C, Suarez AA, Zaino RJ, Pearl ML, DiSilvestro PA, Lele SB, Goodfellow PJ. An NRG Oncology/GOG study of molecular classification for risk prediction in endometrioid endometrial cancer. Gynecol Oncol 2018; 148:174-180. [PMID: 29132872 PMCID: PMC5756518 DOI: 10.1016/j.ygyno.2017.10.037] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/24/2017] [Accepted: 10/27/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the prognostic significance of a simplified, clinically accessible classification system for endometrioid endometrial cancers combining Lynch syndrome screening and molecular risk stratification. METHODS Tumors from NRG/GOG GOG210 were evaluated for mismatch repair defects (MSI, MMR IHC, and MLH1 methylation), POLE mutations, and loss of heterozygosity. TP53 was evaluated in a subset of cases. Tumors were assigned to four molecular classes. Relationships between molecular classes and clinicopathologic variables were assessed using contingency tests and Cox proportional methods. RESULTS Molecular classification was successful for 982 tumors. Based on the NCI consensus MSI panel assessing MSI and loss of heterozygosity combined with POLE testing, 49% of tumors were classified copy number stable (CNS), 39% MMR deficient, 8% copy number altered (CNA) and 4% POLE mutant. Cancer-specific mortality occurred in 5% of patients with CNS tumors; 2.6% with POLE tumors; 7.6% with MMR deficient tumors and 19% with CNA tumors. The CNA group had worse progression-free (HR 2.31, 95%CI 1.53-3.49) and cancer-specific survival (HR 3.95; 95%CI 2.10-7.44). The POLE group had improved outcomes, but the differences were not statistically significant. CNA class remained significant for cancer-specific survival (HR 2.11; 95%CI 1.04-4.26) in multivariable analysis. The CNA molecular class was associated with TP53 mutation and expression status. CONCLUSIONS A simple molecular classification for endometrioid endometrial cancers that can be easily combined with Lynch syndrome screening provides important prognostic information. These findings support prospective clinical validation and further studies on the predictive value of a simplified molecular classification system.
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Affiliation(s)
| | - David L Tritchler
- NRG Oncology Statistics and Data Management Center, Buffalo, NY, United States
| | - David E Cohn
- The Ohio State University, Columbus, OH, United States
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, United States
| | - Craig M Rush
- The Ohio State University, Columbus, OH, United States
| | - Heather A Lankes
- Gynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - William T Creasman
- Department of Obstetrics & Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - David S Miller
- Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nilsa C Ramirez
- Gynecologic Oncology Group Tissue Bank, Biopathology Center, Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Matthew A Powell
- Washington University School of Medicine, St. Louis, MO, United States
| | | | - Lisa M Landrum
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | | | - Richard J Zaino
- Anatomic Pathology, Penn State Milton S. Hersey Medical Center, Hershey, PA, United States
| | - Michael L Pearl
- Stony Brook University Hospital, Stony Brook, NY, United States
| | - Paul A DiSilvestro
- Women and Infants Hospital of Rhode Island, Providence, RI, United States
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16
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Tewari KS, Sill MW, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, DiSaia PJ, Copeland LJ, Creasman WT, Stehman FB, Brady MF, Burger RA, Thigpen JT, Birrer MJ, Waggoner SE, Moore DH, Look KY, Koh WJ, Monk BJ. Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240). Lancet 2017; 390:1654-1663. [PMID: 28756902 PMCID: PMC5714293 DOI: 10.1016/s0140-6736(17)31607-0] [Citation(s) in RCA: 349] [Impact Index Per Article: 49.9] [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: 04/02/2017] [Revised: 05/15/2017] [Accepted: 05/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND On Aug 14, 2014, the US Food and Drug Administration approved the antiangiogenesis drug bevacizumab for women with advanced cervical cancer on the basis of improved overall survival (OS) after the second interim analysis (in 2012) of 271 deaths in the Gynecologic Oncology Group (GOG) 240 trial. In this study, we report the prespecified final analysis of the primary objectives, OS and adverse events. METHODS In this randomised, controlled, open-label, phase 3 trial, we recruited patients with metastatic, persistent, or recurrent cervical carcinoma from 81 centres in the USA, Canada, and Spain. Inclusion criteria included a GOG performance status score of 0 or 1; adequate renal, hepatic, and bone marrow function; adequately anticoagulated thromboembolism; a urine protein to creatinine ratio of less than 1; and measurable disease. Patients who had received chemotherapy for recurrence and those with non-healing wounds or active bleeding conditions were ineligible. We randomly allocated patients 1:1:1:1 (blocking used; block size of four) to intravenous chemotherapy of either cisplatin (50 mg/m2 on day 1 or 2) plus paclitaxel (135 mg/m2 or 175 mg/m2 on day 1) or topotecan (0·75 mg/m2 on days 1-3) plus paclitaxel (175 mg/m2 on day 1) with or without intravenous bevacizumab (15 mg/kg on day 1) in 21 day cycles until disease progression, unacceptable toxic effects, voluntary withdrawal by the patient, or complete response. We stratified randomisation by GOG performance status (0 vs 1), previous radiosensitising platinum-based chemotherapy, and disease status (recurrent or persistent vs metastatic). We gave treatment open label. Primary outcomes were OS (analysed in the intention-to-treat population) and adverse events (analysed in all patients who received treatment and submitted adverse event information), assessed at the second interim and final analysis by the masked Data and Safety Monitoring Board. The cutoff for final analysis was 450 patients with 346 deaths. This trial is registered with ClinicalTrials.gov, number NCT00803062. FINDINGS Between April 6, 2009, and Jan 3, 2012, we enrolled 452 patients (225 [50%] in the two chemotherapy-alone groups and 227 [50%] in the two chemotherapy plus bevacizumab groups). By March 7, 2014, 348 deaths had occurred, meeting the prespecified cutoff for final analysis. The chemotherapy plus bevacizumab groups continued to show significant improvement in OS compared with the chemotherapy-alone groups: 16·8 months in the chemotherapy plus bevacizumab groups versus 13·3 months in the chemotherapy-alone groups (hazard ratio 0·77 [95% CI 0·62-0·95]; p=0·007). Final OS among patients not receiving previous pelvic radiotherapy was 24·5 months versus 16·8 months (0·64 [0·37-1·10]; p=0·11). Postprogression OS was not significantly different between the chemotherapy plus bevacizumab groups (8·4 months) and chemotherapy-alone groups (7·1 months; 0·83 [0·66-1·05]; p=0·06). Fistula (any grade) occurred in 32 (15%) of 220 patients in the chemotherapy plus bevacizumab groups (all previously irradiated) versus three (1%) of 220 in the chemotherapy-alone groups (all previously irradiated). Grade 3 fistula developed in 13 (6%) versus one (<1%). No fistulas resulted in surgical emergencies, sepsis, or death. INTERPRETATION The benefit conferred by incorporation of bevacizumab is sustained with extended follow-up as evidenced by the overall survival curves remaining separated. After progression while receiving bevacizumab, we did not observe a negative rebound effect (ie, shorter survival after bevacizumab is stopped than after chemotherapy alone is stopped). These findings represent proof-of-concept of the efficacy and tolerability of antiangiogenesis therapy in advanced cervical cancer. FUNDING National Cancer Institute.
