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Schellenberg D, Gabos Z, Duimering A, Debenham BJ, Fairchild A, Huang F, Rowe L, Severin DM, Giuliani M, Bezjak A, Lok BH, Raman S, Chung P, Zhao Y, Ho C, Lock MI, Louie A, Lefresne S, Carolan H, Liu MC, Yau V, Ye AY, Olson RA, Mou B, Mohamed IG, Petrik DW, Dosani M, Pai HH, Valev B, Gaede S, Warner A, Palma DA. Stereotactic Ablative Radiotherapy for Oligo-Progressive Cancers: Results of the Randomized Phase II STOP Trial. Int J Radiat Oncol Biol Phys 2023; 117:S58. [PMID: 37784530 DOI: 10.1016/j.ijrobp.2023.06.353] [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) In the metastatic setting, there is uncertain benefit to localized eradication of one or more lesions that are progressing despite systemic therapy. This randomized phase II trial examined if patients with ≤5 sites of oligoprogression benefited from the addition of stereotactic ablative radiotherapy (SABR) to standard of care (SOC) systemic therapy. MATERIALS/METHODS Eligibility criteria included age ≥18 years, ECOG performance status 0-2, and oligoprogressive disease, defined as 1-5 lesions actively progressing while on systemic therapy. Patients were required to have at least 3 months of disease stability/response on systemic therapy prior to oligoprogression. After stratifying by type of systemic therapy (cytotoxic vs. non-cytotoxic), patients were randomized 2:1 to SABR to all progressing lesions plus SOC (SABR arm) vs. SOC alone (SOC arm). The trial began exclusive to non-small cell lung cancer but did not meet accrual goals and was expanded in 2019 to include all non-hematologic malignancies. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), lesional control, quality of life (QOL), toxicity, and duration of current systemic agent post-SABR. RESULTS Between February 2017 and June 2021, 90 patients with 125 oligoprogressive metastases were enrolled across 8 Canadian institutions, with 59 patients randomized to SABR and 31 to SOC. Median age was 67 years (IQR: 61-73 years) and 39 (43%) were female. The most common primary sites were lung (44% of patients), genitourinary (23%) and breast (13%), with the most common oligo-progressive locations being lung (43%), bone (19%), lymph nodes (14%), and liver (13%). In the SABR arm, the most common fractionations were 35 Gy/5 (38% of lesions) and 50 Gy/5 (18%). Protocol adherence in the SOC arm was suboptimal: 3 patients (10%) withdrew immediately after randomization, and 7 additional patients (23%) received high-dose or ablative therapies. Median follow-up was 31 months. There was no difference in PFS between arms (median PFS 8.4 months in the SABR arm vs. 4.3 months in the SOC arm; however, the curves cross and 2-year PFS was 9% vs. 24% respectively, p = 0.91). Median OS was 31.2 months vs. 27.4 months, respectively (p = 0.22). Lesional control with SABR was 71% vs. 39% with SOC (p = 0.002). Median duration of post-randomization first-line systemic therapy was 10.3 months vs. 7.6 months, respectively (p = 0.71). Treatment was well-tolerated with 2 (3.4%) grade 3 treatment-related toxicities in the SABR arm and no grade 4/5 related events in either arm. QOL did not differ between arms. CONCLUSION Despite being a well-tolerated treatment providing superior lesional control, SABR for oligoprogression did not improve PFS or OS. Results may have been impacted by withdrawals and desire for ablative treatments on the SOC arm, and this lack of equipoise may make accrual to phase III trials difficult, although larger studies in select sub-populations are desired. (NCT02756793).
