1
|
Rana D, Westrop S, Jaiswal N, Germeni E, McGarty A, Ells L, Lally P, McEwan M, Melville C, Harris L, Wu O. Lifestyle modification interventions for adults with intellectual disabilities: systematic review and meta-analysis at intervention and component levels. J Intellect Disabil Res 2024; 68:387-445. [PMID: 38414293 DOI: 10.1111/jir.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adults with intellectual disabilities (IDs) are susceptible to multiple health risk behaviours such as alcohol consumption, smoking, low physical activity, sedentary behaviour and poor diet. Lifestyle modification interventions can prevent or reduce negative health consequences caused by these behaviours. We aim to determine the effectiveness of lifestyle modification interventions and their components in targeting health risk behaviours in adults with IDs. METHODS A systematic review and meta-analysis were conducted. Electronic databases, clinical trial registries, grey literature and citations of systematic reviews and included studies were searched in January 2021 (updated February 2022). Randomised controlled trials and non-randomised controlled trials targeting alcohol consumption, smoking, low physical activity, sedentary behaviours and poor diet in adults (aged ≥ 18 years) with ID were included. Meta-analysis was conducted at the intervention level (pairwise and network meta-analysis) and the component-level (component network meta-analysis). Studies were coded using Michie's 19-item theory coding scheme and 94-item behaviour change taxonomies. Risk of bias was assessed using the Cochrane Risk of Bias (ROB) Version 2 and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I). The study involved a patient and public involvement (PPI) group, including people with lived experience, who contributed extensively by shaping the methodology, providing valuable insights in interpreting results and organising of dissemination events. RESULTS Our literature search identified 12 180 articles, of which 80 studies with 4805 participants were included in the review. The complexity of lifestyle modification intervention was dismantled by identifying six core components that influenced outcomes. Interventions targeting single or multiple health risk behaviours could have a single or combination of multiple core-components. Interventions (2 RCTS; 4 non-RCTs; 228 participants) targeting alcohol consumption and smoking behaviour were effective but based on limited evidence. Similarly, interventions targeting low physical activity only (16 RCTs; 17 non-RCTs; 1413 participants) or multiple behaviours (low physical activity only, sedentary behaviours and poor diet) (17 RCTs; 24 non-RCTs; 3164 participants) yielded mixed effectiveness in outcomes. Most interventions targeting low physical activity only or multiple behaviours generated positive effects on various outcomes while some interventions led to no change or worsened outcomes, which could be attributed to the presence of a single core-component or a combination of similar core components in interventions. The intervention-level meta-analysis for weight management outcomes showed that none of the interventions were associated with a statistically significant change in outcomes when compared with treatment-as-usual and each other. Interventions with core-components combination of energy deficit diet, aerobic exercise and behaviour change techniques showed the highest weight loss [mean difference (MD) = -3.61, 95% credible interval (CrI) -9.68 to 1.95] and those with core-components combination dietary advice and aerobic exercise showed a weight gain (MD 0.94, 95% CrI -3.93 to 4.91). Similar findings were found with the component network meta-analysis for which additional components were identified. Most studies had a high and moderate risk of bias. Various theories and behaviour change techniques were used in intervention development and adaptation. CONCLUSION Our systematic review is the first to comprehensively explore lifestyle modification interventions targeting a range of single and multiple health risk behaviours in adults with ID, co-produced with people with lived experience. It has practical implications for future research as it highlights the importance of mixed-methods research in understanding lifestyle modification interventions and the need for population-specific improvements in the field (e.g., tailored interventions, development of evaluation instruments or tools, use of rigorous research methodologies and comprehensive reporting frameworks). Wide dissemination of related knowledge and the involvement of PPI groups, including people with lived experience, will help future researchers design interventions that consider the unique needs, desires and abilities of people with ID.
Collapse
Affiliation(s)
- D Rana
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Westrop
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jaiswal
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - E Germeni
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A McGarty
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
| | - P Lally
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Psychology, University of Surrey, Guildford, UK
| | - M McEwan
- People First (Scotland), Edinburgh, UK
| | - C Melville
- Mental Health and Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - L Harris
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - O Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
2
|
Westrop SC, Rana D, Jaiswal N, Wu O, McGarty AM, Melville C, Ells L, Lally P, McEwan M, Harris L, Germeni E. Supporting active engagement of adults with intellectual disabilities in lifestyle modification interventions: a realist evidence synthesis of what works, for whom, in what context and why. J Intellect Disabil Res 2024; 68:293-316. [PMID: 38379511 DOI: 10.1111/jir.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/10/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Lifestyle modification interventions for adults with intellectual disabilities have had, to date, mixed effectiveness. This study aimed to understand how lifestyle modification interventions for adults with intellectual disabilities work, for whom they work and in what circumstances. METHODS A realist evidence synthesis was conducted that incorporated input from adults with intellectual disabilities and expert researchers. Following the development of an initial programme theory based on key literature and input from people with lived experience and academics working in this field, five major databases (MEDLINE, EMBASE, CINAHL, PsycINFO and ASSIA) and clinical trial repositories were systematically searched. Data from 79 studies were synthesised to develop context, mechanism and outcome configurations (CMOCs). RESULTS The contexts and mechanisms identified related to the ability of adults with intellectual disabilities to actively take part in the intervention, which in turn contributes to what works, for whom and in what circumstances. The included CMOCs related to support involvement, negotiating the balance between autonomy and behaviour change, fostering social connectedness and fun, accessibility and suitability of intervention strategies and delivery and broader behavioural pathways to lifestyle change. It is also essential to work with people with lived experiences when developing and evaluating interventions. CONCLUSIONS Future lifestyle interventions research should be participatory in nature, and accessible data collection methods should also be explored as a way of including people with severe and profound intellectual disabilities in research. More emphasis should be given to the broader benefits of lifestyle change, such as opportunities for social interaction and connectedness.
Collapse
Affiliation(s)
- S C Westrop
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - D Rana
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jaiswal
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - O Wu
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - A M McGarty
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - C Melville
- Mental Health and Wellbeing, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - L Ells
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, UK
| | - P Lally
- UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Department of Psychology, University of Surrey, Guildford, UK
| | - M McEwan
- People First (Scotland), Edinburgh, UK
| | - L Harris
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - E Germeni
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
3
|
Abana CO, Palmiero AN, Liu K, Green MM, Li Z, Harris L, Mayor S, Samuel KQ, Younkin RA, Moore EJ, Norton W, Swain J, Fowlkes NW, Koong AC, Woodward WA, Taniguchi CM, Beddar S, Mitra D, Schueler E, Lin SH. Subacute Cutaneous Toxicity with Single-Fraction Electron FLASH RT in Yorkshire Swine. Int J Radiat Oncol Biol Phys 2023; 117:S10-S11. [PMID: 37784265 DOI: 10.1016/j.ijrobp.2023.06.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Information regarding acute/subacute skin toxicity of electron FLASH radiation therapy (RT) is limited. We evaluated short-term safety of electron FLASH for human trials by investigating subacute toxicity compared to conventional dose-rate RT (CONV) in the Yorkshire pig, an animal model known to closely approximate human skin and routinely used for toxicity studies. MATERIALS/METHODS Two healthy 50 kg pigs underwent CT imaging for RT treatment planning with field visualization via BBs and tattoos on each dorsolateral flank. Each target received a single fraction of 20, 25 or 30 Gy with FLASH and CONV on opposing sides delivered using a dedicated mobile linear accelerator. FLASH dose rates ranged from 164-245 Gy/sec (12 pulses delivered over 0.122 sec) while the CONV dose rate was set at 0.18 Gy/sec. Doses were verified using thermo- and optically stimulated luminescent dosimeters, and Gafchromic films. We obtained baseline and weekly images up to 98 days post-RT (D98) for blinded toxicity grading by 3 expert radiation oncologists using the modified RTOG radiation dermatitis (RD) scale. We measured erythema and pigmentation indices on those timepoints using a handheld spectrophotometer. We also obtained punch biopsies of targets and non-irradiated controls on D10 and D30 for RNA sequencing and two 6-marker multiplex immunofluorescence analyses of inflammation, immune response, and fibrosis. FLASH and CONV data were compared using repeated measures ANOVA and transcriptomic analyses using DESeq2. RESULTS All RT targets developed peak median grade 4 (ulceration, hemorrhage, or necrosis) RD by D84 regardless of FLASH or CONV delivery. However, FLASH targets developed peak RD later than CONV targets after 20 Gy (D84 vs D63), 25 Gy (D84 vs D49) and 30 Gy (D63 vs D42). FLASH induced qualitatively lower mean pigmentation and erythema indices than CONV for all 3 doses. Similarly, peak mean pigmentation indices occurred later with FLASH vs CONV for 20 Gy (D84 vs D63), 25 Gy (D84 vs D49) and 30 Gy (D77 vs D63). However, peak mean erythema indices occurred on the same day for FLASH and CONV (D63 for 20 Gy and D42 for 25 and 30 Gy). Transcriptomic analyses revealed significantly upregulated signals for wound healing (including TGF-beta, cell adhesion and extracellular matrix receptor interaction) and leukocyte infiltration with 20 Gy CONV mostly by D10, while FLASH upregulated those pathways only after 25 or 30 Gy, or by D30, or never at all. Preliminary immunofluorescence data showed FLASH may induce less T cell infiltrate and TGF-beta-expressing macrophages than CONV. CONCLUSION Single-fraction electron FLASH resulted in delayed onsets of both subacute cutaneous toxicity and wound healing with leukocytic infiltration signaling than dose-matched CONV based on both subjective and objective metrics of skin injury. Our findings suggest further investigations of optimal dose of electron FLASH for safe clinical translation is warranted, and we have a dose-finding study currently underway.
Collapse
Affiliation(s)
- C O Abana
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A N Palmiero
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K Liu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M M Green
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Z Li
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - L Harris
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Mayor
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K Q Samuel
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R A Younkin
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E J Moore
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - W Norton
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Swain
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - N W Fowlkes
- Department of Veterinary Medicine & Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - W A Woodward
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - C M Taniguchi
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Beddar
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Mitra
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E Schueler
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
4
|
Minasian LM, Pinsky P, Katki HA, Dickherber T, Han PKJ, Harris L, Patriotis C, Srivastava S, Weil CJ, Prorok PC, Castle PE. Study design considerations for trials to evaluate multicancer early detection assays for clinical utility. J Natl Cancer Inst 2023; 115:250-257. [PMID: 36458902 PMCID: PMC9996206 DOI: 10.1093/jnci/djac218] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 04/26/2022] [Revised: 09/08/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
Blood-based assays using various technologies and biomarkers are in commercial development for the purpose of detecting multiple cancer types concurrently at an early stage of disease. These multicancer early detection (MCED) assays have the potential to improve the detection of cancers, particularly those for which no current screening modality exists. However, the unknown clinical benefits and harms of using MCED assays for cancer screening necessitate the development and implementation of a randomized controlled trial (RCT) to ascertain their clinical effectiveness. This was the consensus of experts at a National Cancer Institute-hosted workshop to discuss initial design concepts for such a trial. Using these assays to screen simultaneously for multiple cancers poses novel uncertainties for patient care compared with conventional screening tests for single cancers, such as establishing the diagnostic workup to confirm the presence of cancer at any organ site; clarifying appropriate follow-up for a positive assay for which there is no definitive diagnosis; identifying potential harms such as overdiagnosis of indolent disease; determining clinically effective and efficient strategies for disseminating MCED screening in real-world practice; and understanding the ethical implications, such as potentially alleviating or exacerbating existing health disparities. These assays present new and complex challenges for designing an RCT. Issues that emerged from the meeting centered around the need for a flexibly designed, clinical utility RCT to rigorously capture the evidence required to fully understand the net benefit of this promising technology. Specific topic areas were endpoints, screening protocols, recruitment, diagnostic pathway, pilot phase, data elements, specimen collection, and ethical considerations.
Collapse
Affiliation(s)
- Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Paul Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, Biostatistics Branch, National Cancer Institute, Bethesda, MD, USA
| | - Tony Dickherber
- Center for Scientific Strategic Initiatives, National Cancer Institute, Bethesda, MD, USA
| | - Paul K J Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Lyndsay Harris
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Christos Patriotis
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Sudhir Srivastava
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Carol J Weil
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Philip C Prorok
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
5
|
Schoenfeld JD, Azad NS, Lee J, Gross J, Overman MJ, Kao K, Steinfeld A, Brunnquell D, Bu X, Guan P, Weirather JL, Pfaff KL, Ranasinghe S, Wang V, O'Dwyer PJ, Wu CJ, Rodig SJ, Patton DR, Harris L. Molecular predictors of response among patients with MMRd tumors treated on NCI-MATCH Arm Z1D. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2616 Background: On arm Z1D of the NCI-MATCH trial, the PD-1 inhibitor nivolumab was found to have activity among patients with mismatch repair-deficient (MMRd) tumors as defined by complete loss of MLH1 or MSH2 nuclear expression determined by immunohistochemistry, with 6-month progression free survival of 51%. We aimed to identify molecular predictors of response in this population. Methods: Among patients treated on NCI-MATCH Z1D, we evaluated genomic and tissue predictors of clinical benefit (CB), defined as patients with RECIST v1.1 complete or partial response or stable disease for ≥ 6months. WES files were processed and filtered using GATK best practices preceding TMB and MSI calculations according to MSI sensor score, a WES-based MSI rating system. Cutoffs were set to define TMB (TMB-Low: ≤10 mutation/Mb; TMB-High: >10) and MSI (MSS: ≤10% unstable loci; MSI-Low: 10 > x ≤ 20; MSI-High: >20). Multiplex immunofluorescence (mIF) used formalin-fixed paraffin-embedded slides stained using a BOND RX automated stainer. Expression analyses followed normalization in DEseq2's median of ratios method. Gene set enrichment analysis was conducted by “empirical phenotype-based permutation test.” Additional RNA, WES, and mIF comparisons used the Wilcoxon rank-sum test. Results: Among 36 patients accrued to NCI-MATCH Z1D with pretreatment correlative samples available, 7 were unevaluable for response, and 1 was misclassified as having an MMRd tumor. Of the remaining 28, 15 had CB (2 CR, 10 PR, 3 SD ≤ 6 months) and correlative data were available for 26 (WES), 27 (RNAseq), and between 10-20 for mIF based on the marker assessed. According to MSI-sensor score, 11 were MSI-high, 8 were MSI-low, and 7 were MSS. MSI-sensor status, but not TMB was associated with CB (p=0.037 and p=0.185, respectively). Similar results were seen when using CR+PR vs SD+PD evaluation. Using RNAseq gene set enrichment analyses, CB patients had increased expression of interferon alpha (p=0.01), interferon gamma (p=0.03), PI3K-AKT-mTOR (p=0.02), cytotoxicity (p=0.05) and antigen processing (p=0.01) gene sets, while hedgehog signaling genes were increased in non-CB patients (p=0.04). The ESTIMATE immune index and infiltration of CD4+/PD1+/Ki67+ cell populations as determined by mIF were nominally higher in patients with CB (p=0.051 and p=0.075). Conclusions: Among patients with MMRd tumors treated with PD-1 checkpoint blockade, correlative analyses demonstrate associations between CB and MSI-sensor score as well as biomarkers indicative of immune infiltration and antigen presentation. This suggests that these measures may help differentiate patient response in MSI tumors. Clinical trial information: NCT02465060.