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Affiliation(s)
- Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
| | - Michael W Sill
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Helen Huang
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | | | - Lisa M Landrum
- Division of Gynecologic Oncology, University of Oklahoma, Oklahoma City, OK, USA
| | - Ana Oaknin
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - Thomas J Reid
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Women's Cancer Center at Kettering, Cincinnati, OH, USA
| | - Mario M Leitao
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Helen E Michael
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Philip J DiSaia
- Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA
| | | | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | | | - Mark F Brady
- Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA
| | - Robert A Burger
- Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - J Tate Thigpen
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Steven E Waggoner
- Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Wui-Jin Koh
- Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Creighton University School of Medicine at St Joseph's Hospital, Phoenix, AZ, USA
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17
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von Gruenigen VE, Huang HQ, Beumer JH, Lankes HA, Tew W, Herzog T, Hurria A, Mannel RS, Rizack T, Landrum LM, Rose PG, Salani R, Bradley WH, Rutherford TJ, Higgins RV, Secord AA, Fleming G. Chemotherapy completion in elderly women with ovarian, primary peritoneal or fallopian tube cancer - An NRG oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 144:459-467. [PMID: 28089376 DOI: 10.1016/j.ygyno.2016.11.033] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 09/18/2016] [Revised: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE A simple measure to predict chemotherapy tolerance in elderly patients would be useful. We prospectively tested the association of baseline Instrumental Activities of Daily Living (IADL) score with ability to complete 4 cycles of first line chemotherapy without dose reductions or >7days delay in elderly ovarian cancer patients. PATIENTS AND METHODS Patients' age ≥70 along with their physicians chose between two regimens: CP (Carboplatin AUC 5, Paclitaxel 135mg/m2) or C (Carboplatin AUC 5), both given every 3weeks either after primary surgery or as neoadjuvant chemotherapy (NACT) with IADL and quality of life assessments performed at baseline, pre-cycle 3, and post-cycle 4. RESULTS Two-hundred-twelve women were enrolled, 152 selecting CP and 60 selecting C. Those who selected CP had higher baseline IADL scores (p<0.001). After adjusting for age and PS, baseline IADL was independently associated with the choice of regimen (p=0.035). The baseline IADL score was not found to be associated with completion of 4 cycles of chemotherapy without dose reduction or delays (p=0.21), but was associated with completion of 4 cycles of chemotherapy regardless of dose reduction and delay (p=0.008) and toxicity, with the odds ratio (OR) of grade 3+ toxicity decreasing 17% (OR: 0.83; 95%CI: 0.72-0.96; p=0.013) for each additional activity in which the patient was independent. After adjustment for chemotherapy regimen, IADL was also associated with overall survival (p=0.019) for patients receiving CP. CONCLUSION Patients with a higher baseline IADL score (more independent) were more likely to complete 4 cycles of chemotherapy and less likely to experience grade 3 or higher toxicity.
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Affiliation(s)
- Vivian E von Gruenigen
- Division of Gynecologic Oncology, Summa Akron City Hospital, NEOMED, Akron, OH 44304, United States.
| | - Helen Q Huang
- NRG Oncology Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Jan H Beumer
- Cancer Therapeutics Program, University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA 15213, United States; Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15213, United States; Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
| | - Heather A Lankes
- NRG Oncology Statistics & Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - William Tew
- Memorial Sloan Kettering Cancer Center, Department of Medicine, Gynecologic Medical Oncology Service, New York, NY 10065, United States.
| | - Thomas Herzog
- Department of Obstetrics and Gynecology, Columbia University Cancer Center, New York NY, 10032, United States.
| | - Arti Hurria
- Department of Obstetrics and Gynecology, Columbia University Cancer Center, New York NY, 10032, United States.
| | - Robert S Mannel
- Division of Obstetrics & Gynecology, The Peggy and Charles Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.
| | - Tina Rizack
- Dept. of Gynecologic Oncology, Women & Infants Hospital, Alpert Medical School of Brown University, Providence, RI 02905, United States.
| | - Lisa M Landrum
- Division of Obstetrics & Gynecology, The Peggy and Charles Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.
| | - Peter G Rose
- Dept. of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44109, United States
| | - Ritu Salani
- Dept. of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States.
| | - William H Bradley
- Dept. of OB/GYN, Medical College of Wisconsin, Milwaukee, WI 53226, United States.
| | - Thomas J Rutherford
- Dept. of OB/GYN, Western Connecticut Health Network, Norwalk, CT 06856, United States.
| | - Robert V Higgins
- Dept. of Gynecologic Oncology, Carolinas Medical Center, Blumenthal Cancer Center, Charlotte, NC 28203, United States.
| | - Angeles Alvarez Secord
- Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC 27710, United States; Dept. of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, United States.
| | - Gini Fleming
- Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL 60637, United States.
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18
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Tewari KS, Sill MW, Monk BJ, Penson RT, Long HJ, Poveda A, Landrum LM, Leitao MM, Brown J, Reid TJA, Michael HE, Moore DH. Prospective Validation of Pooled Prognostic Factors in Women with Advanced Cervical Cancer Treated with Chemotherapy with/without Bevacizumab: NRG Oncology/GOG Study. Clin Cancer Res 2016; 21:5480-7. [PMID: 26672085 DOI: 10.1158/1078-0432.ccr-15-1346] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE In the randomized phase III trial, Gynecologic Oncology Group (GOG) protocol 240, the incorporation of bevacizumab with chemotherapy significantly increased overall survival (OS) in women with advanced cervical cancer. A major objective of GOG-240 was to prospectively analyze previously identified pooled clinical prognostic factors known as the Moore criteria. EXPERIMENTAL DESIGN Potential negative factors included black race, performance status 1, pelvic disease, prior cisplatin, and progression-free interval <365 days. Risk categories included low-risk (0-1 factor), mid-risk (2-3 factors), and high-risk (4-5 factors). Each test of association was conducted at the 5% level of significance. Logistic regression and survival analysis was used to determine whether factors were prognostic or could be used to guide therapy. RESULTS For the entire population (n = 452), high-risk patients had significantly worse OS (P < 0.0001). The HRs of death for treating with topotecan in low-risk, mid-risk, and high-risk subsets are 1.18 [95% confidence interval (CI), 0.63-2.24], 1.11 (95% CI, 0.82-1.5), and 0.84 (95% CI, 0.50-1.42), respectively. The HRs of death for treating with bevacizumab in low-risk, mid-risk, and high-risk subsets are 0.96 (95% CI, 0.51-1.83; P = 0.9087), 0.673 (95% CI, 0.5-0.91; P = 0.0094), and 0.536 (95% CI, 0.32-0.905; P = 0.0196), respectively. CONCLUSIONS This is the first prospectively validated scoring system in cervical cancer. The Moore criteria have real-world clinical applicability. Toxicity concerns may justify omission of bevacizumab in some low-risk patients where survival benefit is small. The benefit to receiving bevacizumab appears to be greatest in the moderate- and high-risk subgroups (5.8-month increase in median OS). Clin Cancer Res; 21(24); 5480-7. ©2015 AACR.
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Affiliation(s)
| | - Michael W Sill
- NRG Oncology/GOG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, Buffalo, New York
| | - Bradley J Monk
- Creighton University at St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | | | - Andrés Poveda
- Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Lisa M Landrum
- Oklahoma University Health Science Center, Oklahoma, Oklahoma
| | - Mario M Leitao
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jubilee Brown
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas J A Reid
- University of Cincinnati/Women's Cancer Center at Kettering, Kettering, Ohio
| | - Helen E Michael
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David H Moore
- Franciscan St. Francis Health, Indianapolis, Indiana
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19
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McMeekin DS, Tritchler DL, Cohn DE, Mutch DG, Lankes HA, Geller MA, Powell MA, Backes FJ, Landrum LM, Zaino R, Broaddus RD, Ramirez N, Gao F, Ali S, Darcy KM, Pearl ML, DiSilvestro PA, Lele SB, Goodfellow PJ. Clinicopathologic Significance of Mismatch Repair Defects in Endometrial Cancer: An NRG Oncology/Gynecologic Oncology Group Study. J Clin Oncol 2016; 34:3062-8. [PMID: 27325856 DOI: 10.1200/jco.2016.67.8722] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The clinicopathologic significance of mismatch repair (MMR) defects in endometrioid endometrial cancer (EEC) has not been definitively established. We undertook tumor typing to classify MMR defects to determine if MMR status is prognostic or predictive. METHODS Primary EECs from NRG/GOG0210 patients were assessed for microsatellite instability (MSI), MLH1 methylation, and MMR protein expression. Each tumor was assigned to one of four MMR classes: normal, epigenetic defect, probable mutation (MMR defect not attributable to MLH1 methylation), or MSI-low. The relationships between MMR classes and clinicopathologic variables were assessed using contingency table tests and Cox proportional hazard models. RESULTS A total of 1,024 tumors were assigned to MMR classes. Epigenetic and probable mutations in MMR were significantly associated with higher grade and more frequent lymphovascular space invasion. Epigenetic defects were more common in patients with higher International Federation of Gynecology and Obstetrics stage. Overall, there were no differences in outcomes. Progression-free survival was, however, worse for women whose tumors had epigenetic MMR defects compared with the MMR normal group (hazard ratio, 1.37; P < .05; 95% CI, 1.00 to 1.86). An exploratory analysis of interaction between MMR status and adjuvant therapy showed a trend toward improved progression-free survival for probable MMR mutation cases. CONCLUSION MMR defects in EECs are associated with a number of well-established poor prognostic indicators. Women with tumors that had MMR defects were likely to have higher-grade cancers and more frequent lymphovascular space invasion. Surprisingly, outcomes in these patients were similar to patients with MMR normal tumors, suggesting that MMR defects may counteract the effects of negative prognostic factors. Altered immune surveillance of MMR-deficient tumors, and other host/tumor interactions, is likely to determine outcomes for patients with MMR-deficient tumors.
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Affiliation(s)
- D Scott McMeekin
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David L Tritchler
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David E Cohn
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - David G Mutch
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Heather A Lankes
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Melissa A Geller
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Matthew A Powell
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Floor J Backes
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Lisa M Landrum
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Richard Zaino
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Russell D Broaddus
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Nilsa Ramirez
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Feng Gao
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Shamshad Ali
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Kathleen M Darcy
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Michael L Pearl
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Paul A DiSilvestro
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Shashikant B Lele
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI
| | - Paul J Goodfellow
- D. Scott McMeekin and Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; David L. Tritchler, Heather A. Lankes, and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; David E. Cohn, Floor J. Backes, and Paul J. Goodfellow, The Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; David G. Mutch, Matthew A. Powell, and Feng Gao, Washington University School of Medicine, St. Louis, MO; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Richard Zaino, Penn State Milton S. Hersey Medical Center, Hershey, PA; Russell D. Broaddus, The University of Texas MD Anderson Cancer Center, Houston, TX; Kathleen M. Darcy, Women's Health Integrated Research Collective, Annandale, VA; and Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI.
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Abstract
Intravenous leiomyomatosis is a benign smooth muscle tumor which despite its histology can have devastating consequences. Furthermore, the clinical manifestations are variable and nonspecific, typically leading to delayed or missed diagnosis. Thus, it is critical for clinicians to be aware of this condition and have a high index of suspicion in a middle-aged woman with a history of uterine leiomyoma presenting with an inferior vena cava mass to enable early diagnosis and treatment. We report a case of a large intravenous leiomyoma which was initially considered to be a very large deep venous thrombosis; with thorough preoperative planning, it was successfully removed intact and in entirety with a single-stage operation.
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Affiliation(s)
- Camille C Gunderson
- University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology; Oklahoma City, OK, USA
| | - Blake Parsons
- University of Oklahoma Health Sciences Center, Department of Radiology; Oklahoma City, OK, USA
| | - Shyla Penaroza
- University of Oklahoma Health Sciences Center, Department of Radiology; Oklahoma City, OK, USA
| | - Marvin D Peyton
- University of Oklahoma Health Sciences Center, Department of Surgery, Section of Cardiothoracic Surgery; Oklahoma City, OK, USA
| | - Lisa M Landrum
- University of Oklahoma Health Sciences Center, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology; Oklahoma City, OK, USA
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21
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Goodfellow PJ, Billingsley CC, Lankes HA, Ali S, Cohn DE, Broaddus RJ, Ramirez N, Pritchard CC, Hampel H, Chassen AS, Simmons LV, Schmidt AP, Gao F, Brinton LA, Backes F, Landrum LM, Geller MA, DiSilvestro PA, Pearl ML, Lele SB, Powell MA, Zaino RJ, Mutch D. Combined Microsatellite Instability, MLH1 Methylation Analysis, and Immunohistochemistry for Lynch Syndrome Screening in Endometrial Cancers From GOG210: An NRG Oncology and Gynecologic Oncology Group Study. J Clin Oncol 2015; 33:4301-8. [PMID: 26552419 PMCID: PMC4678181 DOI: 10.1200/jco.2015.63.9518] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The best screening practice for Lynch syndrome (LS) in endometrial cancer (EC) remains unknown. We sought to determine whether tumor microsatellite instability (MSI) typing along with immunohistochemistry (IHC) and MLH1 methylation analysis can help identify women with LS. PATIENTS AND METHODS ECs from GOG210 patients were assessed for MSI, MLH1 methylation, and mismatch repair (MMR) protein expression. Each tumor was classified as having normal MMR, defective MMR associated with MLH1 methylation, or probable MMR mutation (ie, defective MMR but no methylation). Cancer family history and demographic and clinical features were compared for the three groups. Lynch mutation testing was performed for a subset of women. RESULTS Analysis of 1,002 ECs suggested possible MMR mutation in 11.8% of tumors. The number of patients with a family history suggestive of LS was highest among women whose tumors were classified as probable MMR mutation (P = .001). Lynch mutations were identified in 41% of patient cases classified as probable mutation (21 of 51 tested). One of the MSH6 Lynch mutations was identified in a patient whose tumor had intact MSH6 expression. Age at diagnosis was younger for mutation carriers than noncarriers (54.3 v 62.3 years; P < .01), with five carriers diagnosed at age > 60 years. CONCLUSION Combined MSI, methylation, and IHC analysis may prove useful in Lynch screening in EC. Twenty-four percent of mutation carriers presented with ECs at age > 60 years, and one carrier had an MSI-positive tumor with no IHC defect. Restricting Lynch testing to women diagnosed at age < 60 years or to women with IHC defects could result in missing a substantial fraction of genetic disease.