Collapse
Affiliation(s)
| | - Nilofer Saba Azad
- Department of Oncology, Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD
| | | | | | | | | | | | | | | | - Ping Guan
- National Institutes of Health, Bethesda, MD
| | | | | | | | | | - Peter J. O'Dwyer
- University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | | | - Scott J. Rodig
- Department of Pathology and Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - David R. Patton
- Center for Biomedical Informatics & Information Technology, NCI, NIH, Bethedsa, MD
| | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| |
Collapse
|
6
|
Tsao AS, Song Z, Ho AL, Mehnert JM, Mitchell EP, Wright JJ, Takebe N, Gray RJ, Wang V, McShane L, Rubinstein LV, Patton DR, Williams PM, Hamilton SR, Conley BA, Arteaga CL, Harris L, O'Dwyer PJ, Chen AP, Flaherty K. Phase II study of vismodegib in patients with SMO or PTCH1 mutated tumors: Results from NCI-MATCH ECOG-ACRIN Trial (EAY131) Subprotocol T. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3010 Background: NCI-MATCH (EAY131) is a platform trial enrolling patients (pts) with solid tumors, lymphomas, or multiple myeloma to targeted therapies based on matching genomic alterations (NCT02465060). Subprotocol Arm T evaluated vismodegib (GDC0449), a hedgehog signaling pathway inhibitor with anti-tumor activity in pts with tumors harboring PTCH1 and SMO mutations. Methods: Pts whose tumors had SMO or PTCH1 mutations were eligible; results were confirmed by NCI-MATCH central labs if possible. Pts received oral vismodegib (150 mg daily) for 4-week cycles until progression/toxicity. Tumor response was assessed every 2 cycles. Primary endpoint was ORR; secondary endpoints included PFS, 6-month PFS, OS, and predictive biomarkers. Cutaneous basal cell carcinomas were excluded. Results: Of 34 pts enrolled (6/20/16 – 9/22/20); 2 were ineligible and 1 did not start therapy. The 31 analyzable pts’ demographics were primary tumor sites/histology [gastrointestinal (n = 9), skin/soft tissue (n = 7), gynecologic (n = 5), lung (n = 4), unknown primary (n = 4), ductal breast (n = 1), meningioma (n = 1)]; median age 64 (range 19-81); 48.4% women; 61.3% (19/31) > 3 lines of prior therapy; 74% (23/31) > 1 co-occurring mutation [median 2 co-alterations (range 1-20)]. 8/31 > 4 co-occurring alterations. 9 pts had SMO mutant tumors (all SNVs); 5/9 had > 1 co-occurring gene alterations. 22 pts had PTCH1 alterations (7 SNVs and 15 indels); 18/22 pts had > 1 additional gene alteration. Of 31 analyzable pts, 22 were MATCH-confirmed (i.e. had central confirmation of tumor PTCH1/SMO mutations). MATCH-confirmed pts had ORR 9.1% (2/22) while all analyzable pts had ORR 6.5% (2/31). 2 PRs were seen in pts with a skin/soft tissue sarcoma ( PTCH) and a meningioma ( SMO) with a median duration of response 14 months. The 6-month PFS rate was similar in MATCH-confirmed and analyzable pts (22.4% and 23.2% respectively) and median PFS was identical at 1.8 months. Median OS was 9.1 months in MATCH-confirmed and 7.3 months in analyzable pts. Within analyzable SMO variants: 1 PR, 3 SD, 4 PD, and 1 unevaluable responses were documented. Within analyzable PTCH1 variants: 1 PR, 7 SD, 10 PD, and 4 unevaluable responses were seen. 4 pts (12.9%) discontinued therapy due to AE. Among 33 pts starting therapy, 18 (54.5%) had grade 1-2 toxicity, while 2 (6.1%) had grade 3 treatment-related toxicity. Most common toxicities: grade 1-2 fatigue (n = 11), anorexia (n = 8), weight loss (n = 7), alopecia (n = 7), and dysgeusia (n = 6). There were 4 on-study deaths, but none were treatment related. Conclusions: Although the primary endpoint was not reached, vismodegib was well-tolerated with mostly grade 1-2 toxicities and substantial responses were seen in patients with SMOPro641Ala and PTCHGlu947Ter alterations. Further study of the impact of concomitant molecular alterations may yield additional insights into vismodegib mechanisms of response. Clinical trial information: NCT02465060.
Collapse
Affiliation(s)
- Anne S. Tsao
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Alan Loh Ho
- Solid Tumor Oncology Division, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - John Joseph Wright
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Lisa McShane
- Biometric Research Program, DCTD, NCI, NIH, Bethesda, MD
| | - Larry V. Rubinstein
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - David R. Patton
- Center for Biomedical Informatics & Information Technology, NCI, NIH, Bethedsa, MD
| | | | | | - Barbara A. Conley
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Peter J. O'Dwyer
- University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | - Alice P. Chen
- Developmental Therapeutics Clinic, DCTD, NCI, Bethesda, MD
| | - Keith Flaherty
- Dana-Farber Cancer Institute/Harvard Medical School/Massachusetts General Hospital, Boston, MA
| |
Collapse
|
7
|
Jackman DM, Jegede O, Zauderer MG, Mitchell EP, Zwiebel J, Gray RJ, Li S, McShane L, Rubinstein L, Patton DR, Williams PM, Hamilton SR, Conley BA, Arteaga CL, Harris L, O'Dwyer PJ, Chen AP, Flaherty K. A phase 2 study of defactinib (VS-6063) in patients with NF2 altered tumors: Results from NCI-match (EAY131) subprotocol U. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.3087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3087 Background: The NCI-MATCH trial assigns patients (pts) with solid tumors, lymphomas, or multiple myeloma to targeted therapies based on genetic alterations identified in tumor biopsies. Neurofibromatosis 2 (NF2)-inactivated tumors demonstrate increased sensitivity to FAK inhibition in preclinical models. Arm U evaluated the FAK inhibitor defactinib in pts with NF2 altered tumors. Methods: Patients found to harbor an inactivating NF2 mutation on NGS were assigned to the ARM U substudy MATCH. Defactinib 400 mg was given by mouth twice daily until progression or intolerable toxicity. The primary endpoint was objective response rate (ORR). Secondary endpoints included toxicity, progression-free survival (PFS), and 6-month PFS. Results: Of 5,548 cases with sufficient tissue for genomic analysis, 51 pts were found to have NF2 alterations (< 1% of the total analyzed). While NF2 alterations are known to occur more commonly in meningiomas and mesotheliomas, alterations were also detected in an array of other tumor types, including renal cell carcinomas and ovarian cancers. Thirty-five pts were ultimately enrolled; 33 patients were started on therapy, with 2 of those determined to be ineligible for outcome analysis. All pts had received at least one prior therapy, with 52% (16/31) having received 3 or more prior lines of therapy. Median follow-up was 35.9 months. ORR [90% CI] was 3% (1/31, [0.16, 14.86]), with the one partial response in a pt with choroid meningioma. Of the twelve pts whose best response was stable disease (39%, 12/31), 8 demonstrated some degree of tumor shrinkage (Table) with a disease control rate of 42% (13/31). Median PFS was 1.9 months for the 31 eligible pts who received study treatment, with median PFS of 9.3 months for the 9 patients who had a best response of stable disease or better. Six pts achieved a PFS of greater than 5.5 months. Among all treated pts (n=33), the most common treatment-related toxicities were fatigue (36%), nausea (33%), and hyperbilirubinemia (27%). There were no grade 4 or 5 toxicities; 27% of pts had grade 3 toxicities. No correlation could be made between clinical outcomes and tumor histology or specific NF2 genotype. Conclusions: Defactinib monotherapy had limited clinical activity in this cohort of previously treated patients with solid tumors exhibiting NF2 loss. Clinical trial information: NCT04439331. [Table: see text]
Collapse
Affiliation(s)
| | | | | | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Shuli Li
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Lawrence Rubinstein
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - David R Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | - Paul M. Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Barbara A. Conley
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Peter J. O'Dwyer
- University of Pennsylvania, Pennsylvania Hospital, Philadelphia, PA
| | - Alice P. Chen
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Keith Flaherty
- Dana-Farber Cancer Institute/Harvard Medical School/Massachusetts General Hospital, Boston, MA
| |
Collapse
|
8
|
Korde LA, Best AF, Gnjatic S, Denicoff AM, Mishkin GE, Bowman M, Harris L, Geiger AM, McCaskill-Stevens WJ, Chanock SJ, Spears P, Rubinstein L, Mark NM, Warner JL, Allegra CJ, Esbenshade AJ, Knopp MV, Doroshow JH, Rini BI. Initial reporting from the prospective National Cancer Institute (NCI) COVID-19 in Cancer Patients Study (NCCAPS). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6565 Background: Patients (pts) with cancer are at increased risk of SARS-CoV-2 infection and severe COVID-19 disease. Longitudinal follow-up is needed to characterize the severity, sequelae and outcomes in pts with cancer who develop COVID-19. Methods: NCCAPS is a prospective, longitudinal study (NCT04387656) aiming to accrue 2,000 pts with cancer undergoing active treatment or prior stem cell transplant for hematologic or solid tumor malignancy. Adult patients are eligible to enroll within 14 days of their first positive SARS-CoV-2 test; pediatric patients may also enroll retrospectively. Clinical data, patient-reported outcomes, blood specimens, and imaging are collected for up to 2 years. This abstract provides initial baseline and 2-month follow-up data. Results: As of Jan 22, 2021, 585 pts (552 adults and 33 pediatric pts) had complete baseline data and of these pts, 215 adults had 2 months of complete follow-up data. 23.4% of adults and 42.4% of pediatric pts were of non-White race and/or Hispanic/Latinx ethnicity. The most common cancer diagnoses were breast (19.6%), lung (9.9%) and multiple myeloma (8.9%) in adults and acute leukemia (AML/ALL; 63.6%) in children. The most recent treatment was chemotherapy in 38.2%, immunotherapy in 9.6%, and radiation in 5.4%. Median time from positive SARS-CoV-2 test to study enrollment was 10.5 days in adults and 18 days in pediatric pts. Preliminary analysis of plasma cytokines will be presented. At enrollment, 84.6% of adults had COVID-19 symptoms. 55.9% reported symptoms 2 weeks after their positive SARS-CoV-2 test; this fell to 39.0% at 1 month and 28.8% at 2 months (see Table). Of the 215 adults with complete data at 2 months, sequelae included pulmonary (n=22, 10%), cardiovascular (n=12, 6%) thromboembolic (n=9, 4%), bleeding (n=9, 4%) and gastrointestinal (n=11, 5%). 144 (67%) reported at least one cancer treatment disruption in the first 2 months, most commonly delayed therapy (n=98; 46%).Of the 348 adults with baseline data and SARS-CoV-2 test date prior to Nov 23, 2020, 6.3% had died (median time from SARS-CoV-2 test to death: 27 days), and 22.1% reported at least one hospitalization for COVID-19. No deaths were reported in the pediatric population. Conclusion: Cancer pts with COVID-19 report ongoing symptoms after acute infection and a substantial number develop sequelae. Cancer treatment disruptions are common in the initial months following SARS-CoV-2 infection. Longer follow-up will inform whether these treatment disruptions are associated with adverse outcomes. Clinical trial information: NCT04387656. [Table: see text]
Collapse
Affiliation(s)
- Larissa A. Korde
- Clinical Investigations Branch, National Cancer Institute, Bethesda, MD
| | | | - Sacha Gnjatic
- The Tisch Cancer Institute at Mount Sinai Health System, New York, NY
| | | | | | | | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Ann M. Geiger
- National Cancer Institute at the National Institutes of Health, Rockville, MD
| | | | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Lawrence Rubinstein
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | | | | | - Adam J. Esbenshade
- Department of Pediatrics, Vanderbilt University School of Medicine and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Michael V. Knopp
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | | |
Collapse
|
9
|
Cruikshank N, Harris L, Richards S, Metcalfe J, Page B, Watson A, Wijesinghe L. 497 Targeting Improvements in The Elective Aneurysm Pathway in The Dorset and Wiltshire Vascular Network (DWVN). Br J Surg 2021. [DOI: 10.1093/bjs/znab134.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Two consecutive NVR reports identified the DWVN as the 7th slowest network to treat patients with AAAs. We aimed to detect if there were any significant delays in our pathway.
Method
We performed a retrospective audit of patients having elective open and endovascular repair. 144 patients who had AAA repair between 30/06/2016-01/08/2018 were included. Data were collected on the following stages: the date the AAA reached ≥55mm, referral date, date clinician reviewed, CT scan date, CPET testing date, MDT date and operation date. The time in days between each stage was recorded and any delays documented.
Results
At RBH the longest delay was between MDT and surgery (median 73 days, IQR 32 days-130 days). At DCH the major delay was between CPET and MDT (median 28.5 days, IQR 10 days-31 days). At SDH the longest stage was between MDT and operation (median of 88 days, IQR 37 days-154 days).
Examples of reasons for delays across the three hospitals included awaiting specialist opinions, patient being unwell and no ITU beds available.
Conclusions
The pathway for elective AAA treatment in the DWVN is slow across all three hospitals. The greatest delay is often between MDT and surgery. Targeting this stage could significantly shorten the pathway.
Collapse
Affiliation(s)
- N Cruikshank
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom
| | - L Harris
- Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - S Richards
- Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - J Metcalfe
- Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom
| | - B Page
- Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom
| | - A Watson
- Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom
| | - L Wijesinghe
- The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom
| |
Collapse
|
10
|
Wheeler DA, Takebe N, Hinoue T, Hoadley KA, Cardenas MF, Hamilton AM, Laird PW, Wang L, Johnson A, Dewal N, Miller V, Piñeyro D, Castro de Moura M, Esteller M, Shen H, Zenklusen JC, Tarnuzzer R, McShane LM, Tricoli JV, Williams PM, Lubensky I, O'Sullivan-Coyne G, Kohn EC, Little RF, White J, Malik S, Harris L, Weil C, Chen AP, Karlovich C, Rodgers B, Shankar L, Jacobs P, Nolan T, Hu J, Muzny DM, Doddapaneni H, Korchina V, Gastier-Foster J, Bowen J, Leraas K, Edmondson EF, Doroshow JH, Conley BA, Ivy SP, Staudt LM. Molecular Features of Cancers Exhibiting Exceptional Responses to Treatment. Cancer Cell 2021; 39:38-53.e7. [PMID: 33217343 PMCID: PMC8478080 DOI: 10.1016/j.ccell.2020.10.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 06/23/2020] [Revised: 08/23/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022]
Abstract
A small fraction of cancer patients with advanced disease survive significantly longer than patients with clinically comparable tumors. Molecular mechanisms for exceptional responses to therapy have been identified by genomic analysis of tumor biopsies from individual patients. Here, we analyzed tumor biopsies from an unbiased cohort of 111 exceptional responder patients using multiple platforms to profile genetic and epigenetic aberrations as well as the tumor microenvironment. Integrative analysis uncovered plausible mechanisms for the therapeutic response in nearly a quarter of the patients. The mechanisms were assigned to four broad categories-DNA damage response, intracellular signaling, immune engagement, and genetic alterations characteristic of favorable prognosis-with many tumors falling into multiple categories. These analyses revealed synthetic lethal relationships that may be exploited therapeutically and rare genetic lesions that favor therapeutic success, while also providing a wealth of testable hypotheses regarding oncogenic mechanisms that may influence the response to cancer therapy.
Collapse
Affiliation(s)
- David A Wheeler
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Naoko Takebe
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | | | - Katherine A Hoadley
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Maria F Cardenas
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alina M Hamilton
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Linghua Wang
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | - Ninad Dewal
- Foundation Medicine Inc, Cambridge, MA 02141, USA
| | | | - David Piñeyro
- Josep Carreras Leukaemia Research Institute, Badalona, 08916 Barcelona, Catalonia, Spain; Institucio Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Catalonia, Spain
| | - Manuel Castro de Moura
- Josep Carreras Leukaemia Research Institute, Badalona, 08916 Barcelona, Catalonia, Spain
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute, Badalona, 08916 Barcelona, Catalonia, Spain; Centro de Investigacion Biomedica en Red Cancer (CIBERONC), 28029 Madrid, Spain; Institucio Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Catalonia, Spain; Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), 08007 Barcelona, Catalonia, Spain
| | - Hui Shen
- Van Andel Institute, Grand Rapids, MI 49503, USA
| | | | - Roy Tarnuzzer
- Center for Cancer Genomics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Lisa M McShane
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - James V Tricoli
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Paul M Williams
- Frederick National Laboratory for Cancer Research, Frederick, MD 21701, USA
| | - Irina Lubensky
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | | | - Elise C Kohn
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Richard F Little
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Jeffrey White
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Shakun Malik
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Lyndsay Harris
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Carol Weil
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Alice P Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chris Karlovich
- Frederick National Laboratory for Cancer Research, Frederick, MD 21701, USA
| | - Brian Rodgers
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Lalitha Shankar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Paula Jacobs
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Tracy Nolan
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Jianhong Hu
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Viktoriya Korchina
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX 77030, USA
| | | | - Jay Bowen
- Nationwide Children's Hospital, Columbus, OH 43205, USA
| | | | - Elijah F Edmondson
- Pathology and Histology Laboratory, Frederick National Laboratory for Cancer Research, National Cancer Institute, NIH, Frederick, MD 21701, USA
| | - James H Doroshow
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Barbara A Conley
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - S Percy Ivy
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD 20892, USA
| | - Louis M Staudt
- Center for Cancer Genomics, National Cancer Institute, Bethesda, MD 20892, USA.
| |
Collapse
|
11
|
Fernandez-Martinez A, Krop IE, Hillman DW, Polley MY, Parker JS, Huebner L, Hoadley KA, Shepherd J, Tolaney S, Henry NL, Dang C, Harris L, Berry D, Hahn O, Hudis C, Winer E, Partridge A, Perou CM, Carey LA. Survival, Pathologic Response, and Genomics in CALGB 40601 (Alliance), a Neoadjuvant Phase III Trial of Paclitaxel-Trastuzumab With or Without Lapatinib in HER2-Positive Breast Cancer. J Clin Oncol 2020; 38:4184-4193. [PMID: 33095682 DOI: 10.1200/jco.20.01276] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE CALGB 40601 assessed whether dual versus single human epidermal growth factor receptor 2 (HER2) -targeting drugs added to neoadjuvant chemotherapy increased pathologic complete response (pCR). Here, we report relapse-free survival (RFS), overall survival (OS), and gene expression signatures that predict pCR and survival. PATIENTS AND METHODS Three hundred five women with untreated stage II and III HER2-positive breast cancer were randomly assigned to receive weekly paclitaxel combined with trastuzumab plus lapatinib (THL), trastuzumab (TH), or lapatinib (TL). The primary end point was pCR, and secondary end points included RFS, OS, and gene expression analyses. mRNA sequencing was performed on 264 pretreatment samples. RESULTS One hundred eighteen patients were randomly allocated to THL, 120 to TH, and 67 to TL. At more than 7 years of follow-up, THL had significantly better RFS and OS than did TH (RFS hazard ratio, 0.32; 95% CI, 0.14 to 0.71; P = .005; OS hazard ratio, 0.34; 95% CI, 0.12 to 0.94; P = .037), with no difference between TH and TL. Of 688 previously described gene expression signatures, significant associations were found in 215 with pCR, 45 with RFS, and only 22 with both pCR and RFS (3.2%). Specifically, eight immune signatures were significantly correlated with a higher pCR rate and better RFS. Among patients with residual disease, the immunoglobulin G signature was an independent, good prognostic factor, whereas the HER2-enriched signature, which was associated with a higher pCR rate, showed a significantly shorter RFS. CONCLUSION In CALGB 40601, dual HER2-targeting resulted in significant RFS and OS benefits. Integration of intrinsic subtype and immune signatures allowed for the prediction of pCR and RFS, both overall and within the residual disease group. These approaches may provide means for rational escalation and de-escalation treatment strategies in HER2-positive breast cancer.
Collapse
Affiliation(s)
- Aranzazu Fernandez-Martinez
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Ian E Krop
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Mei-Yin Polley
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Joel S Parker
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Lucas Huebner
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Katherine A Hoadley
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Jonathan Shepherd
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Sara Tolaney
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - N Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lyndsay Harris
- National Cancer Institute, Cancer Diagnostics Program, Bethesda, MD
| | - Donald Berry
- Division of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Olwen Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | | | - Eric Winer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Charles M Perou
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Lisa A Carey
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Division of Hematology-Oncology, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
12
|
Flaum S, Seewald M, Echols A, Minadeo L, Dalton V, Harris L. P81 Family planning and the Flint water crisis. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
|
14
|
Seewald M, Martin L, Simon A, Harris L. P5 Public perceptions of physicians who provide abortion care. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Connolly R, Wang V, Hyman D, Grivas P, Mitchell E, Wright J, Sharon E, Gray R, Li S, McShane L, Rubinstein L, Patton D, Williams P, Hamilton S, Conley B, Arteaga C, Harris L, O'Dwyer P, Chen A, Flaherty K. 553P Activity of trastuzumab and pertuzumab (HP) in patients with non-breast/gastroesophgeal HER2-amplified tumours: Results of the NCI-MATCH trial (EAY131) subprotocol J. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
16
|
Cleary JM, Wang V, Heist R, Kopetz S, Mitchell EP, Zwiebel J, Chen HX, Li S, Gray R, McShane L, Rubinstein L, Patton D, Meric-Bernstam F, Dillmon M, Williams M, Hamilton S, Conley B, O'Dwyer P, Harris L, Arteaga C, Chen A, Flaherty K. Abstract CT061: Binimetinib in patients with tumors with NRAS mutations: NCI-MATCH ECOG-ACRIN Cancer Research Group subprotocol EAY131-Z1A. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: NRAS-mutations are established oncologic drivers in many malignancies with no effective targeted therapy options. Preclinical and clinical data have suggested that downstream inhibition with a MEK inhibitor, such as binimetinib, might be efficacious for NRAS-mutated cancers. Methods: Patients who enrolled in the multicenter NCI-MATCH trial master protocol underwent tumor biopsy and molecular profiling by targeted next generation sequencing with a custom Oncomine AmpliSeq™ panel. Patients with refractory solid tumors harboring codon 12, 13, or 61 NRAS-mutations were enrolled in subprotocol Z1A, a single arm study of binimetinib 45 mg twice daily. Patients with melanoma were excluded. The primary endpoint was objective response rate (ORR). Secondary endpoints included progression-free survival (PFS) and overall survival (OS). A post-hoc analysis examined association of NRAS-mutation allele with outcome and histology. Results: 47 eligible patients with refractory solid tumors harboring codon 12, 13, or 61 NRAS-mutations were treated on this trial. The most common cancer types enrolled on this subprotocol were colorectal adenocarcinoma (24/47, 51%), cholangiocarcinoma (7/47, 15%), low-grade papillary serous carcinoma of the ovary (3/47, 6%), and endometrioid endometrial adenocarcinoma patients (3/47, 6%). Observed toxicity was moderate, similar to previous reports, and 27.7% (13 of 47) of eligible patients discontinued binimetinib because of adverse events. The ORR was 2.1% (1 of 47 patients), and the median PFS was 3.5 months. The sole confirmed partial response (PR) was observed in a codon 61 NRAS-mutated indolent malignant ameloblastoma. One patient with a colorectal cancer harboring a NRAS codon 61 mutation had an unconfirmed PR, and two others with NRAS codon 61 mutated colorectal cancer had stable disease for at least 12 months. In a post-hoc analysis, patients with cancers bearing a codon 61 NRAS-mutation (n=22) had a significantly longer OS (p=0.04) and PFS (p=0.006) than those with tumors harboring codon 12 or 13 NRAS-mutations (n=25). Similarly, colorectal cancer patients with NRAS codon 61 mutations treated with binimetinib (n=8) had a significantly longer OS (p=0.03) and PFS (p=0.007) than those with NRAS codon 12 or 13 mutated (n=16) tumors. Conclusions: Single-agent binimetinib did not demonstrate promising efficacy in NRAS-mutated solid tumors. Further studies are needed to clarify whether the increased OS and PFS observed in codon 61 NRAS-mutated cancers reflects a more favorable prognosis for this subtype.
Citation Format: James M. Cleary, Victoria Wang, Rebecca Heist, Scott Kopetz, Edith P. Mitchell, James Zwiebel, Helen X. Chen, Shuli Li, Robert Gray, Lisa McShane, Larry Rubinstein, David Patton, Funda Meric-Bernstam, Melissa Dillmon, Mickey Williams, Stanley Hamilton, Barbara Conley, Peter O'Dwyer, Lyndsay Harris, Carlos Arteaga, Alice Chen, Keith Flaherty. Binimetinib in patients with tumors with NRAS mutations: NCI-MATCH ECOG-ACRIN Cancer Research Group subprotocol EAY131-Z1A [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT061.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Shuli Li
- 1Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Alice Chen
- 5National Cancer Institute, Bethesda, MD
| | | |
Collapse
|
17
|
McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, McKinstry S, Milligan W, Ooi L, Rafiq NM, Sammut T, Sinclair E, Smith M, Baker C, Boulton APR, Collins J, Copley HC, Fearnhead N, Fox H, Mah T, McKenna J, Naruka V, Nigam N, Nourallah B, Perera S, Qureshi A, Saggar S, Sun L, Wang X, Yang DD, Caroll P, Doyle C, Elangovan S, Falamarzi A, Perai KG, Greenan E, Jain D, Lang-Orsini M, Lim S, O'Byrne L, Ridgway P, Van der Laan S, Wong J, Arthur J, Barclay J, Bradley P, Edwin C, Finch E, Hayashi E, Hopkins M, Kelly D, Kelly M, McCartan N, Ormrod A, Pakenham A, Hayward J, Hitchen C, Kishore A, Martins T, Philomen J, Rao R, Rickards C, Burns N, Copeland M, Durand C, Dyal A, Ghaffar A, Gidwani A, Grant M, Gribbon C, Gruhn A, Leer M, Ahmad K, Beattie G, Beatty M, Campbell G, Donaldson G, Graham S, Holmes D, Kanabar S, Liu H, McCann C, Stewart R, Vara S, Ajibola-Taylor O, Andah EJE, Ani C, Cabdi NMO, Ito G, Jones M, Komoriyama A, Patel P, Titu L, Basra M, Gallogly P, Harinath G, Leong SH, Pradhan A, Siddiqui I, Zaat S, Ali A, Galea M, Looi WL, Ng JCK, Atkin G, Azizi A, Cargill Z, China Z, Elliot J, Jebakumar R, Lam J, Mudalige G, Onyerindu C, Renju M, Babu VS, Hussain M, Joji N, Lovett B, Mownah H, Ali B, Cresswell B, Dhillon AK, Dupaguntla YS, Hungwe C, Lowe-Zinola JD, Tsang JCH, Bevan K, Cardus C, Duggal A, Hossain S, McHugh M, Scott M, Chan F, Evans R, Gurung E, Haughey B, Jacob-Ramsdale B, Kerr M, Lee J, McCann E, O'Boyle K, Reid N, Hayat F, Hodgson S, Johnston R, Jones W, Khan M, Linn T, Long S, Seetharam P, Shaman S, Smart B, Anilkumar A, Davies J, Griffith J, Hughes B, Islam Y, Kidanu D, Mushaini N, Qamar I, Robinson H, Schramm M, Tan CY, Apperley H, Billyard C, Blazeby JM, Cannon SP, Carse S, Göpfert A, Loizidou A, Parkin J, Sanders E, Sharma S, Slade G, Telfer R, Huppatz IW, Worley E, Chandramoorthy L, Friend C, Harris L, Jain P, Karim MJ, Killington K, McGillicuddy J, Rafferty C, Rahunathan N, Rayne T, Varathan Y, Verma N, Zanichelli D, Arneill M, Brown F, Campbell B, Crozier L, Henry J, McCusker C, Prabakaran P, Wilson R, Asif U, Connor M, Dindyal S, Math N, Pagarkar A, Saleem H, Seth I, Sharma S, Standfield N, Swartbol T, Adamson R, Choi JE, El Tokhy O, Ho W, Javaid NR, Kelly M, Mehdi AS, Menon D, Plumptre I, Sturrock S, Turner J, Warren O, Crane E, Ferris B, Gadsby C, Smallwood J, Vipond M, Wilson V, Amarnath T, Doshi A, Gregory C, Kandiah K, Powell B, Spoor H, Toh C, Vizor R, Common M, Dunleavy K, Harris S, Luo C, Mesbah Z, Kumar AP, Redmond A, Skulsky S, Walsh T, Daly D, Deery L, Epanomeritakis E, Harty M, Kane D, Khan K, Mackey R, McConville J, McGinnity K, Nixon G, Ang A, Kee JY, Leung E, Norman S, Palaniappan SV, Sarathy PP, Yeoh T, Frost J, Hazeldine P, Jones L, Karbowiak M, Macdonald C, Mutarambirwa A, Omotade