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Affiliation(s)
- Paul J Goodfellow
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Caroline C Billingsley
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Heather A Lankes
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shamshad Ali
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - David E Cohn
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Russell J Broaddus
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Nilsa Ramirez
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Colin C Pritchard
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Heather Hampel
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Alexis S Chassen
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Luke V Simmons
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Amy P Schmidt
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Feng Gao
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Louise A Brinton
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Floor Backes
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Lisa M Landrum
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Melissa A Geller
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Paul A DiSilvestro
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Michael L Pearl
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shashikant B Lele
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Matthew A Powell
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Richard J Zaino
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - David Mutch
- Paul J. Goodfellow, Caroline C. Billingsley, David E. Cohn, Heather Hampel, Alexis S. Chassen, Luke V. Simmons, and Floor Backes, Ohio State University; Nilsa Ramirez, Research Institute at Nationwide Children's Hospital, Columbus, OH; Heather A. Lankes and Shamshad Ali, NRG Oncology Statistics and Data Management Center; Shashikant B. Lele, Roswell Park Cancer Institute, Buffalo; Michael L. Pearl, Stony Brook University Hospital, Stony Brook, NY; Russell J. Broaddus, University of Texas MD Anderson Cancer Center, Houston, TX; Colin C. Pritchard, University of Washington, Seattle, WA; Amy P. Schmidt, Feng Gao, Matthew A. Powell, and David Mutch, Washington University School of Medicine, St Louis, MO; Louise A. Brinton, National Cancer Institute, Washington, DC; Lisa M. Landrum, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Melissa A. Geller, University of Minnesota, Minneapolis, MN; Paul A. DiSilvestro, Women and Infants Hospital of Rhode Island, Providence, RI; and Richard J. Zaino, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Landrum LM, Blank S, Chen LM, Duska L, Bae-Jump V, Lee PS, Levine L, McCourt C, Moore KN, Urban RR. Comprehensive care in gynecologic oncology: The importance of palliative care. Gynecol Oncol 2015; 137:193-202. [DOI: 10.1016/j.ygyno.2015.02.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
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Brooks SE, Carter RL, Plaxe SC, Basen-Engquist KM, Rodriguez M, Kauderer J, Walker JL, Myers TKN, Drake JG, Havrilesky LJ, Van Le L, Landrum LM, Brown CL. Patient and physician factors associated with participation in cervical and uterine cancer trials: an NRG/GOG247 study. Gynecol Oncol 2015; 138:101-8. [PMID: 25937529 DOI: 10.1016/j.ygyno.2015.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/25/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to identify patient and physician factors related to enrollment onto Gynecologic Oncology Group (GOG) trials. METHODS Prospective study of women with primary or recurrent cancer of the uterus or cervix treated at a GOG institution from July 2010 to January 2012. Logistic regression examined probability of availability, eligibility and enrollment in a GOG trial. Odds ratios (OR) and 95% confidence intervals (CI) for significant (p<0.05) results reported. RESULTS Sixty institutions, 781 patients, and 150 physicians participated, 300/780 (38%) had a trial available, 290/300 had known participation status. Of these, 150 women enrolled (59.5%), 102 eligible did not enroll (35%), 38 (13%) were ineligible. Ethnicity and specialty of physician, practice type, data management availability, and patient age were significantly associated with trial availability. Patients with >4 comorbidities (OR 4.5; CI 1.7-11.8) had higher odds of trial ineligibility. Non-White patients (OR 7.9; CI 1.3-46.2) and patients of Black physicians had greater odds of enrolling (OR 56.5; CI 1.1-999.9) in a therapeutic trial. Significant patient therapeutic trial enrollment factors: belief trial may help (OR 76.9; CI 4.9->1000), concern about care if not on trial (OR12.1; CI 2.1-71.4), pressure to enroll (OR .27; CI 0.12-.64), caregiving without pay (OR 0.13; CI .02-.84). Significant physician beliefs were: patients would not do well on standard therapy (OR 3.6; CI 1.6-8.4), and trial would not be time consuming (OR 3.3; CI 1.3-8.1). CONCLUSIONS Trial availability, patient and physician beliefs were factors identified that if modified could improve enrollment in cancer cooperative group clinical trials.
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Affiliation(s)
| | - Randy L Carter
- University at Buffalo, NY, United States; NRG Oncology Statistics and Data Management Center, United States; Roswell Park Cancer Institute, Buffalo, NY 14263, United States
| | - Steven C Plaxe
- Gynecologic Oncology, Rebecca and John Moores UCSD Cancer Center, La Jolla, CA 92093, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Michael Rodriguez
- Gynecologic Oncology, Northern Indiana Cancer Research Consortium, Memorial Hospital, Mishawaka, IN 46545, United States
| | - James Kauderer
- University at Buffalo, NY, United States; NRG Oncology Statistics and Data Management Center, United States; Roswell Park Cancer Institute, Buffalo, NY 14263, United States
| | - Joan L Walker
- Gynecologic Oncology, University of Oklahoma, Oklahoma City, OK 73104, United States
| | | | - Janet G Drake
- Gynecologic Oncology, Waukesha Memorial Hospital, Waukesha, WI 01199, United States
| | | | - Linda Van Le
- Gynecologic Oncology, University of Norton Carolina, Chapel Hill, NC 26588, United States
| | - Lisa M Landrum
- Gynecologic Oncology, University of Oklahoma, Oklahoma City, OK 73104, United States
| | - Carol L Brown
- Office of Diversity Programs in Clinical Care, Research and Training, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
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Penson RT, Huang HQ, Wenzel LB, Monk BJ, Stockman S, Long HJ, Ramondetta LM, Landrum LM, Oaknin A, Reid TJA, Leitao MM, Method M, Michael H, Tewari KS. Bevacizumab for advanced cervical cancer: patient-reported outcomes of a randomised, phase 3 trial (NRG Oncology-Gynecologic Oncology Group protocol 240). Lancet Oncol 2015; 16:301-11. [PMID: 25638326 DOI: 10.1016/s1470-2045(15)70004-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND GOG 240 was a practice-changing randomised phase 3 trial that concluded that chemotherapy plus bevacizumab for advanced cervical cancer significantly improves overall and progression-free survival, and the proportion of patients achieving an overall objective response, compared with chemotherapy alone. In this study, we aimed to analyse patient-reported outcomes in GOG 240. METHODS Eligible adult participants (aged ≥18 years) had primary stage IVB or recurrent or persistent carcinoma of the cervix with measurable disease and GOG performance status of 0-1. Participants were randomly assigned by web-based permuted block randomisation (block size 4) in a 1:1:1:1 ratio to the four treatment groups: cisplatin (50 mg/m(2) intravenously on day 1 or 2 of the treatment cycle) and paclitaxel (135 mg/m(2) intravenously over 24 h or 175 mg/m(2) intravenously over 3 h on day 1), with or without bevacizumab (15 mg/kg intravenously on day 1 or 2), or paclitaxel (175 mg/m(2) over 3 h on day 1) and topotecan (0·75 mg/m(2) for 30 min on days 1-3) with or without bevacizumab (15 mg/kg intravenously on day 1). Treatment assignment was concealed at randomisation (everyone was masked to treatment assignment, achieved by the use of a computer encrypted numbering system at the National Cancer Institute) and became open-label when each patient was registered to the trial. Treatment cycles were repeated every 21 days until disease progression or unacceptable toxicity, whichever occurred first. The coprimary endpoints of the trial were overall survival and safety; the primary quality-of-life endpoint was the score on the Functional Assessment of Cancer Therapy-Cervix Trial Outcome Index (FACT-Cx TOI). For our analysis of patient-reported outcomes, participants were assessed before treatment cycles 1, 2, and 5, and at 6 and 9 months after the start of cycle 1, with the FACT-Cx TOI, items from the FACT-GOG-Neurotoxicity subscale, and a worst pain item from the Brief Pain Inventory. All patients who completed baseline quality-of-life assessments and at least one further follow-up assessment were evaluable for quality-of-life outcomes. This study is registered with ClinicalTrials.gov, number NCT00803062. FINDINGS Between April 6, 2009, and Jan 3, 2012, a total of 452 patients were enrolled in the trial, of whom 390 completed baseline quality-of-life assessment and at least one further assessment and were therefore evaluable for quality-of-life outcomes. In these patients, patient-reported outcome completion declined from 426 (94%) of 452 (at baseline) to 193 (63%) of 307 (9 months post-cycle 1), but completion rates did not differ significantly between treatment regimens (p=0·78). The baseline FACT-Cx TOI scores did not differ significantly between patients who received bevacizumab versus those who did not (p=0·27). Compared with patients who received chemotherapy alone, patients who received chemotherapy plus bevacizumab reported FACT-Cx TOI scores that were an average of 1·2 points lower (98·75% CI -4·1 to 1·7; p=0·30). INTERPRETATION Improvements in overall survival and progression-free survival attributed to the incorporation of bevacizumab into the treatment of advanced cervical cancer were not accompanied by any significant deterioration in health-related quality of life. Patients responding to anti-angiogenesis therapy who maintain an acceptable quality of life could be suitable at progression for treatment with other novel therapies that might confer additional benefit. FUNDING National Institutes of Health.
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Affiliation(s)
- Richard T Penson
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Helen Q Huang
- NRG Oncology/Gynecologic Oncology Group, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Lari B Wenzel
- University of California, Irvine Medical Center, Orange, CA, USA
| | - Bradley J Monk
- University of Arizona Cancer Center and Creighton University at St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | | | - Lisa M Landrum
- Oklahoma University Health Science Center, Oklahoma City, OK, USA
| | - Ana Oaknin
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Thomas J A Reid
- University of Cincinnati College of Medicine/Women's Cancer Center at Kettering, Kettering, OH, USA
| | - Mario M Leitao
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Michael Method
- Michiana Hematology Oncology PC-Mishawaka, Mishawaka, IN, USA
| | - Helen Michael
- Indiana University School of Medicine, Indianapolis, IN, USA
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Miller DS, Blessing JA, Ramondetta LM, Pham HQ, Tewari KS, Landrum LM, Brown J, Mannel RS. Pemetrexed and cisplatin for the treatment of advanced, persistent, or recurrent carcinoma of the cervix: a limited access phase II trial of the gynecologic oncology group. J Clin Oncol 2014; 32:2744-9. [PMID: 25071133 DOI: 10.1200/jco.2013.54.7448] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To estimate the antitumor activity of pemetrexed and cisplatin with objective tumor response (partial and complete) in patients with advanced, persistent, or recurrent carcinoma of the cervix and to determine the nature and degree of toxicity of this regimen. Secondarily, this study will determine the effects of this regimen on progression-free survival and overall survival. PATIENTS AND METHODS Eligible, consenting patients received pemetrexed 500 mg/m(2) and cisplatin 50 mg/m(2) intravenously repeated every 21 days until disease progression or adverse events prohibited further therapy. Patients received no prior therapeutic chemotherapy, except when administered concurrently with primary radiation therapy. Subsequent doses were adjusted according to observed toxicity and protocol guidelines. Adverse events were assessed with Common Terminology Criteria for Adverse Events v 3.0. The primary measure of efficacy was tumor response according to Response Evaluation Criteria in Solid Tumors. The study was stratified by prior radiation therapy. RESULTS From September 2008 to November 2011, 55 patients were enrolled by five Gynecologic Oncology Group member institutions; of those, 54 patients were eligible and assessable. The regimen was well tolerated with 26% receiving more than nine cycles. The most common greater than grade 2 toxicities were neutropenia 35%, leukopenia 28%, and metabolic 28%. The overall response rate was 31% (one complete and 16 partial). The median progression-free survival was 5.7 months, and overall survival was 12.3 months. CONCLUSION Pemetrexed in combination with cisplatin demonstrates activity in the treatment of advanced, persistent, or recurrent carcinoma of the cervix.
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Affiliation(s)
- David Scott Miller
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK.
| | - John A Blessing
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Lois M Ramondetta
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Huyen Q Pham
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Krishnansu S Tewari
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Lisa M Landrum
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Jubilee Brown
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
| | - Robert S Mannel
- David Scott Miller, University of Texas Southwestern Medical Center, Dallas; Lois M. Ramondetta and Jubilee Brown, MD Anderson Cancer Center, Houston, TX; John A. Blessing, Roswell Park Cancer Institute, Buffalo, NY; Huyen Q. Pham, University of Southern California, Los Angeles; Krishnansu S. Tewari, University of California Medical Center at Irvine, Orange, CA; and Lisa M. Landrum and Robert S. Mannel, University of Oklahoma, Oklahoma City, OK
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Tewari KS, Sill MW, Long HJ, Penson RT, Huang H, Ramondetta LM, Landrum LM, Oaknin A, Reid TJ, Leitao MM, Michael HE, Monk BJ. Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med 2014; 370:734-43. [PMID: 24552320 PMCID: PMC4010094 DOI: 10.1056/nejmoa1309748] [Citation(s) in RCA: 911] [Impact Index Per Article: 91.1] [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: 12/12/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) promotes angiogenesis, a mediator of disease progression in cervical cancer. Bevacizumab, a humanized anti-VEGF monoclonal antibody, has single-agent activity in previously treated, recurrent disease. Most patients in whom recurrent cervical cancer develops have previously received cisplatin with radiation therapy, which reduces the effectiveness of cisplatin at the time of recurrence. We evaluated the effectiveness of bevacizumab and nonplatinum combination chemotherapy in patients with recurrent, persistent, or metastatic cervical cancer. METHODS Using a 2-by-2 factorial design, we randomly assigned 452 patients to chemotherapy with or without bevacizumab at a dose of 15 mg per kilogram of body weight. Chemotherapy consisted of cisplatin at a dose of 50 mg per square meter of body-surface area, plus paclitaxel at a dose of 135 or 175 mg per square meter or topotecan at a dose of 0.75 mg per square meter on days 1 to 3, plus paclitaxel at a dose of 175 mg per square meter on day 1. Cycles were repeated every 21 days until disease progression, the development of unacceptable toxic effects, or a complete response was documented. The primary end point was overall survival; a reduction of 30% in the hazard ratio for death was considered clinically important. RESULTS Groups were well balanced with respect to age, histologic findings, performance status, previous use or nonuse of a radiosensitizing platinum agent, and disease status. Topotecan-paclitaxel was not superior to cisplatin-paclitaxel (hazard ratio for death, 1.20). With the data for the two chemotherapy regimens combined, the addition of bevacizumab to chemotherapy was associated with increased overall survival (17.0 months vs. 13.3 months; hazard ratio for death, 0.71; 98% confidence interval, 0.54 to 0.95; P=0.004 in a one-sided test) and higher response rates (48% vs. 36%, P=0.008). Bevacizumab, as compared with chemotherapy alone, was associated with an increased incidence of hypertension of grade 2 or higher (25% vs. 2%), thromboembolic events of grade 3 or higher (8% vs. 1%), and gastrointestinal fistulas of grade 3 or higher (3% vs. 0%). CONCLUSIONS The addition of bevacizumab to combination chemotherapy in patients with recurrent, persistent, or metastatic cervical cancer was associated with an improvement of 3.7 months in median overall survival. (Funded by the National Cancer Institute; GOG 240 ClinicalTrials.gov number, NCT00803062.).
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Affiliation(s)
- Krishnansu S Tewari
- From the University of California, Irvine, Medical Center, Orange (K.S.T.); Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo (M.W.S., H.H.); Mayo Clinic, Rochester, MN (H.J.L.); Massachusetts General Hospital, Boston (R.T.P.); M.D. Anderson Cancer Center, Houston (L.M.R.); University of Oklahoma, Oklahoma City (L.M.L.); Vall d'Hebron University Hospital, Barcelona (A.O.); University of Cincinnati College of Medicine-Women's Cancer Center at Kettering, Kettering, OH (T.J.R.); Memorial Sloan-Kettering Cancer Center, New York (M.M.L.); Indiana University School of Medicine, Indianapolis (H.E.M.); and the University of Arizona Cancer Center and Creighton University at St. Joseph's Hospital and Medical Center, Phoenix (B.J.M.)
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Landrum LM, Nugent EK, Zuna RE, Syzek E, Mannel RS, Moore KN, Walker JL, McMeekin DS. Phase II trial of vaginal cuff brachytherapy followed by chemotherapy in early stage endometrial cancer patients with high-intermediate risk factors. Gynecol Oncol 2013; 132:50-4. [PMID: 24219982 DOI: 10.1016/j.ygyno.2013.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 09/26/2013] [Revised: 11/01/2013] [Accepted: 11/04/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the progression free survival (PFS), toxicity, and patterns of failure for early stage, high-intermediate risk (H-IR) patients in a phase II trial with adjuvant vaginal cuff brachytherapy (VCB) and three cycles of carboplatin and paclitaxel. METHODS Surgically staged patients with stage I-IIb endometrial cancer with H-IR factors were treated with VCB (2100cGy) followed by three cycles of carboplatin (AUC 6) and paclitaxel (175 mg/m(2)). The primary endpoint was PFS at 2 years, with toxicity and sites of failure as secondary endpoints. Toxicity was assessed by patient report (CTCAE v. 3) as well as by delays or dose modifications in treatment. RESULTS All patients completed VCB and 19/23 (83%) completed both VCB and 3 cycles of chemotherapy. Mean time to complete VCB was 14.5 days with minimal acute toxicity noted. At 6 months, all toxicity related to VCB had resolved. In total 60 cycles of chemotherapy were given, with one dose reduction (1.6%) for grade 2 neuropathy and seven delays (11.6%) in treatment due to hematologic toxicity. At a median follow-up of 44.5 months, 91% of patients remained progression free at 2 years. Four patients experienced a recurrence; they recurred both locally and distant. CONCLUSIONS Adjuvant therapy with VCB and chemotherapy is well tolerated in a population of patients with H-IR endometrial carcinoma and provides 2 year PFS of 91%. A randomized trial is currently underway to assess whether combined VCB and chemotherapy reduces the rate of recurrence compared to external beam radiation therapy (EBRT) in this patient population.