A, Runkel M, Ryan G, Sawers N, Searle C, Suresh S, Vig S, Ahmad A, McGartland R, Sim R, Song A, Wayman J, Brown R, Chang LH, Concannon K, Crilly C, Arnold TJ, Burgin A, Cadden F, Choy CH, Coleman M, Lim D, Luk J, Mahankali-Rao P, Prudence-Taylor AJ, Ramakrishnan D, Russell J, Fawole A, Gohil J, Green B, Hussain A, McMenamin L, McMenamin L, Tang M, Azmi F, Benchetrit S, Cope T, Haque A, Harlinska A, Holdsworth R, Ivo T, Martin J, Nisar T, Patel A, Sasapu K, Trevett J, Vernet G, Aamir A, Bird C, Durham-Hall A, Gibson W, Hartley J, May N, Maynard V, Johnson S, Wood CM, O'Brien M, Orbell J, Stringfellow TD, Tenters F, Tresidder S, Cheung W, Grant A, Tod N, Bews-Hair M, Lim ZH, Lim SW, Vella-Baldacchino M, Auckburally S, Chopada A, Easdon S, Goodson R, McCurdie F, Narouz M, Radford A, Rea E, Taylor O, Yu T, Alfa-Wali M, Amani L, Auluck I, Bruce P, Emberton J, Kumar R, Lagzouli N, Mehta A, Murtaza A, Raja M, Dennahy IS, Frew K, Given A, He YY, Karim MA, MacDonald E, McDonald E, McVinnie D, Ng SK, Pettit A, Sim DPY, Berthaume-Hawkins SD, Charnley R, Fenton K, Jones D, Murphy C, Ng JQ, Reehal R, Robinson H, Seraj SS, Shang E, Tonks A, White P, Yeo A, Chong P, Gabriel R, Patel N, Richardson E, Symons L, Aubrey-Jones D, Dawood S, Dobrzynska M, Faulkner S, Griffiths H, Mahmood F, Patel P, Perry M, Power A, Simpson R, Ali A, Brobbey P, Burrows A, Elder P, Ganyani R, Horseman C, Hurst P, Mann H, Marimuthu K, McBride S, Pilsworth E, Powers N, Stanier P, Innes R, Kersey T, Kopczynska M, Langasco N, Patel N, Rajagopal R, Atkins B, Beasley W, Lim ZC, Gill A, Ang HL, Williams H, Yogeswara T, Carter R, Fam M, Fong J, Latter J, Long M, Mackinnon S, McKenzie C, Osmanska J, Raghuvir V, Shafi A, Tsang K, Walker L, Bountra K, Coldicutt O, Fletcher D, Hudson S, Iqbal S, Bernal TL, Martin JWB, Moss-Lawton F, Smallwood J, Vipond M, Cardwell A, Edgerton K, Laws J, Rai A, Robinson K, Waite K, Ward J, Youssef H, Knight C, Koo PY, Lazarou A, Stanger S, Thorn C, Triniman MC, Botha A, Boyles L, Cumming S, Deepak S, Ezzat A, Fowler AJ, Gwozdz AM, Hussain SF, Khan S, Li H, Morrell BL, Neville J, Nitiahpapand R, Pickering O, Sagoo H, Sharma E, Welsh K, Denley S, Khan S, Agarwal M, Al-Saadi N, Bhambra R, Gupta A, Jawad ZAR, Jiao LR, Khan K, Mahir G, Singagireson S, Thoms BL, Tseu B, Wei R, Yang N, Britton N, Leinhardt D, Mahfooz M, Palkhi A, Price M, Sheikh S, Barker M, Bowley D, Cant M, Datta U, Farooqi M, Lee A, Morley G, Amin MN, Parry A, Patel S, Strang S, Yoganayagam N, Adlan A, Chandramoorthy S, Choudhary Y, Das K, Feldman M, France B, Grace R, Puddy H, Soor P, Ali M, Dhillon P, Faraj A, Gerard L, Glover M, Imran H, Kim S, Patrick Y, Peto J, Prabhudesai A, Smith R, Tang A, Vadgama N, Dhaliwal R, Ecclestone T, Harris A, Ong D, Patel D, Philp C, Stewart E, Wang L, Wong E, Xu Y, Ashaye T, Fozard T, Galloway F, Kaptanis S, Mistry P, Nguyen T, Olagbaiye F, Osman M, Philip Z, Rembacken R, Tayeh S, Theodoropoulou K, Herman A, Lau J, Saha A, Trotter M, Adeleye O, Cave D, Gunwa T, Magalhães J, Makwana S, Mason R, Parish M, Regan H, Renwick P, Roberts G, Salekin D, Sivakumar C, Tariq A, Liew I, McDade A, Stewart D, Hague M, Hudson-Peacock N, Jackson CES, James F, Pitt J, Walker EY, Aftab R, Ang JJ, Anwar S, Battle J, Budd E, Chui J, Crook H, Davies P, Easby S, Hackney E, Ho B, Imam SZ, Rammell J, Andrews H, Perry C, Schinle P, Ahmed P, Aquilina T, Balai E, Church M, Cumber E, Curtis A, Davies G, Dennis Y, Dumann E, Greenhalgh S, Kim P, King S, Metcalfe KHM, Passby L, Redgrave N, Soonawalla Z, Waters S, Zornoza A, Gulzar I, Hole J, Hull K, Ishaq H, Karaj J, Kelkar A, Love E, Patel S, Thakrar D, Vine M, Waterman A, Dib NP, Francis N, Hanson M, Ingleton R, Sadanand KS, Sukirthan N, Arnell S, Ball M, Bassam N, Beghal G, Chang A, Dawe V, George A, Huq T, Hussain A, Ikram B, Kanapeckaite L, Khan M, Ramjas D, Rushd A, Sait S, Serry M, Yardimci E, Capella S, Chenciner L, Episkopos C, Karam E, McCarthy C, Moore-Kelly W, Watson N, Ahluwalia V, Barnfield J, Ben-Gal O, Bloom I, Gharatya A, Khodatars K, Merchant N, Moonan A, Moore M, Patel K, Spiers H, Sundaram K, Turner J, Bath MF, Black J, Chadwick H, Huisman L, Ingram H, Khan S, Martin L, Metcalfe M, Sangal P, Seehra J, Thatcher A, Venturini S, Whitcroft I, Afzal Z, Brown S, Gani A, Gomaa A, Hussein N, Oh SY, Pazhaniappan N, Sharkey E, Sivagnanasithiyar T, Williams C, Yeung J, Cruddas L, Gurjar S, Pau A, Prakash R, Randhawa R, Chen L, Eiben I, Naylor M, Osei-Bordom D, Trenear R, Bannard-Smith J, Griffiths N, Patel BY, Saeed F, Abdikadir H, Bennett M, Church R, Clements SE, Court J, Delvi A, Hubert J, Macdonald B, Mansour F, Patel RR, Perris R, Small S, Betts A, Brown N, Chong A, Croitoru C, Grey A, Hickland P, Ho C, Hollington D, McKie L, Nelson AR, Stewart H, Eiben P, Nedham M, Ali I, Brown T, Cumming S, Hunt C, Joyner C, McAlinden C, Roberts J, Rogers D, Thachettu A, Tyson N, Vaughan R, Verma N, Yasin T, Andrew K, Bhamra N, Leong S, Mistry R, Noble H, Rashed F, Walker NR, Watson L, Worsfold M, Yarham E, Abdikadir H, Arshad A, Barmayehvar B, Cato L, Chan-lam N, Do V, Leong A, Sheikh Z, Zheleniakova T, Coppel J, Hussain ST, Mahmood R, Nourzaie R, Prowle J, Sheik-Ali S, Thomas A, Alagappan A, Ashour R, Bains H, Diamond J, Gordon J, Ibrahim B, Khalil M, Mittapalli D, Neo YN, Patil P, Peck FS, Reza N, Swan I, Whyte M, Chaudhry S, Hernon J, Khawar H, O'Brien J, Pullinger M, Rothnie K, Ujjal S, Bhatte S, Curtis J, Green S, Mayer A, Watkinson G, Chapple K, Hawthorne T, Khaliq M, Majkowski L, Malik TAM, Mclauchlan K, En BNW, Parton S, Robinson SD, Saat MI, Shurovi BN, Varatharasasingam K, Ward AE, Behranwala K, Bertelli M, Cohen J, Duff F, Fafemi O, Gupta R, Manimaran M, Mayhew J, Peprah D, Wong MHY, Farmer N, Houghton C, Kandhari N, Khan K, Ladha D, Mayes J, McLennan F, Panahi P, Seehra H, Agrawal R, Ahmed I, Ali S, Birkinshaw F, Choudhry M, Gokani S, Harrogate S, Jamal S, Nawrozzadeh F, Swaray A, Szczap A, Warusavitarne J, Abdalla M, Asemota N, Cullum R, Hartley M, Maxwell-Armstrong C, Mulvenna C, Phillips J, Yule A, Ahmed L, Clement KD, Craig N, Elseedawy E, Gorman D, Kane L, Livie J, Livie V, Moss E, Naasan A, Ravi F, Shields P, Zhu Y, Archer M, Cobley H, Dennis R, Downes C, Guevel B, Lamptey E, Murray H, Radhakrishnan A, Saravanabavan S, Sardar M, Shaw C, Tilliridou V, Wright R, Ye W, Alturki N, Helliwell R, Jones E, Kelly D, Lambotharan S, Scott K, Sivakumar R, Victor L, Boraluwe-Rallage H, Froggatt P, Haynes S, Hung YMA, Keyte A, Matthews L, Evans E, Haray P, John I, Mathivanan A, Morgan L, Oji O, Okorocha C, Rutherford A, Spiers H, Stageman N, Tsui A, Whitham R, Amoah-Arko A, Cecil E, Dietrich A, Fitzpatrick H, Guy C, Hair J, Hilton J, Jawad L, McAleer E, Taylor Z, Yap J, Akhbari M, Debnath D, Dhir T, Elbuzidi M, Elsaddig M, Glace S, Khawaja H, Koshy R, Lal K, Lobo L, McDermott A, Meredith J, Qamar MA, Vaidya A, Acquaah F, Barfi L, Carter N, Gnanappiragasam D, Ji C, Kaminski F, Lawday S, Mackay K, Sulaiman SK, Webb R, Ananthavarathan P, Dalal F, Farrar E, Hashemi R, Hossain M, Jiang J, Kiandee M, Lex J, Mason L, Matthews JH, McGeorge E, Modhwadia S, Pinkney T, Radotra A, Rickard L, Rodman L, Sales A, Tan KL, Bachi A, Bajwa DS, Battle J, Brown LR, Butler A, Calciu A, Davies E, Gardner I, Girdlestone T, Ikogho O, Keelan G, O'Loughlin P, Tam J, Elias J, Ngaage M, Thompson J, Bristow S, Brock E, Davis H, Pantelidou M, Sathiyakeerthy A, Singh K, Chaudhry A, Dickson G, Glen P, Gregoriou K, Hamid H, Mclean A, Mehtaji P, Neophytou G, Potts S, Belgaid DR, Burke J, Durno J, Ghailan N, Hanson M, Henshaw V, Nazir UR, Omar I, Riley BJ, Roberts J, Smart G, Van Winsen K, Bhatti A, Chan M, D'Auria M, Green S, Keshvala C, Li H, Maxwell-Armstrong C, Michaelidou M, Simmonds L, Smith C, Wimalathasan A, Abbas J, Cairns C, Chin YR, Connelly A, Moug S, Nair A, Svolkinas D, Coe P, Subar D, Wang H, Zaver V, Brayley J, Cookson P, Cunningham L, Gaukroger A, Ho M, Hough A, King J, O'Hagan D, Widdison A, Brown R, Brown B, Chavan A, Francis S, Hare L, Lund J, Malone N, Mavi B, McIlwaine A, Rangarajan S, Abuhussein N, Campbell HS, Daniels J, Fitzgerald I, Mansfield S, Pendrill A, Robertson D, Smart YW, Teng T, Yates J, Belgaumkar A, Katira A, Kossoff J, Kukran S, Laing C, Mathew B, Mohamed T, Myers S, Novell R, Phillips BL, Thomas M, Turlejski T, Turner S, Varcada M, Warren L, Wynell-Mayow W, Church R, Linley-Adams L, Osborn G, Saunders M, Spencer R, Srikanthan M, Tailor S, Tullett A, Ali M, Al-Masri S, Carr G, Ebhogiaye O, Heng S, Manivannan S, Manley J, McMillan LE, Peat C, Phillips B, Thomas S, Whewell H, Williams G, Bienias A, Cope EA, Courquin GR, Day L, Garner C, Gimson A, Harris C, Markham K, Moore T, Nadin T, Phillips C, Subratty SM, Brown K, Dada J, Durbacz M, Filipescu T, Harrison E, Kennedy ED, Khoo E, Kremel D, Lyell I, Pronin S, Tummon R, Ventre C, Walls L, Wootton E, Akhtar A, Davies E, El-Sawy D, Farooq M, Gaddah M, Griffiths H, Katsaiti I, Khadem N, Leong K, Williams I, Chean CS, Chudek D, Desai H, Ellerby N, Hammad A, Malla S, Murphy B, Oshin O, Popova P, Rana S, Ward T, Abbott TEF, Akpenyi O, Edozie F, El Matary R, English W, Jeyabaladevan S, Morgan C, Naidu V, Nicholls K, Peroos S, Prowle J, Sansome S, Torrance HD, Townsend D, Brecher J, Fung H, Kazmi Z, Outlaw P, Pursnani K, Ramanujam N, Razaq A, Sattar M, Sukumar S, Tan TSE, Chohan K, Dhuna S, Haq T, Kirby S, Lacy-Colson J, Logan P, Malik Q, McCann J, Mughal Z, Sadiq S, Sharif I, Shingles C, Simon A, Burnage S, Chan SSN, Craig ARJ, Duffield J, Dutta A, Eastwood M, Iqbal F, Mahmood F, Mahmood W, Patel C, Qadeer A, Robinson A, Rotundo A, Schade A, Slade RD, De Freitas M, Kinnersley H, McDowell E, Moens-Lecumberri S, Ramsden J, Rockall T, Wiffen L, Wright S, Bruce C, Francois V, Hamdan K, Limb C, Lunt AJ, Manley L, Marks M, Phillips CFE, Agnew CJF, Barr CJ, Benons N, Hart SJ, Kandage D, Krysztopik R, Mahalingam P, Mock J, Rajendran S, Stoddart MT, Clements B, Gillespie H, Lee S, McDougall R, Murray C, O'Loane R, Periketi S, Tan S, Amoah R, Bhudia R, Dudley B, Gilbert A, Griffiths B, Khan H, McKigney N, Roberts B, Samuel R, Seelarbokus A, Stubbing-Moore A, Thompson G, Williams P, Ahmed N, Akhtar R, Chandler E, Chappelow I, Gil H, Gower T, Kale A, Lingam G, Rutler L, Sellahewa C, Sheikh A, Stringer H, Taylor R, Aglan H, Ashraf MR, Choo S, Das E, Epstein J, Gentry R, Mills D, Poolovadoo Y, Ward N, Bull K, Cole A, Hack J, Khawari S, Lake C, Mandishona T, Perry R, Sleight S, Sultan S, Thornton T, Williams S, Arif T, Castle A, Chauhan P, Chesner R, Eilon T, Kamarajah S, Kambasha C, Lock L, Loka T, Mohammad F, Motahariasl S, Roper L, Sadhra SS, Sheikh A, Toma T, Wadood Q, Yip J, Ainger E, Busti S, Cunliffe L, Flamini T, Gaffing S, Moorcroft C, Peter M, Simpson L, Stokes E, Stott G, Wilson J, York J, Yousaf A, Borakati A, Brown M, Goaman A, Hodgson B, Ijeomah A, Iroegbu U, Kaur G, Lowe C, Mahmood S, Sattar Z, Sen P, Szuman A, Abbas N, Al-Ausi M, Anto N, Bhome R, Eccles L, Elliott J, Hughes EJ, Jones A, Karunatilleke AS, Knight JS, Manson CCF, Mekhail I, Michaels L, Noton TM, Okenyi E, Reeves T, Yasin IH, Banfield DA, Harris R, Lim D, Mason-Apps C, Roe T, Sandhu J, Shafiq N, Stickler E, Tam JP, Williams LM, Ainsworth P, Boualbanat Y, Doull C, Egan E, Evans L, Hassanin K, Ninkovic-Hall G, Odunlami W, Shergill M, Traish M, Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
Collapse
|
18
|
Damodaran S, Zhao F, Deming DA, Mitchell EP, Wright JJ, Doyle LA, Gray RJ, Li S, McShane L, Rubinstein LV, Patton DR, Williams M, Hamilton SR, Suga JM, Conley BA, Arteaga CL, Harris L, O'Dwyer PJ, Chen AP, Flaherty K. Phase II study of copanlisib in patients with tumors with PIK3CA mutations ( PTEN loss allowed): NCI MATCH EAY131-Z1F. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3506 Background: The NCI-MATCH (EAY131) is a platform trial that enrolls patients (pts) with solid tumors, lymphomas, or multiple myeloma to targeted therapies based on matching genomic alterations of interest (NCT02465060). Arm Z1F evaluated copanlisib, a highly selective, pan-Class 1 PI3K inhibitor with predominant activity against both the δ and α isoforms in pts with PIK3CA mutations. Methods: Pts received copanlisib (60 mg IV) on days 1, 8, and 15 in 28-day cycles until progression/toxicity. Tumor assessment was every 2 cycles. The primary endpoint was objective response rate (ORR); secondary endpoints were PFS, 6-month PFS, and predictive biomarkers. Pts with KRAS mutations, HER2+ve breast cancers, lymphomas were excluded. Results: 35 pts were enrolled (from 8/2/18 to 12/27/18), of which, 28 pts were available for analysis (7 patients, not eligible or did not start therapy). Multiple histologies were enrolled with gynecologic (n = 7), gastrointestinal (n = 6), and genitourinary (n = 5) the most common tumors. Median age 61 (range 42-78). 75% of pts had ≥ 3 lines of prior therapy. 54% of PIK3CA mutations were located in the helical domain, 32% in kinase domain and 14% in other domains. Twenty-six pts had co-occurring gene alterations (median 3; range 1-9), with 9 patients having 4 or more gene alterations. The ORR was 11% (3/28, 90% CI: 3%-25%). Partial responses were seen in uterine cancer, clear cell carcinoma of anterior abdominal wall, and liposarcoma. 6 pts had > 6 months of stable disease and clinical benefit rate was 32% (9/28). Two pts are still on treatment. The most common reason for protocol discontinuation was disease progression (n = 18, 69%). Thirty pts were included for toxicity analysis. Ten pts (33%) had grade 1 or 2 toxicities, 16 pts (53%) had grade 3 toxicities, and one patient (3%) had grade 4 toxicity (CTCAE v5.0). Most common toxicities include hyperglycemia (n = 19), fatigue (n = 11), hypertension (n = 10), diarrhea (n = 10), and nausea (n = 9). Total of 5 deaths were reported, none related to treatment. Conclusions: Copanlisib showed meaningful clinical activity across various tumors with PIK3CA mutation in the late-line refractory setting. Further study either alone or in combinations in select tumors is warranted. G3/4 toxicities observed were consistent with reported toxicities for PI3K pathway inhibition. Clinical trial information: NCT02465060 .