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Affiliation(s)
- Lisa M Landrum
- Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
| | - Elizabeth K Nugent
- Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Rosemary E Zuna
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Elizabeth Syzek
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Robert S Mannel
- Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Kathleen N Moore
- Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Joan L Walker
- Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - D Scott McMeekin
- Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Landrum LM, Java J, Mathews CA, Lanneau GS, Copeland LJ, Armstrong DK, Walker JL. Prognostic factors for stage III epithelial ovarian cancer treated with intraperitoneal chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol 2013; 130:12-8. [PMID: 23578540 DOI: 10.1016/j.ygyno.2013.04.001] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/27/2013] [Accepted: 04/01/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine prognostic factors for survival in ovarian cancer patients treated with intraperitoneal (IP) chemotherapy using ancillary data from cooperative group clinical trials. METHODS Data were collected from 428 patients with stage III ovarian cancer who underwent optimal surgical cytoreduction (<1 cm) followed by IP paclitaxel/platinum chemotherapy. Primary endpoints were progression free survival (PFS) and overall survival (OS). Potential prognostic variables were included in Cox proportional hazard regression models. Multivariate analysis was conducted to identify independent prognostic factors. RESULTS Median PFS was 24.9 months (95% CI, 23.0-29.2) and median OS was 61.8 months (95% CI, 55.5-69.8). Predictors for PFS were histology, surgical stage and residual disease. Age, histology, and residual disease were prognostic for OS. There were no differences in the hazard ratio for death or progression between patients with positive, negative, or unknown lymph node status. For patients receiving IP chemotherapy (n=428), 36% of patients had no residual disease with median PFS of 43.2 months (95% CI 32.5-60.4) and median OS of 110 months (95% CI, 60.0-161.3). CONCLUSIONS Age, histology, and extent of residual disease were predictors of OS in stage III patients treated with IP chemotherapy following optimal cytoreduction. Patients with no residual disease following primary surgery that are treated with adjuvant platinum based IP chemotherapy have survival measures that exceed any rates previously seen in this population.
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Affiliation(s)
- Lisa M Landrum
- University of Oklahoma Health Sciences Center, Section of GYN Oncology, Oklahoma City, OK 73104, USA.
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Mathews CA, Stoner JA, Wentzensen N, Moxley KM, Tenney ME, Tuller ER, Myers T, Landrum LM, Lanneau G, Zuna RE, Gold MA, Wang SS, Walker JL. Tubal ligation frequency in Oklahoma women with cervical cancer. Gynecol Oncol 2012; 127:278-82. [PMID: 22858904 DOI: 10.1016/j.ygyno.2012.07.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/07/2012] [Accepted: 07/24/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Infrequent Pap screening is an important risk factor for cervical cancer. We studied the association between contraceptive methods, screening frequency, and cancer. METHODS Women (n=2004) enrolled in the cross-sectional Study to Understand Cervical Cancer Endpoints and Determinants (SUCCEED) underwent colposcopy to evaluate an abnormal Pap test. Questionnaire data were compared between those with cervical intraepithelial neoplasia (CIN) 3/adenocarcinoma in situ (AIS) and those with invasive cancer to identify factors associated with cancer. Logistic regression was used to calculate age-stratified measures of association between contraceptive method and Pap frequency as well as tubal ligation (TL) and cancer risk. RESULTS In all age groups, women with TL were more likely to have had no Pap screening in the previous 5 years compared to women using other contraception: 26-35 years (OR 4.6, 95% CI 2.4-8.6; p<0.001), 36-45 years (OR 3.8, 95% CI 2.1-7.0; p<0.001), and 46-55 years (OR 2.2, 95% CI 1.0-4.9; p=0.050). Subjects with cancer (n=163) were more likely to have had a TL (41% vs. 21%, p<0.001) than those with CIN 3/AIS (n=370). Age-stratified analyses showed increased odds of tubal ligation in women with cancer versus those with CIN 3/AIS between 25 and 45 years, with a significant increase in women 26 to 35 years old (OR 3.3, 95% CI 1.4-8.1; p=0.009). Adjusting for Pap frequency changed the effect only slightly, suggesting that increased risk was not fully mediated by lack of screening. CONCLUSION Contraceptive type is associated with Pap screening. Women with TLs obtain less frequent Pap testing and may be at an increased risk for cervical cancer.
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Affiliation(s)
- Cara A Mathews
- Division of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Yang HP, Zuna RE, Schiffman M, Walker JL, Sherman ME, Landrum LM, Moxley K, Gold MA, Dunn ST, Allen RA, Zhang R, Long R, Wang SS, Wentzensen N. Clinical and pathological heterogeneity of cervical intraepithelial neoplasia grade 3. PLoS One 2012; 7:e29051. [PMID: 22253702 PMCID: PMC3258246 DOI: 10.1371/journal.pone.0029051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/18/2011] [Indexed: 11/18/2022] Open
Abstract
Objective Cervical intraepithelial neoplasia grade 3 (CIN3), the immediate cervical cancer precursor, is a target of cervical cancer prevention. However, less than half of CIN3s will progress to cancer. Routine treatment of all CIN3s and the majority of CIN2s may lead to overtreatment of many lesions that would not progress. To improve our understanding of CIN3 natural history, we performed a detailed characterization of CIN3 heterogeneity in a large referral population in the US. Methods We examined 309 CIN3 cases in the SUCCEED, a large population-based study of women with abnormal cervical cancer screening results. Histology information for 12 individual loop electrosurgical excision procedure (LEEP) segments was evaluated for each woman. We performed case-case comparisons of CIN3s to analyze determinants of heterogeneity and screening test performance. Results CIN3 cases varied substantially by size (1–10 LEEP segments) and by presentation with concomitant CIN2 and CIN1. All grades of CINs were equally distributed over the cervical surface. In half of the women, CIN3 lesions were found as multiple distinct lesions on the cervix. Women with large and solitary CIN3 lesions were more likely to be older, have longer sexual activity span, and have fewer multiple high risk HPV infections. Screening frequency, but not HPV16 positivity, was an important predictor of CIN3 size. Large CIN3 lesions were also characterized by high-grade clinical test results. Conclusions We demonstrate substantial heterogeneity in clinical and pathological presentation of CIN3 in a US population. Time since sexual debut and participation in screening were predictors of CIN3 size. We did not observe a preferential site of CIN3 on the cervical surface that could serve as a target for cervical biopsy. Cervical cancer screening procedures were more likely to detect larger CIN3s, suggesting that CIN3s detected by multiple independent diagnostic tests may represent cases with increased risk of invasion.
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Affiliation(s)
- Hannah P Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America.
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Nugent EK, Bishop EA, Mathews CA, Moxley KM, Tenney M, Mannel RS, Walker JL, Moore KN, Landrum LM, McMeekin DS. Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma? Gynecol Oncol 2011; 125:94-8. [PMID: 22155415 DOI: 10.1016/j.ygyno.2011.11.049] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 11/26/2011] [Accepted: 11/29/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Controversy continues over the importance of lymph node (LN) status in treating and predicting recurrence in endometrial cancer. Several predictive models are available which use uterine factors to stratify risk groups. Our objective was to determine how LN status affects recurrence and survival compared to uterine factors alone. METHODS A retrospective review was performed of patients undergoing complete surgical staging for clinical stage 1 endometrioid adenocarcinoma of the uterus. Patients were assessed based on PORTEC 1 high intermediate risk (H-IR) criteria (2 factors : age>60, grade 3, >50% DOI), GOG-99 H-IR criteria (age >70+1 factor, age 50-70+2 factors, any age +3 factors: grade 2 or 3, LVSI, >50% DOI), and PORTEC 2 criteria. Rates of nodal involvement, recurrence rates, PFS, and OS were compared. RESULTS We identified 352 clinical stage I patients with positive LN in 24% (87). 175 patients met PORTEC 1 eligibility and 66 met H-IR criteria. Rates of LN positivity were similar among groups (18.4% vs 19.7%, p=0.83) but recurrence rates were dissimilar (7.4% vs 27.3%, p=0.0004). Only 93 met PORTEC 2 criteria for treatment with no association between LN status, recurrence, and eligibility. 188 patients met H-IR eligibility criteria for GOG-99 with LN positive and recurrence rates higher in the H-IR group compared to GOG-99 eligible (34.6% vs 16.3%, p=0.0004, 28.3% vs. 10.6%, p=0.0002). CONCLUSIONS Patients with H-IR disease based on uterine characteristics alone have substantial risk of nodal involvement. Knowledge of LN status may better define risk, prognosis, and postoperative treatment.
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Affiliation(s)
- E K Nugent
- Department of Obstetrics and Gynecology, The University of Oklahoma Health Science Center, Oklahoma City, OK, USA.
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Landrum LM, McMeekin DS. Response to “Residual tumor after neoadjuvant chemotherapy and interval debulking for advanced endometrial cancer”. Gynecol Oncol 2009. [DOI: 10.1016/j.ygyno.2009.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moore KN, Frank SG, Alward EK, Landrum LM, Myers TK, Walker JL, Gold MA, McMeekin DS, Vesely SK, Mannel RS. Adjuvant chemotherapy for the “oldest old” ovarian cancer patients. Cancer 2009; 115:1472-80. [DOI: 10.1002/cncr.24190] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Landrum LM, Moore KN, Myers TK, Lanneau GS, McMeekin DS, Walker JL, Gold MA. Stage IVB endometrial cancer: Does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis. Gynecol Oncol 2009; 112:337-41. [DOI: 10.1016/j.ygyno.2008.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 09/29/2008] [Accepted: 10/08/2008] [Indexed: 11/24/2022]
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Landrum LM, Rutledge TL, Osunkoya AO, Mannel R. Uterine leiomyoma with associated pseudo-Meigs syndrome mimicking ovarian carcinoma. J Okla State Med Assoc 2008; 101:38-39. [PMID: 18361033] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Uterine leiomyoma are commonly diagnosed in women of reproductive age. However, these benign tumors may present with clinical signs and symptoms that are consistent with ovarian carcinoma. CASE A 47-year-old gravida 0 presented with a large pelvic mass, ascites, bilateral pleural effusions, and an elevated CA 125 worrisome for ovarian carcinoma. Exploratory laparotomy revealed a 20,120 g pelvic mass, with 2 L ascites, and pelvic and periaortic lymphadenopathy. Final pathology was consistent with a benign giant leiomyoma. Postoperative course was complicated by reaccumulation of pleural effusion requiring therapeutic thoracentesis and diuretics. Patient had return to full activity with 50 pound weight loss at 8 weeks after surgery. CONCLUSION Elevated CA 125 levels and ascites are often associated with ovarian carcinoma, but it is also important to keep benign processes in the differential diagnosis when considering malignancy.
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Affiliation(s)
- Lisa M Landrum
- Department of Obstetrics and Gynecology, 920 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
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Landrum LM, Skaggs V, Gould N, Walker JL, McMeekin DS. Comparison of outcome measures in patients with advanced squamous cell carcinoma of the vulva treated with surgery or primary chemoradiation. Gynecol Oncol 2007; 108:584-90. [PMID: 18155755 DOI: 10.1016/j.ygyno.2007.11.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 10/19/2007] [Accepted: 11/15/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review outcome measures including overall survival (OS), progression free survival (PFS), and patterns of recurrence in patients with advanced vulvar cancer managed by primary surgery (PS) or primary chemoradiation (PCRT) as well as population characteristics for the two groups. METHODS Patients diagnosed with stage III and IV squamous cell carcinoma of the vulva from 1990 to 2006 were identified for retrospective analysis at a single institution. Charts were abstracted for clinical and pathologic findings, treatment modalities, complications, recurrence, and follow-up. Kaplan-Meier method was used to determine PFS and OS. RESULTS Sixty-three patients with stage III (n=47) and IV (n=16) carcinoma of the vulva were identified; 30 patients were treated with PS, and 33 patients had tumor that was unresectable by vulvectomy and underwent PCRT. Patients treated with PCRT were younger (61 vs. 72 years; p=0.09), had less metastasis to lymph nodes (54% vs. 83%, p=0.01), and larger tumors (6 vs. 3.5 cm, p=0.0001) compared to patients treated with PS. Despite these differences, OS for the PS and PCRT groups was 69% and 76% (NS), respectively, with median follow-up at 31 months. There were no differences in PFS or recurrence rates between the two groups. By multivariate analysis, age was the only significant predictor of OS or PFS. CONCLUSIONS Patients with advanced vulvar cancer that are managed with PS tend to be older patients that have smaller lesions but positive lymph nodes, whereas patients requiring PCRT are younger and have larger volume disease but fewer lymph node metastases. Despite these differences, patients treated with PS and PCRT have no differences in OS, PFS, or recurrence rates. Age is the most powerful predictor of survival when size, lymph node status, stage and treatment are accounted for.
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Affiliation(s)
- Lisa M Landrum
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Oklahoma Health Sciences Center, PO Box 26901, Williams Pavilion 2410, Oklahoma City, OK 73190, USA.
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Landrum LM, Gold MA, Moore KN, Myers TKN, McMeekin DS, Walker JL. Intraperitoneal chemotherapy for patients with advanced epithelial ovarian cancer: a review of complications and completion rates. Gynecol Oncol 2007; 108:342-7. [PMID: 17988721 DOI: 10.1016/j.ygyno.2007.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 10/04/2007] [Accepted: 10/04/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Intraperitoneal (i.p.) chemotherapy has a clear survival advantage in patients with advanced ovarian cancer, but the high rate of complications has discouraged widespread acceptance. The purpose of this study was to review the completion rate of patients receiving i.p. chemotherapy as first line treatment at a single institution and determine what factors prohibit completion of therapy. METHODS Patients receiving i.p. chemotherapy from 1993 to 2006 were identified by hospital registries for a retrospective review. Charts were abstracted for patient demographics, clinical and pathologic findings, surgical intervention, treatment modalities, and toxicity. RESULTS Eighty-three patients were identified who received front line treatment with i.p. chemotherapy. All patients received a platinum and taxane agent. Port placement (single lumen, venous access device) was completed at time of cytoreductive surgery (33%, n=27) or by mini-laparotomy (67%, n=56). Fifty patients (60%) completed a minimum of 6 cycles of treatment with a mean of 5 cycles. Eleven patients (13%) discontinued treatment due to catheter-related complications including infection (n=4), access difficulties (n=3), grade 4 abdominal pain (n=1), port leaking (n=1), and development of a peritoneal-vaginal fistula (n=1). Sixteen patients (19%) did not complete i.p. treatment because of chemotherapy-related toxicity. The remaining six patients did not complete chemotherapy due to disease progression or other reasons unrelated to modality of treatment. CONCLUSIONS Few catheter-related complications were encountered in a review of front-line i.p. chemotherapy administration at a single institution using a single lumen venous access device. The majority of failures were due to persistent grade 3-4 chemotherapy toxicity. i.p. chemotherapy can be safely administered by a dedicated health-care team committed to i.p. chemotherapy as a front-line treatment.