Collapse
Affiliation(s)
- Senthil Damodaran
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Dustin A. Deming
- University of Wisconsin Carbone Cancer Center, and ECOG-ACRIN, Madison, WI
| | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - John Joseph Wright
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Shuli Li
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Larry V Rubinstein
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - David R Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | - Mickey Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | - Barbara A. Conley
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Peter J. O'Dwyer
- University of Pennsylvania, Division of Medical Oncology, Philadelphia, PA
| | - Alice P. Chen
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Keith Flaherty
- Dana-Farber Cancer Institute/Harvard Medical School/Massachusetts General Hospital, Boston, MA
| |
Collapse
|
19
|
Baslan T, Kendall J, Volyanskyy K, McNamara K, Cox H, D'Italia S, Ambrosio F, Riggs M, Rodgers L, Leotta A, Song J, Mao Y, Wu J, Shah R, Gularte-Mérida R, Chadalavada K, Nanjangud G, Varadan V, Gordon A, Curtis C, Krasnitz A, Dimitrova N, Harris L, Wigler M, Hicks J. Novel insights into breast cancer copy number genetic heterogeneity revealed by single-cell genome sequencing. eLife 2020; 9:51480. [PMID: 32401198 PMCID: PMC7220379 DOI: 10.7554/elife.51480] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/03/2020] [Indexed: 11/13/2022] Open
Abstract
Copy number alterations (CNAs) play an important role in molding the genomes of breast cancers and have been shown to be clinically useful for prognostic and therapeutic purposes. However, our knowledge of intra-tumoral genetic heterogeneity of this important class of somatic alterations is limited. Here, using single-cell sequencing, we comprehensively map out the facets of copy number alteration heterogeneity in a cohort of breast cancer tumors. Ou/var/www/html/elife/12-05-2020/backup/r analyses reveal: genetic heterogeneity of non-tumor cells (i.e. stroma) within the tumor mass; the extent to which copy number heterogeneity impacts breast cancer genomes and the importance of both the genomic location and dosage of sub-clonal events; the pervasive nature of genetic heterogeneity of chromosomal amplifications; and the association of copy number heterogeneity with clinical and biological parameters such as polyploidy and estrogen receptor negative status. Our data highlight the power of single-cell genomics in dissecting, in its many forms, intra-tumoral genetic heterogeneity of CNAs, the magnitude with which CNA heterogeneity affects the genomes of breast cancers, and the potential importance of CNA heterogeneity in phenomena such as therapeutic resistance and disease relapse. Cells in the body remain healthy by tightly preventing and repairing random changes, or mutations, in their genetic material. In cancer cells, however, these mechanisms can break down. When these cells grow and multiply, they can then go on to accumulate many mutations. As a result, cancer cells in the same tumor can each contain a unique combination of genetic changes. This genetic heterogeneity has the potential to affect how cancer responds to treatment, and is increasingly becoming appreciated clinically. For example, if a drug only works against cancer cells carrying a specific mutation, any cells lacking this genetic change will keep growing and cause a relapse. However, it is still difficult to quantify and understand genetic heterogeneity in cancer. Copy number alterations (or CNAs) are a class of mutation where large and small sections of genetic material are gained or lost. This can result in cells that have an abnormal number of copies of the genes in these sections. Here, Baslan et al. set out to explore how CNAs might vary between individual cancer cells within the same tumor. To do so, thousands of individual cancer cells were isolated from human breast tumors, and a technique called single-cell genome sequencing used to screen the genetic information of each of them. These experiments confirmed that CNAs did differ – sometimes dramatically – between patients and among cells taken from the same tumor. For example, many of the cells carried extra copies of well-known cancer genes important for treatment, but the exact number of copies varied between cells. This heterogeneity existed for individual genes as well as larger stretches of DNA: this was the case, for instance, for an entire section of chromosome 8, a region often affected in breast and other tumors. The work by Baslan et al. captures the sheer extent of genetic heterogeneity in cancer and in doing so, highlights the power of single-cell genome sequencing. In the future, a finer understanding of the genetic changes present at the level of an individual cancer cell may help clinicians to manage the disease more effectively.
Collapse
Affiliation(s)
- Timour Baslan
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States.,Department of Molecular and Cellular Biology, Stony Brook University, Stony Brook, United States
| | - Jude Kendall
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | | | - Katherine McNamara
- Department of Genetics, Stanford University School of Medicine, Stanford, United States
| | - Hilary Cox
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Sean D'Italia
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Frank Ambrosio
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Michael Riggs
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Linda Rodgers
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Anthony Leotta
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Junyan Song
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States.,Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, United States
| | - Yong Mao
- Philips Research North America, Biomedical Informatics, Cambridge, United States
| | - Jie Wu
- Philips Research North America, Biomedical Informatics, Cambridge, United States
| | - Ronak Shah
- Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | | | - Kalyani Chadalavada
- Molecular Cytogenetics Core Facility, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Gouri Nanjangud
- Molecular Cytogenetics Core Facility, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Vinay Varadan
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, United States
| | - Assaf Gordon
- House Gordon Software Company LTD, Calgary, Canada
| | - Christina Curtis
- Department of Genetics, Stanford University School of Medicine, Stanford, United States
| | - Alex Krasnitz
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Nevenka Dimitrova
- Philips Research North America, Biomedical Informatics, Cambridge, United States
| | - Lyndsay Harris
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, United States.,Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, United States.,Seidman Cancer Center, University Hospitals of Case Western, Cleveland, United States
| | - Michael Wigler
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - James Hicks
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| |
Collapse
|
20
|
Mackie JT, Blyde D, Harris L, Roe WD, Keyburn AL. Brucellosis associated with stillbirth in a bottlenose dolphin in Australia. Aust Vet J 2020; 98:92-95. [PMID: 32030727 DOI: 10.1111/avj.12903] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/10/2019] [Accepted: 11/15/2019] [Indexed: 01/31/2023]
Abstract
A captive adult female bottlenose dolphin presented with stillbirth. The placenta appeared oedematous. No other gross lesions were evident in the placenta or the stillborn calf. Histopathology revealed mild multifocal placentitis and foetal encephalitis. Brucella sp. was isolated from lung, liver, spleen and kidney. Sequence and phylogenetic analysis demonstrated this organism to be most similar to Brucella ceti sequence type (ST) 27. Brucella sp. DNA was detected in formalin-fixed paraffin-embedded placenta and brain by real-time PCR using primers targeting the IS711 gene. Immunohistochemical staining revealed Brucella sp. antigen in placental inflammation. This is the first report of isolation of Brucella sp. from a marine mammal in the Southern Hemisphere and the first report of marine Brucella-associated disease in Australia.
Collapse
Affiliation(s)
- J T Mackie
- QML Vetnostics, Murarrie, Queensland, Australia
| | - D Blyde
- Sea World, Main Beach, Queensland, Australia
| | - L Harris
- QML Vetnostics, Murarrie, Queensland, Australia
| | - W D Roe
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - A L Keyburn
- CSIRO Australian Animal Health Laboratory, Geelong, Victoria, Australia
| |
Collapse
|
21
|
Azad NS, Gray RJ, Overman MJ, Schoenfeld JD, Mitchell EP, Zwiebel JA, Sharon E, Streicher H, Li S, McShane LM, Rubinstein L, Patton DR, Williams PM, Coffey B, Hamilton SR, Bahary N, Suga JM, Hatoum H, Abrams JS, Conley BA, Arteaga CL, Harris L, O'Dwyer PJ, Chen AP, Flaherty KT. Nivolumab Is Effective in Mismatch Repair-Deficient Noncolorectal Cancers: Results From Arm Z1D-A Subprotocol of the NCI-MATCH (EAY131) Study. J Clin Oncol 2020; 38:214-222. [PMID: 31765263 PMCID: PMC6968795 DOI: 10.1200/jco.19.00818] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [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] [Accepted: 10/07/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The National Cancer Institute Molecular Analysis for Therapy Choice (NCI-MATCH) trial, the largest national precision oncology study to date (> 1,100 sites) of patients with relapsed or refractory malignancies, assigned patients to targeted therapy in parallel phase II studies based on tumor molecular alterations. The anti-programmed death receptor 1 inhibitor nivolumab previously showed activity in mismatch repair (MMR)-deficient colon cancer. We hypothesized that nivolumab would have activity in patients with MMR-deficient, noncolorectal tumors. PATIENTS AND METHODS Eligible patients with relapsed or refractory tumors, good end-organ function, and Eastern Cooperative Oncology Group performance status of ≤ 1 underwent tumor biopsy for centralized screening of molecular alterations. MMR deficiency was defined by complete loss of nuclear expression of MLH1 or MSH2 MMR gene products by immunohistochemistry (IHC). Patients with MMR-deficient colorectal cancer were excluded. Nivolumab, 3 mg/kg every 2 weeks (28-day cycles) and 480 mg every 4 weeks after cycle 4, was administered intravenously. Disease reassessment was performed every 2 cycles. The primary end point was RECIST 1.1 objective response rate (ORR). RESULTS Two percent of 4,902 screened patients had an MMR-deficient cancer by IHC. Forty-two evaluable patients were enrolled, with a median age of 60 years and a median of 3 prior therapies. The most common histologies were endometrioid endometrial adenocarcinoma (n = 13), prostate adenocarcinoma (n = 5), and uterine carcinosarcoma (n = 4). ORR was 36% (15 of 42 patients). An additional 21% of patients had stable disease. The estimated 6-, 12-, and 18-month progression-free survival rates were 51.3% (90% CI, 38.2% to 64.5%), 46.2% (90% CI, 33.1% to 59.3%), and 31.4% (90% CI, 18.7% to 44.2%), respectively. Median overall survival was 17.3 months. Toxicity was predominantly low grade. CONCLUSION A variety of refractory cancers (2.0% of those screened) had MMR deficiency as defined in NCI-MATCH. Nivolumab has promising activity in MMR-deficient noncolorectal cancers of a wide variety of histopathologic types.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | - Brent Coffey
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | - J. Marie Suga
- Kaiser Permanente Vallejo Medical Center, San Diego, CA
| | - Hassan Hatoum
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Curiale MS, Gangar V, Gravens C, Agin JR, Bound A, Bowles L, Brockman R, Brusatti L, Bulawka CE, Cohen A, Deeks C, Eklund CA, Fukuoka J, Gangar V, Hammer C, Harris L, Hoffman C, Jost-Keating K, Keng JG, Kerdahi K, Krzyanowski W, Manley D, Miller C, Mondon D, Neufang K, Niroomand F, Plante R, Post L, Roman M, Rude D, Raghubeer EV, Ryder J, Smith C, Stoltzner L, Thomas L, Vanderbilt B, Wright T. VIDAS Enzyme-Linked Fluorescent Immunoassay for Detection of Salmonella in Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.491] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
The VIDAS SLM method for detection of Salmonella was compared with the Bacteriological Analytical Manual (BAM)/AOAC culture method in a collaborative study. Twenty laboratories participated in the evaluation. Each laboratory tested one or more of 6 test products: milk chocolate, nonfat dry milk, dried whole egg, soy flour, ground black pepper, and ground raw turkey. No significant differences (P< 0.05) were observed between the 2 methods. The 2 methods were in agreement for 99% of 1544 samples analyzed. Of the 20 samples out of agreement, 8 were VIDAS SLM positive and BAM/AOAC negative, and 12 were VIDAS SLM negative and BAM/AOAC positive. The VIDAS SLM method for detection of Salmonella in foods has been adopted first action by AOAC INTERNATIONAL.
Collapse
Affiliation(s)
- Michael S Curiale
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Vidhya Gangar
- Silliker Laboratories Group, Inc., Corporate Research Center, 160 Armory Dr, South Holland, IL 60473
| | - Carol Gravens
- bioMérieux Vitek, Inc., 595 Anglum Rd, Hazelwood, MO 63042-2320
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Foley N, O'Connor M, Harris L. A050 Defibrillator Therapy in Patients Receiving a Primary Prevention CRT-D Device: The Wellington Experience. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
24
|
Vehmeijer JT, Koyak Z, Zwinderman AH, Harris L, Peinado R, Oechslin EN, Silversides CK, Bouma BJ, Budts W, van Gelder IC, Oliver JM, Mulder BJM, de Groot JR. PREVENTION-ACHD: PRospEctiVE study on implaNTable cardioverter-defibrillator therapy and suddeN cardiac death in Adults with Congenital Heart Disease; Rationale and Design. Neth Heart J 2019; 27:474-479. [PMID: 31270738 PMCID: PMC6773785 DOI: 10.1007/s12471-019-1297-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Many adult congenital heart disease (ACHD) patients are at risk of sudden cardiac death (SCD). An implantable cardioverter-defibrillator (ICD) may prevent SCD, but the evidence for primary prevention indications is still unsatisfactory. STUDY DESIGN PREVENTION-ACHD is a prospective study with which we aim to prospectively validate a new risk score model for primary prevention of SCD in ACHD patients, as well as the currently existing guideline recommendations. Patients are screened using a novel risk score to predict SCD as well as current ICD indications according to an international Consensus Statement. Patients are followed up for two years. The primary endpoint is the occurrence of SCD and sustained ventricular arrhythmias. The Study was registered at ClinicalTrials.gov (NCT03957824). CONCLUSION PREVENTION-ACHD is the first prospective study on SCD in ACHD patients. In the light of a growing and aging population of patients with more severe congenital heart defects, more robust clinical evidence on primary prevention of SCD is urgently needed.