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Affiliation(s)
- Lisa M Landrum
- Section of Gynecology Oncology, Department of Obstetrics & Gynecology, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP 2410, Oklahoma City, OK 73190, USA.
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Landrum LM, Lanneau GS, Skaggs VJ, Gould N, Walker JL, McMeekin DS, Gold MA. Gynecologic Oncology Group risk groups for vulvar carcinoma: Improvement in survival in the modern era. Gynecol Oncol 2007; 106:521-5. [PMID: 17540438 DOI: 10.1016/j.ygyno.2007.04.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 04/20/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with vulvar cancer were stratified into risk groups for survival based on surgicopathologic findings from a prospective study conducted by the Gynecologic Oncology Group from 1977-1984. The purpose of this study is to reassess these risk groups in patients treated in an era of contemporary management. METHODS Patients with vulvar carcinoma were identified from 1990-2005 for retrospective analysis. Charts were abstracted for clinical, histopathologic and surgical data, and patients stratified into four risk groups for survival based on the clinical size of tumor and extent of lymph node metastasis. Univariate and multivariate characteristics were evaluated and 5-year survival determined by Kaplan-Meier method. RESULTS 175 patients were identified that underwent surgical management with a median age at diagnosis of 59.9 years. Stage distribution included: I (n=89, 51%), II (n=53, 30%), III (n=29, 17%), and IV (n=4, 2%). Stratification into risk groups included: minimal (n=89, 51%), low (n=69, 40%), intermediate (n=11, 6%), and high (n=6; 3%). The survival rate was 100%, 97%, 82% and 100%, respectively, at median follow-up of 54.5 months. Comparatively, the survival rates for historic groups were 97.9%, 87.4%, 74.8% and 29.0%. Using multivariate analysis, age (p=0.04) and lymph node metastasis (p=0.009) were predictive of survival. CONCLUSIONS Survival among the minimal and low risk groups is preserved in spite of less radical surgery. 5-year survival rate for intermediate and high risk patients also appears to be improved. This is likely a result of advancement in adjuvant chemo-radiation and a younger patient population that presents with less advanced disease.
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Affiliation(s)
- Lisa M Landrum
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, Oklahoma University Health Sciences Center, PO Box 26901, WP2410, Oklahoma City, OK 73190, USA.
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Landrum LM, Hawkins A, Goodman JR. Pneumococcal meningitis during pregnancy: a case report and review of literature. Infect Dis Obstet Gynecol 2007; 2009:63624. [PMID: 17485820 PMCID: PMC1852901 DOI: 10.1155/2007/63624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 01/25/2007] [Indexed: 11/24/2022] Open
Abstract
Background. Bacterial meningitis is a medical emergency for which prompt diagnosis and treatment are imperative to reducing the rate of death and long-term neurologic compromise. Few cases of meningitis have been reported during pregnancy, many of which had devastating outcomes for mother, neonate, or both. Case. A 38-year-old multigravida at 35 weeks of gestation presented with mental status changes, fever, and preterm contractions. Lumbar puncture revealed gram positive cocci consistent with S. pneumoniae. Patient was intubated and admitted to ICU where she was given antibiotics and adjunctive therapy with dexamethasone. Continuous fetal monitoring was utilized throughout her course of her hospitalization. Patient was discharged home after ten days in the hospital and had an uncomplicated vaginal birth after caesarean section (VBAC) at 38 weeks. Both she and the infant are doing well with no permanent neurologic sequelae. Conclusion. A review of literature indicates only isolated cases of pneumococcal meningitis being described during pregnancy. An extended period of time between onset of maternal illness and delivery appears to reduce the risk of neonatal transmission and improve both maternal and fetal outcomes.
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Affiliation(s)
- Lisa M. Landrum
- Section of Maternal Fetal Medicine,
Department of Obstetrics and Gynecology,
Oklahoma University Health Sciences Center, Oklahoma City, OK 73190, USA
- *Lisa M. Landrum:
| | - Angela Hawkins
- Section of Maternal Fetal Medicine,
Department of Obstetrics and Gynecology,
Oklahoma University Health Sciences Center, Oklahoma City, OK 73190, USA
| | - Jean Ricci Goodman
- Section of Maternal Fetal Medicine,
Department of Obstetrics and Gynecology,
Oklahoma University Health Sciences Center, Oklahoma City, OK 73190, USA
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Landrum LM, Jones SL, Blair RW. The expression of Fos-labeled spinal neurons in response to colorectal distension is enhanced after chronic spinal cord transection in the rat. Neuroscience 2002; 110:569-78. [PMID: 11906794 DOI: 10.1016/s0306-4522(01)00548-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [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: 11/26/2022]
Abstract
The present study used Fos-like immunoreactivity to examine neuronal activation in response to colorectal distension in rats at 1 day or 30 days following spinal cord transection or sham transection. Fifty-five Wistar rats were anesthetized and an incision was made to expose the T(5) spinal segment. The dura was reflected away in all rats and a complete transection at the rostral end of the T(5) segment was given to the lesioned group. At 1 day (acute) or 30 days (chronic) post-surgery, conscious rats were subjected to a 2 h period of intermittent colorectal distension. Rats were perfused and spinal segments L(5)-S(2) were removed and processed for Fos-like immunoreactivity. Spinal cord transection alone had no effect on Fos-labeling in either acute or chronic rats. In acute rats, colorectal distension produced significant increases in Fos-labeling in the superficial and deep dorsal horn regions. In chronic rats, colorectal distension produced a three-fold increase in Fos-labeled neurons that was manifest throughout all laminar regions. These results indicate that the number of neurons expressing Fos in response to colorectal distension is much greater after a chronic spinal cord transection than after an acute transection. Since Fos is an indicator of neuronal activation, the results show that many more neurons become active in response to colorectal distension following a chronic spinal injury. This suggests that a functional reorganization of spinal circuits occurs following chronic spinal cord transection. This may ultimately result in altered visceral and somatic functions associated with spinal cord injury in humans.
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Affiliation(s)
- L M Landrum
- Department of Physiology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA
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Abstract
Quadriplegics often experience periods of severe hypertension known as autonomic dysreflexia. Clinically, these events have been well documented, but the mechanisms for mediating autonomic dysreflexia remain unclear. We used a chronic rat model to investigate the potential development of supersensitivity at postsynaptic alpha 1-adrenergic receptors as a contributing factor to the exaggerated sympathetic response characteristic of autonomic dysreflexia. Adult male Wistar and Sprague-Dawley rats were anesthetized and given spinal transection at T5. After 30 days, rats were reanesthetized and arterial and venous catheters implanted. Twenty-four hours later, colorectal distension (CRD) was used to evoke autonomic dysreflexia in conscious, spinalized rats. To gauge changes in alpha 1-receptor sensitivity, we assessed mean arterial pressure (MAP) in response to intravenous phenylephrine (PE) infusions. No consistent differences were observed between intact and spinalized rats. Therefore, supersensitivity of alpha 1-receptors cannot completely account for the hypertensive bouts associated with autonomic dysreflexia. In addition, while attempting to develop an appropriate model for autonomic dysreflexia, we discovered that spinalized Wistar rats exhibited MAP responses characteristic of autonomic dysreflexia, whereas lesioned Sprague-Dawley rats did not, when subjected to CRD. Thus Wistar rats provide a better animal model for autonomic dysreflexia.
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Affiliation(s)
- L M Landrum
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
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