Collapse
Affiliation(s)
- J T Vehmeijer
- Heart Center, Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
| | - Z Koyak
- Heart Center, Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - A H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - L Harris
- Division of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center of Adults, University of Toronto, Toronto, Canada
| | - R Peinado
- Department of Cardiology, La Paz University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - E N Oechslin
- Division of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center of Adults, University of Toronto, Toronto, Canada
| | - C K Silversides
- Division of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center of Adults, University of Toronto, Toronto, Canada
| | - B J Bouma
- Heart Center, Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - W Budts
- Department of Cardiology, Universitair Ziekenhuis Leuven, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - I C van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J M Oliver
- Department of Cardiology, Gregorio Marañon University Hospital and CIBERCV, Madrid, Spain
| | - B J M Mulder
- Heart Center, Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - J R de Groot
- Heart Center, Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
25
|
Salama AK, Li S, Macrae ER, Park JI, Mitchell EP, Zwiebel JA, Chen HX, Gray RJ, McShane L, Rubinstein L, Patton D, Williams PM, Hamilton SR, Armstrong DK, Conley BA, Arteaga CL, Harris L, O'Dwyer PJ, Chen AP, Flaherty K. Dabrafenib and trametinib in patients with tumors with BRAF V600E/K mutations: Results from the molecular analysis for therapy choice (MATCH) Arm H. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3002 Background: The NCI-MATCH precision medicine trial assigns patients (pts) with solid tumors, lymphomas, or multiple myeloma with progression on prior treatment to a targeted therapy based on genetic alterations identified in pre-treatment biopsies. Arm H (EAY131-H) evaluated the combination of the BRAF inhibitor (inh) dabrafenib (DAB), and the MEK inh, trametinib (TRM), in pts with BRAF V600E/K mutations. Methods: Pts with melanoma, thyroid, or colorectal cancer were excluded. Pts with NSCLC were excluded after the U.S. Food and Drug Administration (FDA) approved DAB/TRM for this indication. Pts received DAB 150 mg po BID and TRM 2 mg PO daily on 28 day cycles until disease progression or intolerable toxicity; restaging was performed every 2 cycles. The primary endpoint was objective response rate (ORR); secondary endpoints included progression-free survival (PFS), 6-month PFS, and overall survival (OS). Results: A total of 35 pts were enrolled from 1/2016-2/2018; 2 were ineligible (CrCl below criteria; labs out of window). Over 17 distinct tumor histologies were represented. 58% of pts were female, median age was 63 (range 21-85), 94% were Caucasian, and 48% of pts had received at least 3 prior therapies (range 1- 8). The confirmed ORR was 33.3% (90% CI 19.9%, 49.1%), with a median duration of response (DoR) of 12 months (mon). Varied histologies had a DoR of > 12 mon: histiocytic sarcoma, cholangiocarcinoma and mixed adenoneuroendocrine carcinoma of unknown primary, among others. Median PFS was 9.4 mon; the 6 mon PFS rate was 70.6% (90% CI 58.2%-85.5%), and an additional 10 pts had a PFS > 5.5 mon. Median OS has not been reached. At the time of data cutoff (12/2018) 11 pts continue on treatment. Adverse events (AE) were comparable to previously reported profiles of DAB/TRM; no new AEs were identified. The most frequent grade 3 AEs were fatigue, neutropenia, hyponatremia, hypophosphatemia, and urinary tract infection; there was 1 grade 4 sepsis; no grade 5 AEs. Conclusions: In this pre-treated, mixed histology cohort, DAB and TRM showed promising activity outside of currently approved FDA indications warranting further investigations. Correlative analyses are planned. Clinical trial information: NCT02465060.
Collapse
Affiliation(s)
| | - Shuli Li
- E-A Biostatistical Center-Boston, Boston, MA
| | | | | | | | | | | | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Lisa McShane
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Lawrence Rubinstein
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - David Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | - Paul M. Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Deborah Kay Armstrong
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | - Barbara A. Conley
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Peter J. O'Dwyer
- University of Pennsylvania Abramson Cancer Center, Division of Medical Oncology, Philadelphia, PA
| | - Alice P. Chen
- Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, MD
| | - Keith Flaherty
- Dana-Farber Cancer Institute/Harvard Medical School and Massachusetts General Hospital, Boston, MA
| |
Collapse
|
26
|
Tricoli JV, Zane L, Harrington R, Yee L, Harper KN, Chang TC, Harris L, Chen AP, Flaherty K, O'Dwyer PJ, Conley BA, Winter C, Lee J, Williams PM, Sklar J, Patton D, Tsongalis GJ, Hamilton SR, Iafrate AJ, Karlovich CA. Design and development of the molecular analysis for Therapy Choice (NCI-MATCH) Designated Laboratory Network. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3016 Background: NCI-MATCH is a precision medicine trial that assigns treatment to refractory cancer patients by tumor mutation profile rather than by histology. After screening fresh tumor biopsies from nearly 6000 patients many treatment arms did not meet accrual due to the low prevalence of the eligible variants. NCI MATCH developed an approach to identify patients for the remaining arms utilizing a network of academic and commercial CLIA-certified labs that perform NGS assays as routine care at MATCH participating sites. Methods: Candidate labs were recruited through a notice in the Federal Register and posted on the NCI and ECOG ACRIN web sites. Twenty-seven labs (17 academic/10 commercial) submitted applications. After acceptance each lab analyzed a common set of 10 DNAs extracted from 8 cell lines and 2 clinical samples for concordance with the central NCI-MATCH NGS assay. Results: For the 17 labs with concordance results, a median of 8 (range 2 – 58) copy number variants (CNVs) were evaluated by the NGS assay of each DL, with the number evaluated depending on each lab’s clinical assay panel content. CNV concordance between central and DL assays, as measured by positive percent agreement (PPA), averaged 98.7% (range 87.5% - 100%) with the central assay as referent and 94.1% (range 77.8% – 100%) with the DL assay as referent. For single nucleotide variants (SNVs) and Insertion/deletions (Indels) combined, a median of 19 variants (range 11 – 26) were evaluated by each DL for concordance. PPA between central and DL assays averaged 98.0% (range 87.5% – 100%) and 98.6% (range 90.0% – 100%) with central and DL assay as referents, respectively. Strong correlations were observed between central and DL assays for both CNVs (median r = 0.93; 0.33 – 1.00) and SNV/Indels (median r = 0.98; 0.67 – 0.99). Conclusions: Our results suggest that different NGS assay platforms using diverse strategies for target enrichment and data analysis may still achieve high concordance if pre-analytical variables are minimized and the common genomic regions interrogated by each assay are well-understood. The designated lab network allows for a wider search for rare variants in tumors and provides a model for conducting future clinical trials. Clinical trial information: NCT02465060.
Collapse
Affiliation(s)
| | - Linda Zane
- Division of Cancer Treatment and Diagnosis, Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Robin Harrington
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Laura Yee
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Kneshay N. Harper
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Ting-Chia Chang
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Alice P. Chen
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Keith Flaherty
- Dana-Farber Cancer Institute/Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Peter J. O'Dwyer
- University of Pennsylvania Abramson Cancer Center, Division of Medical Oncology, Philadelphia, PA
| | - Barbara A. Conley
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Cynthia Winter
- Biomedical Applications Development Center, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Paul M. Williams
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Jeffrey Sklar
- Yale School of Medicine, Yale University, New Haven, CT
| | - David Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | - Gregory J. Tsongalis
- The Geisel School of Medicine at Dartmouth and Dartmouth Hitchcock Medical Center, Lebanon, NH
| | | | | | - Chris Alan Karlovich
- Molecular Characterization Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | |
Collapse
|
27
|
Salgado R, Solit DB, Rimm DL, Bogaerts J, Canetta R, Lively T, Lyerly K, Span PN, Bateman-House A, Makady A, Bergmann L, Nagai S, Smith C, Robson M, Savage M, Voest E, Sweeney C, Lambin P, Thomas M, Harris L, Lacombe D, Massard C. Addressing the dichotomy between individual and societal approaches to personalised medicine in oncology. Eur J Cancer 2019; 114:128-136. [PMID: 31060925 DOI: 10.1016/j.ejca.2019.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022]
Abstract
Academic, industry, regulatory leaders and patient advocates in cancer clinical research met in November 2018 at the Innovation and Biomarkers in Cancer Drug Development meeting in Brussels to address the existing dichotomy between increasing calls for personalised oncology approaches based on individual molecular profiles and the need to make resource and regulatory decisions at the societal level in differing health-care delivery systems around the globe. Novel clinical trial designs, the utility and limitations of real-world evidence (RWE) and emerging technologies for profiling patient tumours and tumour-derived DNA in plasma were discussed. While randomised clinical trials remain the gold standard approach to defining clinical utility of local and systemic therapeutic interventions, the broader adoption of comprehensive tumour profiling and novel trial designs coupled with RWE may allow patient and physician autonomy to be appropriately balanced with broader assessments of safety and overall societal benefit.
Collapse
Affiliation(s)
- Roberto Salgado
- Department of Pathology GZA-ZNA, Antwerp, Belgium; Division of Research, Peter Mac Callum Cancer Center, Melbourne, Australia.
| | - David B Solit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David L Rimm
- Dept. of Pathology, Yale University School of Medicine, New Haven, CT, USA; Dept. of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | | | | | | | - Paul N Span
- Radiotherapy and OncoImmunology Laboratory, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Amr Makady
- The National Healthcare Institute (ZIN), Diemen, the Netherlands
| | - L Bergmann
- Medical Clinic II, University Hospital Frankfurt, Germany; Ambulantes Krebszentrum Frankfurt, Germany
| | - Sumimasa Nagai
- Translational Research Center, The University of Tokyo Hospital and PMDA, Tokyo, Japan
| | - Chris Smith
- CRUK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Emile Voest
- The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Philippe Lambin
- The D-Lab & The M-Lab, Department of Precision Medicine, GROW Research Institute for Oncology, Maastricht, The Netherlands
| | | | | | | | | | | |
Collapse
|
28
|
Harris L, Hateley S, Seemungal B. P22 Phenytoin versus levetiracetam for post traumatic brain injury seizure prophylaxis; a retrospective study at a UK major trauma centre. J Neurol Neurosurg Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives12% of patients with severe Traumatic brain injury (TBI) suffer from seizures. Evidence suggests that the use of an antiepileptic drug (AED) is beneficial in preventing early post TBI seizures. To date, no specific NICE guidelines exist on the choice of post TBI seizure prophylaxis. This study aims to identify the trend in AED usage, the impact on length of stay and to compare the tolerability of phenytoin and levetiracetam.DesignRetrospective observational study.Subjects201 patients.MethodsAll patients admitted to a Major Trauma Unit following a head injury treated with levetiracetam or phenytoin for seizure prophylaxis were included in the study. Data was collected between October 2013 – September 2014 and November 2016 – October 2017. Patient demographics, Glasgow Coma Score (GCS) on admission, length of treatment, AED toxicity, length of stay, complications, surgical input and length of ITU stay were recorded.Results85.6% of patients were treated with phenytoin in 2013–2014% and 82.5% were treated with levetiracetam in 2016–2017. The average length of stay for phenytoin was 23.2 days and 13.9 days for levetiracetam. Subgroup analysis was performed on patients with an admission GCS of 14–15. Length of stay for phenytoin was 14.9 days (SD −11.87) and levetiracetam 9.4 days (SD 10.588) (p=0.07). 24% of patients on phenytoin and 14% on levetiracetam suffered from dizziness.ConclusionsThis suggests that levetiracetam is tolerated better with fewer side effects. We recommend its use in clinical practice.
Collapse
|
29
|
Tanioka M, Parker JS, Henry LN, Tolaney S, Dang C, Krop IE, Harris L, Polley M, Berry DA, Winer EP, Carey LA, Perou CM. Abstract P3-08-04: Transient state change, but not permanent subtype change, after HER2-targeted therapy for HER2-positive breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In CALGB 40601 (Alliance, NCT00770809), a neoadjuvant phase III trial of paclitaxel and trastuzumab with or without lapatinib for 12 weeks for patients with HER2-positive breast cancer, 33% of pretreatment tumors were Luminal A subtype, however, 69% of post-treatment samples with residual disease were Luminal A subtype. In addition, 71% of Luminal B (12/17) and 67% of HER2-Enriched (6/9) tumors changed into Luminal A, while 80% of Luminal A (20/24) remained Luminal A (Carey et al. J Clin Oncol. 2016). It is not known whether this shift to Luminal A was transient or permanent.
Methods: We selected matched pairs of pre- and post-treatment 40601 samples with tumor purity >10% based upon DNA analyses to ensure all samples contained tumor. PAM50 intrinsic subtyping was applied to the 40601 samples gene expression data using a two-step normalization process based on The Genome Cancer Atlas, and PAM50 training set. In addition, a HER2-enriched expression subtype patient-derived xenograft (PDX) tumor called WHIM35, was studied and was either untreated (n=10), or treated with lapatinib at 220 mg/kg for 1 week (wk) (n=5), for 2 wks (n=8), or for 3 wks (n=4). We also treated WHIM35 tumors with lapatinib for 2 wks (on) and then removed laptinib for 1 wk (off) (n=6), or for 2 wks on and 2-4 wk off (n=6), and finally for 3 wks on, and 1 wk off (n=3). PAM50 intrinsic subtyping was applied to the PDX gene expression data and subtype assessed as well as a genomic-based proliferation score. ANOVA p-values were calculated by comparing median values across all gene signature or correlation scores.
Results: We found 10 pairs of 40601 samples that kept their tumor purity values, however, their subtype changed to Luminal A after treatment (i.e., in the residual disease), and in these cases no minor tumor subclone became a dominant clone in the post treatment sample. Pretreatment subtypes were 6 Luminal B, 3 Luminal A, and 1 HER2-enriched. The tumor purity values did not change after the treatments, but correlation to Luminal A was significantly higher (p=0.01), while correlation to HER2-enriched (p=0.004) and proliferation signature scores (p=0.003) were significantly lower in the post-treatment samples. Among the WHIM35 PDX tumors, one sample changed its subtype from HER2-enriched to Luminal A after the lapatinib treatment and the rest remained HER2-enriched, suggesting environmental differences between patient samples and the PDX model. However, correlation to Luminal A was significantly higher in all lapatinib treated WHIM35 samples (p=8.3e-12), and notably went back to the initial low levels just one week after removing lapatinib. Likewise, correlation to HER2-enriched (p=1.2e-10) and proliferation signature scores (p=6.2e-12) also got lower while treated with lapatinib, but went back to the initial levels after cessation of treatment.
Conclusions: Our findings suggest that the apparent subtype change during HER2-targeting therapy is not permanent, but is more likely a transient state change from a HER2-enriched subtype into a more Luminal A-like state. When we plan additional treatment strategies using residual disease phenotypes, it may not be clear what is the true subtype of the sample due to this inherent plasticity.
Citation Format: Tanioka M, Parker JS, Henry LN, Tolaney S, Dang C, Krop IE, Harris L, Polley M, Berry DA, Winer EP, Carey LA, Perou CM. Transient state change, but not permanent subtype change, after HER2-targeted therapy for HER2-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-04.
Collapse
Affiliation(s)
- M Tanioka
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - JS Parker
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - LN Henry
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - S Tolaney
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - C Dang
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - IE Krop
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - L Harris
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - M Polley
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - DA Berry
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - EP Winer
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - LA Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| | - CM Perou
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; University of North Carolina, Chapel Hill; University of Utah, Salt Lake City; Dana-Farber/Partners CancerCare, Boston; Memorial Sloan Kettering Cancer Center, New York; National Cancer Institute, Washington; Alliance Statistics and Data Center, Mayo Clinic, Rochester; Alliance Statistics and Data Center, M.D. Anderson, Houston
| |
Collapse
|
30
|
Abstract
ObjectivesType 2 peg fractures are known to have low fusion rates but most are elderly with comorbidities and not fit for surgery. Increasingly, clinicians want to stop using hard collars due to its complications, but with little supporting evidence. We aim to provide data to add to this debate.DesignSingle centre cohort study.Subjects145 consecutive patients referred to a Major Trauma Centre as type 2 peg fracture.MethodsAll patients referred with a suspected peg fracture between March 2015 and December 2017 were included. All imaging were assessed and case notes reviewed for patient demographics, fracture management, complications and outcomes.Results102 cases were peg fractures (mean age=80 years). 92 (90.2%) were managed conservatively with a hard collar (mean of 87 days). 37% developed symptoms from the collar, namely pain, stiffness and non-tolerance. Bony union was achieved in only 39.1% of patients with increasing age being an independent risk factor (p<0.001). Of the 56 patients who did not have bony union, there were no reported symptoms and 90% were discharged without a collar. 2 patients were offered but declined fixation and neither reported any on-going symptoms.ConclusionsThis study adds to the body of evidence that fusion rates are low, and collar complications are not insignificant when type 2 peg fractures are treated in a hard collar. However, outcomes are good regardless of union, potentially rendering the collar unnecessary. We aim to conduct a randomised prospective study to further investigate.
Collapse
|
31
|
Harris L, Hankey C, Jones N, Murray H, Pert C, Tobin J, Boyle S, Shearer R, Melville CA. Process evaluation of a cluster-randomised controlled trial of multi-component weight management programme in adults with intellectual disabilities and obesity. J Intellect Disabil Res 2019; 63:49-63. [PMID: 30417575 DOI: 10.1111/jir.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/10/2018] [Accepted: 09/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Providing effective weight management to adults with intellectual disabilities is necessary to challenge the high rates of obesity. The aim of this process evaluation was to explore the feasibility of conducting a full-scale clinical trial of the TAKE 5 multi-component weight management programme. METHODS The study was a 12-month pilot cluster-randomised controlled trial. Adults with intellectual disabilities and obesity were randomised to either TAKE 5, which included an energy deficit diet (EDD) or Waist Winners Too, based on health education principles. A mixed-methods process evaluation was conducted focussing on the reach, recruitment, fidelity, implementation, dose (delivered/received) and context. RESULTS The study successfully recruited adults with intellectual disabilities. Both weight management programmes were delivered with high fidelity and implemented as intended. Only one weight management programme, TAKE 5, demonstrated potential efficacy in reducing body weight and body composition. The effectiveness was largely attributed to the EDD and social support from carers. CONCLUSIONS The extensive process evaluation illustrated that a full-scale trial of a multi-component programme including an EDD is feasible and an acceptable approach to weight management for adults with intellectual disabilities and obesity.
Collapse
Affiliation(s)
- L Harris
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Hankey
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N Jones
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - H Murray
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Pert
- Learning Disability Psychology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J Tobin
- Glasgow City CHP North East Sector, Eastbank Conference Training Centre, Glasgow, UK
| | - S Boyle
- Consultant Clinical Psychologist NHS Greater, Glasgow, UK
| | - R Shearer
- Glasgow and Clyde Specialist Weight Management Service, Glasgow, UK
| | - C A Melville
- College of Medical Veterinary and Life Sciences, Institute of Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
32
|
Street LM, Harris L, Curry RS, Eisenach JC. Capsaicin-induced pain and sensitisation in the postpartum period. Br J Anaesth 2018; 122:103-110. [PMID: 30579387 DOI: 10.1016/j.bja.2018.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/20/2018] [Revised: 09/12/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recovery from Caesarean delivery in women and surgical nerve injury in animals after delivery is more rapid than expected, an effect reversed in animals by spinal injection of an oxytocin receptor antagonist. We hypothesised that endogenous modulation of acute pain is altered postpartum. METHODS Endogenous inhibition of acute pain in a conditioned pain modulation paradigm or endogenous sensitisation by topical capsaicin was tested in women who were breastfeeding 10-14 days after Caesarean delivery and age-matched controls (n=80 total: 20 per group and 20 per test). The study was powered to detect a difference in area of hyperalgesia after capsaicin of 33%. Capsaicin-evoked pain was recorded in women, and capsaicin-evoked mechanical hypersensitivity was measured in rats 48 h after delivery and in age-matched female and male animals. RESULTS There was no effect of the postpartum period in the endogenous sensitisation assay in women, and the conditioned pain modulation assay failed to produce analgesia in either group. Postpartum women, however, reported less intense pain than controls at the end of topical capsaicin exposure (1.3 [1.4] vs 2.0 [2.0] on 0-10 verbal scale), and acute hypersensitivity after capsaicin was less in postpartum than control rats (withdrawal threshold 25 [15] vs 3.6 [1] g). CONCLUSIONS These results agree with a recent report that oxytocin may desensitise the transient receptor potential for vanilloid-1 channel, although other explanations, including hormone effects, are possible. These results do not, however, support the inhibition of capsaicin-evoked spinal sensitisation in the postpartum period. CLINICAL TRIAL REGISTRATION NCT01843517.
Collapse
Affiliation(s)
- L M Street
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA
| | - L Harris
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - R S Curry
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - J C Eisenach
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
33
|
Parker C, Emlet C, Furlotte C, Harris L. SEXUALITY AND INTIMACY AMONG OLDER ADULTS LIVING WITH HIV IN ONTARIO: CHANGES, CHALLENGES, AND CONCERNS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - C Emlet
- University of Washington, Tacoma
| | | | - L Harris
- Kent School of Social Work, University of Louisville
| |
Collapse
|
34
|
Harris L, Rocca C, Upadhyay U, Dworkin S, Ndunyu L, Gitome S, Bukusi E, Newmann S. Reproductive autonomy and covert contraceptive use in Nyanza, Kenya. Contraception 2018. [DOI: 10.1016/j.contraception.2018.07.088] [Citation(s) in RCA: 5] [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: 11/15/2022]
|
35
|
Tanioka M, Parker JS, Henry LN, Tolaney S, Dang C, Krop IE, Harris L, Hillman D, Polley M, Berry DA, Winer EP, Carey LA, Perou CM. A prognostic model integrating clinical data and gene signatures in phase III neoadjuvant trial CALGB 40601 (Alliance). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Axinte L, Harris L. CT head scans for head injury; Are we NICE enough... Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
37
|
Tsung K, Thompson CL, Knight JM, Maximuk S, Sadri N, Gilmore H, Keri R, Vinayak S, Harris L, Silverman P. A breast multi-disciplinary genomic tumor board is feasible and can provide timely and impactful recommendations. Breast J 2018. [DOI: 10.1111/tbj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Karen Tsung
- University Hospitals Seidman Cancer Center; Cleveland OH USA
| | - Cheryl L. Thompson
- Department of Nutrition; Case Western Reserve University; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | - Joy M. Knight
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | - Steve Maximuk
- University Hospitals Seidman Cancer Center; Cleveland OH USA
| | - Navid Sadri
- University Hospitals Seidman Cancer Center; Cleveland OH USA
| | - Hannah Gilmore
- University Hospitals Seidman Cancer Center; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | - Ruth A. Keri
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
- Department of Pharmacology; Case Western Reserve University; Cleveland OH USA
- Department of Genetics and Genome Sciences; Case Western Reserve University; Cleveland OH USA
| | - Shaveta Vinayak
- University Hospitals Seidman Cancer Center; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| | | | - Paula Silverman
- University Hospitals Seidman Cancer Center; Cleveland OH USA
- Case Comprehensive Cancer Center; Case Western Reserve University; Cleveland OH USA
| |
Collapse
|
38
|
Harbhajanka A, Chahar S, Miskimen K, Silverman P, Harris L, Williams N, Varadan V, Gilmore H. Clinicopathological, immunohistochemical and molecular correlation of neural crest transcription factor SOX10 expression in triple-negative breast carcinoma. Hum Pathol 2018; 80:163-169. [PMID: 29894722 DOI: 10.1016/j.humpath.2018.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/23/2018] [Accepted: 06/01/2018] [Indexed: 12/21/2022]
Abstract
The transcription factor SOX10 mediates the differentiation of neural crest-derived cells, and SOX10 by immunohistochemistry (IHC) is used primarily for the diagnosis of melanoma. SOX10 expression has been previously documented in benign breast myoepithelial cells. However there is limited literature on its expression in triple-negative breast carcinoma (TNBC). The aim was to study the clinical, pathologic and molecular profiles of SOX10+ tumors in TNBC. Tissue microarrays of TNBC were evaluated for SOX10 expression in 48 cases. SOX10 expression was correlated with clinical and pathologic features such as age, grade, and stage. Gene expression was analyzed on RNA extracted from formalin-fixed paraffin-embedded (FFPE) specimens with Affymetrix 2.0 HTA. Co-expression of SOX10 with androgen receptor (AR), WT1, gross cystic disease fluid protein-15 (GCDFP-15), mammaglobin, epidermal growth factor receptor (EGFR), CK5/6 and GATA transcription factor 3 (GATA3) were also assessed. The mean age was 59.38 (range, 28-90 years). Overall, 37.5% cases (18/48) were SOX10+. There was no association between SOX10 expression and age, grade or stage of patients; 6 of 10 (60%) cases of basal-like 1 (BL1), and 5 of 8 cases of unstable (UNS) molecular subtype were SOX10+. One of 5 basal-like-2 (BL2), 1 of 6 immunomodulatory (IM), 1 of 4 mesenchymal (M), 1 of 5 luminal androgen receptor (LAR) and 2 of 8 mesenchymal stem cell (MSL) showed lower frequencies of SOX10 expression. There was negative correlation between SOX10 and AR+ subtypes (P < .002). SOX10 was positively correlated with WT1 (P = .05). SOX10 did not show significant correlation with mammaglobin, GCDFP15, EGFR, CK5/6 and GATA3. SOX10 expression in the basal-like and unstable molecular subtypes supports the concept that these neoplasms show myoepithelial differentiation.
Collapse
Affiliation(s)
- Aparna Harbhajanka
- Department of Pathology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH.
| | - Satyapal Chahar
- Department of Pathology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH
| | - Kristy Miskimen
- Department of Epidemiology and Biostatistics, Case Western Reserve University, 44106 Cleveland, OH
| | - Paula Silverman
- Department of Medicine, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH
| | | | - Nicole Williams
- Department of Medicine, The Ohio State University Hospitals, 43210 Columbus, OH
| | - Vinay Varadan
- Case Comprehensive Cancer Center, Case Western Reserve University, 44106 Cleveland, OH
| | - Hannah Gilmore
- Department of Pathology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH
| |
Collapse
|
39
|
Jhaveri KL, Makker V, Wang XV, Chen AP, Flaherty K, Conley BA, O'Dwyer PJ, Williams PM, Hamilton SR, Harris L, McShane L, Rubinstein L, Gray RJ, Li S, Mitchell EP, Patton D, Moscow J, Zwiebel JA, Arteaga CL, Luoh SW. Ado-trastuzumab emtansine (T-DM1) in patients (pts) with HER2 amplified (amp) tumors excluding breast and gastric/gastro-esophageal junction (GEJ) adenocarcinomas: Results from the National Cancer Institute (NCI) Molecular Analysis for Therapy Choice (MATCH) trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alice P. Chen
- Early Clinical Trials Development Program, DCTD, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | | | | - Peter J. O'Dwyer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Paul M. Williams
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | | | | | | | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - David Patton
- National Cancer Institute/Center for Biomedical Informatics & Information Technology, Rockville, MD
| | | | | | | | | |
Collapse
|
40
|
Takebe N, O'Sullivan Coyne GH, Kummar S, Do KT, Bruns A, Juwara L, Quinn MF, Harris L, Piekarz R, Prindiville SA, Sharon E, Streicher H, Mugundu G, Ji JJ, Wilsker D, Kinders RJ, Rubinstein L, Doroshow JH, Chen AP. Safety, tolerability, and antitumor activity of once-daily Wee-1 inhibitor AZD1775. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Shivaani Kummar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Khanh Tu Do
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | | | | | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Richard Piekarz
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | | | | | - Howard Streicher
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD
| | | | - Jiuping Jay Ji
- National Clinical Target Validation Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | - Larry Rubinstein
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - James H. Doroshow
- Center for Cancer Research, Division of Cancer Treatment and Diagnosis, Bethesda, MD
| | - Alice P. Chen
- Early Clinical Trials Development Program, DCTD, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| |
Collapse
|
41
|
Krop IE, Jegede O, Grilley-Olson JE, Lauring JD, Hamilton SR, Zwiebel JA, Li S, Rubinstein L, Doyle A, Patton DR, Mitchell EP, Arteaga CL, Conley BA, Sims D, Harris L, Chen AP, Flaherty K. Results from molecular analysis for therapy choice (MATCH) arm I: Taselisib for PIK3CA-mutated tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.101] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | - David Sims
- Frederick National Laboratory of Cancer Research, Frederick, MD
| | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Alice P. Chen
- Early Clinical Trials Development Program, DCTD, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | |
Collapse
|
42
|
Takebe N, O'Sullivan Coyne GH, Kummar S, Reid JM, Piekarz R, Harris L, Juwara L, Quinn MF, Moore N, Choyke PL, Mena E, Lindenberg L, Lin F, Goetz MP, McGovern RM, Streicher H, Covey JM, Collins JM, Doroshow JH, Chen AP. Phase I trial of z-endoxifen with estrogen receptor imaging in adults with advanced hormone receptor–positive solid tumors including desmoid and gynecologic tumors. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Shivaani Kummar
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Joel M. Reid
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Richard Piekarz
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | | | | | - Nancy Moore
- DCTD, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L. Choyke
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Esther Mena
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | | - Frank Lin
- National Institutes of Health, National Cancer Institute, Bethesda, MD
| | | | | | - Howard Streicher
- Division of Cancer Treatment and Diagnosis, National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD
| | | | - Jerry M. Collins
- National Cancer Institute/Division of Cancer Treatment and Diagnosis, Rockville, MD
| | - James H. Doroshow
- Center for Cancer Research, Division of Cancer Treatment and Diagnosis, Bethesda, MD
| | - Alice P. Chen
- Early Clinical Trials Development Program, DCTD, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| |
Collapse
|
43
|
Chae YK, Vaklavas C, Cheng HH, Hong F, Harris L, Mitchell EP, Zwiebel JA, McShane L, Gray RJ, Li S, Ivy SP, Ansher SS, Hamilton SR, Williams PM, Tricoli JV, Arteaga CL, Conley BA, O'Dwyer PJ, Chen AP, Flaherty K. Molecular analysis for therapy choice (MATCH) arm W: Phase II study of AZD4547 in patients with tumors with aberrations in the FGFR pathway. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2503] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | - Edith P. Mitchell
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Shuli Li
- Dana-Farber Cancer Institute, Boston, MA
| | - S. Percy Ivy
- National Cancer Institute at the National Institutes of Health, Rockville, MD
| | | | | | - Paul M. Williams
- Frederick National Laboratory for Cancer Research, Frederick, MD
| | | | | | | | - Peter J. O'Dwyer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Alice P. Chen
- Early Clinical Trials Development Program, DCTD, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | | |
Collapse
|
44
|
Singh S, Harris L, Gilmore HL, Cheung YH, Dimitrova N, Varadan V. InFlo: A systems biology framework to discover molecular mechanisms underlying response to therapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e12635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Salendra Singh
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Lyndsay Harris
- Cancer Diagnosis Program, National Cancer Institute, Rockville, MD
| | | | | | | | - Vinay Varadan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| |
Collapse
|
45
|
McGarty AM, Downs SJ, Melville CA, Harris L. A systematic review and meta-analysis of interventions to increase physical activity in children and adolescents with intellectual disabilities. J Intellect Disabil Res 2018; 62:312-329. [PMID: 29277930 DOI: 10.1111/jir.12467] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/26/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Increasing physical activity (PA) through intervention can promote physical and mental health benefits in children and adolescents. However, children and adolescents with intellectual disabilities (ID) have consistently been shown to engage in low levels of PA, which are insufficient for long-term health. Despite this, little is known about the effectiveness of interventions to increase PA in children and adolescents with ID. The aims of this study were therefore to systematically review how effective interventions are at increasing PA levels in children and adolescents with ID and to further examine what components have been used in these interventions. METHOD A systematic search of MEDLINE, EMBASE, Education Resources Information Center, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, Cochrane Central Register for Controlled Trials and International Standard Randomised Controlled Trial Number trials registry was conducted (up to July 2016). Articles were included if they met the following eligibility criteria: children and adolescents (<18 years) with ID, measurement of PA at baseline and post-intervention and intervention studies. Effect sizes were calculated as standardised mean difference (d) and meta-analysis calculated between intervention and no treatment control intervention. RESULTS Five studies met the eligibility criteria and were included in the review. Study design, methodological quality and intervention components were varied. Interventions did not support sufficient changes in PA to improve health. The meta-analysis demonstrated that intervention groups were not more effective at increasing PA levels post-intervention (d: 2.20; 95% CI -0.57 to 0.97) compared with control. However, due to a decrease in PA in the control intervention, a moderate significant effect was demonstrated at follow-up (d: 0.49; 95% CI 0.14 to 0.84). CONCLUSIONS There is a lack of studies which aim to increase PA levels in children and adolescents with ID, with current interventions ineffective. Future studies are required before accurate recommendations for appropriate intervention design and components can be made.
Collapse
Affiliation(s)
- A M McGarty
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - S J Downs
- Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - C A Melville
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - L Harris
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
46
|
Abstract
c-erbB-2 is an oncoprotein which is overexpressed in up to 40% of primary breast cancers. c-erbB-2 overexpression is a bad prognostic factor in patients with lymph node-positive disease. Unfortunately, there has been no agreement to date on whether c-erbB-2 overexpression is of prognostic significance in patients with lymph node-negative disease. c-erbB-2 overexpression is correlated with the absence of estrogen receptor expression in a number of publications. Correlation between c-erbB-2 overexpression and hormone sensitivity in the clinical setting is less well established and is the focus of ongoing studies. Both preclinical and clinical studies support an association between c-erbB-2 receptor overexpression and resistance to alkylating agents. In contrast, the data for c-erbB-2 and anthracyclines should be viewed in a slightly different manner. Anthracyclines appear to have a greater therapeutic effect in c-erbB-2-positive disease which may be dose sensitive. In c-erbB-2-negative disease not only is the therapeutic effect reduced but there does not appear to be any improved response to higher doses of anthracyclines. The data for c-erbB-2 and the taxanes is still not clear enough to provide any definite conclusions. If there is a correlation it would at present appear to be between paclitaxel and response rates, but this needs to be confirmed in larger studies. Few studies have looked at changes in c-erbB-2 on therapy. Those that have seem to show no significant change on either tamoxifen or chemotherapy.
Collapse
Affiliation(s)
- E Tagliabue
- Division of Experimental Oncology E, Istituto Nazionale Tumori, Milan, Italy.
| | | | | | | |
Collapse
|
47
|
Abstract
c-erbB-2 is an oncoprotein which is overexpressed in some breast cancers. Recently it has been established that the extracellular domain of c-erbB-2 is shed into the serum of patients with breast cancer. There appears to be no association between tumor stage and extracellular domain of c-erbB-2 (c-erbB-2/ECD): c-erbB-2/ECD seems to correlate with patient prognosis whatever the stage of disease. The data also suggest that c-erbB-2/ECD may be useful in monitoring for tumor recurrence and in predicting resistance to hormonal therapy, but not as useful in predicting response to chemotherapy. This may relate to the power of this marker to reflect disease burden, which has an overwhelmingly negative impact on outcome.
Collapse
Affiliation(s)
- L Harris
- Department of Hematology/Oncology, Duke University, Durham, North Carolina, USA
| | | | | | | |
Collapse
|
48
|
Lacy B, Harris L, Chang L, Lucak S, Gutman C, Dove L, Covington P, Lembo A. A169 EFFICACY AND SAFETY OF ELUXADOLINE IN ELDERLY PATIENTS WITH IRRITABLE BOWEL SYNDROME WITH DIARRHEA. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Lacy
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - L Chang
- University of California, Los Angeles, CA
| | - S Lucak
- Weill Cornell Medical Center, New York, NY
| | | | - L Dove
- Former employee of Furiex Pharmaceuticals, Inc., an affiliate of Allergan plc, Parsippany, NJ
| | - P Covington
- Former employee of Furiex Pharmaceuticals, Inc., an affiliate of Allergan plc, Parsippany, NJ
| | - A Lembo
- Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
49
|
Krop IE, Hillman D, Polley MY, Tanioka M, Parker J, Huebner L, Henry NL, Tolaney SM, Dang C, Harris L, Berry DA, Perou CM, Partridge A, Winer EP, Carey LA. Abstract GS3-02: Invasive disease-free survival and gene expression signatures in CALGB (Alliance) 40601, a randomized phase III neoadjuvant trial of dual HER2-targeting with lapatinib added to chemotherapy plus trastuzumab. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs3-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose
Dual HER2 targeting increases pathologic complete response (pCR) rate to neoadjuvant therapy and improves outcomes in both early and metastatic HER2-positive disease. CALGB 40601 is a randomized phase III trial examining the impact of dual HER2 blockade consisting of trastuzumab (H) and lapatinib (L) added to paclitaxel (T) on pCR, considering tumor and microenvironment molecular features. We previously found that pCR was numerically but not significantly increased with dual therapy, and that tumor molecular subtype and evidence of immune activation significantly and independently affected pCR (Carey et al, JCO 2016). In this secondary analysis, we sought to evaluate the effects of treatment arm and gene expression-defined subgroups on invasive disease free survival (IDFS).
Patients and Methods
Patients (Pts) with stage II to III HER2-positive breast cancer underwent tumor biopsy followed by random assignment with equal probabilityto paclitaxel plus trastuzumab alone (TH) or with the addition of lapatinib (THL) for 16 weeks before surgery. A paclitaxel plus lapatinib (TL) arm was closed early based on reports of futility from other trials. A secondary endpoint was IDFS, defined as the time from surgery until local or distant recurrence, new primary, or death from any cause, whichever was first. Gene expression signatures were identified by RNA sequencing.
Results
Between 12/2008 and 2/2012, 305 pts were enrolled. 261 pts had IDFS and gene expression information available (THL, n = 103; TH, n =101; TL, n = 57); there were no significant differences in clinical characteristics between this subset and the entire population. The median IDFS follow-up was 4.6 years with 40 IDFS events having occurred (THL, n=7; TH, n=19; TL, n=14). IDFS was significantly longer in the THL arm compared to standard TH (HR=0.34; 95% CI: 0.14-0.82; p=0.02). IDFS was also significantly longer among pCR than non-pCR pts (HR=0.40; 95% CI: 0.19-0.81; p=0.01), and did not differ by hormone receptor (HR) status, clinical stage, tumor size, race, menopausal status or age. Among gene expression signatures, only immune activation measured by an IgG signature was associated with longer IDFS (HR=0.71; 95% CI: 0.51-0.98; p=0.04); this signature was previously also associated with pCR. Multivariate analysis showed dual therapy (HR=0.35; p=0.02), pCR (HR=0.36; p=0.01), IgG (HR=0.69; p=0.05), and molecular subtype (LumA vs HER2E, HR=0.24, p=0.005) were associated with longer IDFS. A subgroup analysis by hormone receptor status revealed that among pts with HR+ disease, pts with luminal A experienced longer IDFS (HR=0.23; p=0.02) compared to those with luminal B or HER2-enriched molecular subtypes.
Conclusion
Dual HER2-targeting with lapatinib added to 16 weeks of TH produced significantly longer IDFS than TH alone, despite modest effects on pCR. Similar to pts with HER2-negative disease, pts with luminal A had better IDFS than those with other molecular subtypes. Immune activation as measured by RNA-based signature independently predicted both pCR and IDFS.
Support: U10CA180882, U10CA180821, U24CA196171, P50-CA58823, Susan G Komen, BCRF
Citation Format: Krop IE, Hillman D, Polley M-Y, Tanioka M, Parker J, Huebner L, Henry NL, Tolaney SM, Dang C, Harris L, Berry DA, Perou CM, Partridge A, Winer EP, Carey LA. Invasive disease-free survival and gene expression signatures in CALGB (Alliance) 40601, a randomized phase III neoadjuvant trial of dual HER2-targeting with lapatinib added to chemotherapy plus trastuzumab [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS3-02.
Collapse
Affiliation(s)
- IE Krop
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - D Hillman
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - M-Y Polley
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - M Tanioka
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - J Parker
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - L Huebner
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - NL Henry
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - SM Tolaney
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - C Dang
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - L Harris
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - DA Berry
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - CM Perou
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - A Partridge
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| | - LA Carey
- Dana-Farber Cancer Institute, Boston, MA; Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN; University of North Carolina, Chapel Hill, NC; University of Michigan, Ann Arbor, MI; Memorial Sloan Kettering Cancer Center, New York, NY; National Cancer Institute, Bethesda, MD; MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
50
|
Braman N, Prasanna P, Singh S, Beig N, Gilmore H, Etesami M, Bates D, Gallagher K, Bloch BN, Somlo G, Sikov W, Harris L, Plecha D, Varadan V, Madabhushi A. Abstract P4-02-06: Intratumoral and peritumoral MRI signatures of HER2-enriched subtype also predict pathological response to neoadjuvant chemotherapy in HER2+ breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Applying the PAM50 classifier to targeted RNA-Sequencing data allows HER2+ tumors to be sub-categorized into intrinsic breast cancer subtypes. HER2+ breast cancers belonging to the HER2-enriched [HER2-E] subtype exhibit the highest rate of response to neoadjuvant therapy with combination of HER2-blockade and chemotherapy, as well as dual-HER2 blockade alone. A non-invasive predictor of PAM50 subtype from clinical dynamic contrast-enhanced MRI [DCE-MRI] could provide valuable clinical guidance in the treatment of HER2+ breast cancer. In this work, we identify a set of computer-extracted heterogeneity features computed within the lesion and its surrounding peritumoral region capable of distinguishing HER2-E from other HER2+ breast cancers [Non-HER2-E]. We then demonstrate that this imaging signature of HER2-E is also predictive of pathological complete response [pCR] in an independent HER2+ testing set, consistent with the HER2-E subtype's elevated response to HER2-targeted therapy.
Methods: The training set consisted of 42 HER2+ patients with both 1.5 or 3 T DCE-MRI and targeted RNA sequencing collected prior to neoadjuvant treatment from a multicenter trial [BrUOG 211B, n=35] and The Cancer Genome Atlas-Breast Cancer project [TCGA-BRCA, n=7]. Intrinsic subtypes were assigned by unsupervised hierarchical clustering of the PAM50 gene set. 19 patients were determined to belong to the HER2-E subtype, while the remaining 23 represented non-HER2-E subtypes [19 HER2-Luminal, 4 HER2-basal]. Lesion boundaries were annotated by an expertly trained radiologist and expanded to 5 annular peritumoral regions in 3 mm increments out to a maximum radius of 15 mm. Computer-extracted heterogeneity features were computed voxelwise within intratumoral and peritumoral regions by first order statistics. A top HER2-E-associated feature from each region was identified by Wilcoxon feature selection and used to train a diagonal linear discriminant analysis [DLDA] classifier to predict HER2-E in a 3-fold cross-validation setting. This classifier was then applied to pCR prediction from DCE-MRI in a testing set of 28 HER2+ patients with available post neoadjuvant chemotherapy surgical specimens at one institution. 16 patients achieved pCR (ypT0/is), while the remainder had partial or no response (non-pCR).
Results: A combination of heterogeneity features within the intratumoral region and annular peritumoral regions out to 12 mm from the tumor yielded optimal results within the training set, with an average HER2-E prediction AUC of .77 +/- .03. When applied to response prediction in an independent testing set, this HER2-E classifier was predictive of pCR (AUC = .72).
Conclusions: Computer-extracted heterogeneity features calculated within the tumor and the surrounding peritumoral environment on DCE-MRI were able to distinguish the HER2-E PAM50 intrinsic subtype from other HER2+ breast cancers. HER2-E was characterized by elevated expression of intratumoral and peritumoral heterogeneity features, indicating a more disordered imaging phenotype within and around the tumor. Additional independent validation of these findings is needed.
Citation Format: Braman N, Prasanna P, Singh S, Beig N, Gilmore H, Etesami M, Bates D, Gallagher K, Bloch BN, Somlo G, Sikov W, Harris L, Plecha D, Varadan V, Madabhushi A. Intratumoral and peritumoral MRI signatures of HER2-enriched subtype also predict pathological response to neoadjuvant chemotherapy in HER2+ breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-06.
Collapse
Affiliation(s)
- N Braman
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - P Prasanna
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - S Singh
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - N Beig
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - H Gilmore
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - M Etesami
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - D Bates
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - K Gallagher
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - BN Bloch
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - G Somlo
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - W Sikov
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - L Harris
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - D Plecha
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - V Varadan
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| | - A Madabhushi
- Case Western Reserve University, Cleveland, OH; Case Comprehensive Cancer Center, Cleveland, OH; National Institutes of Health; Boston Medical Center, Boston, MA; City of Hope Beckman Research Institute and Medical Center, Duarte, CA; Brown University, Providence, RI
| |
Collapse
|