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Affiliation(s)
| | - Z Gabos
- University of Alberta, Edmonton, AB, Canada
| | | | | | | | - F Huang
- University of Alberta, Edmonton, AB, Canada
| | - L Rowe
- Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - D M Severin
- Division of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - P Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Y Zhao
- Dalhousie University, Halifax, NS, Canada
| | - C Ho
- BC Cancer - Fraser Valley, Surrey, BC, Canada
| | - M I Lock
- London Health Sciences Centre, London, ON, Canada
| | - A Louie
- Sunnybrook Odette Cancer Centre, TORONTO, ON, Canada
| | - S Lefresne
- BC Cancer Vancouver, Vancouver, BC, Canada
| | | | - M C Liu
- Department of Radiation Oncology, BC Cancer - Vancouver Centre, Vancouver, BC, Canada
| | - V Yau
- BC Cancer - Centre for the North, Prince George, BC, Canada
| | - A Y Ye
- University of British Columbia, Kelowna, BC, Canada
| | - R A Olson
- BC Cancer - Prince George, Prince George, BC, Canada
| | - B Mou
- BC Cancer - Kelowna, Kelowna, BC, Canada
| | | | | | - M Dosani
- BC Cancer - Victoria, Victoria, BC, Canada
| | - H H Pai
- BC Cancer - Victoria, Victoria, BC, Canada
| | - B Valev
- BC Cancer - Victoria, Victoria, BC, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - D A Palma
- Department of Oncology, Western University, London, ON, Canada
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Sun L, Xiong YP, Liu MC, Hu J, Peng CF. [Orbital cellulitis secondary to odontogenic superior maxillary sinus septum infection: a case report]. Zhonghua Yan Ke Za Zhi 2022; 58:917-919. [PMID: 36348529 DOI: 10.3760/cma.j.cn112142-20220414-00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 66-year-old woman presented with recurrent erythema, swelling and pain in her right eye. She had a history of extraction of the right upper second molar 5 months ago with subsequent development of an abscess which was incised and drained 4 months ago. Orbital CT scan revealed the formation of subperiosteal sinus cavity with an abscess in the right maxillary sinus and infraorbital foramen. The diagnosis was orbital honeycombing caused by odontogenic maxillary sinus septum infection. Utilizing the anterior lacrimal recess approach under nasal endoscope,incision and drainage of ocular abscess and debridement and drainage of right orbital abscess plus partial resection of the inner wall of the jaw were performed successfully with maxillary sinus septal drainage and maxillary sinus opening. The patient improved significantly after the operation.
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Affiliation(s)
- L Sun
- Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - Y P Xiong
- Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - M C Liu
- Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - J Hu
- Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - C F Peng
- Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
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Routman DM, Kumar S, Chera BS, Jethwa KR, Van Abel KM, Frechette K, DeWees T, Golafshar M, Garcia JJ, Price DL, Kasperbauer JL, Patel SH, Neben-Wittich MA, Laack NL, Chintakuntlawar AV, Price KA, Liu MC, Foote RL, Moore EJ, Gupta GP, Ma DJ. Detectable Post-operative Circulating Tumor Human Papillomavirus (HPV) DNA And Association with Recurrence in Patients with HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2022; 113:530-538. [PMID: 35157995 DOI: 10.1016/j.ijrobp.2022.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 01/22/2022] [Accepted: 02/06/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To determine the rate of detectability of ctHPVDNA after surgery but before adjuvant therapy in patients with HPV-associated oropharyngeal squamous cell carcinoma (HPV(+)OPSCC) and to investigate whether detectable ctHPVDNA at this time point may be associated with risk of recurrence. METHODS AND MATERIALS Prospectively collected samples from patients with OPSCC were examined in a blinded fashion using a multi-analyte PCR assay. 45 samples were collected from HPV(+)OPSCC patients pre-op (prior to any treatment), and 159 samples post-op (before or at the start of adjuvant RT). Samples were identified via the radiation oncology biobank or via participation in a clinical trial. RT consisted of 60 Gy +/- cisplatin or de-escalation (30 Gy to 36 Gy in 20 b.i.d. fractions + docetaxel). 32 patients had paired samples available pre and post-op for the primary analysis. Additional exploratory analyses including associations of patient and tumor characteristics with recurrence were assessed using Cox proportional hazards models for all 159 post-op samples.. Detectability of ctHPVDNA was compared across groups utilizing logistic regression. Estimates of recurrence free survival (RFS) were made using Kaplan-Meier (KM). RESULTS In a paired analysis of 32 pre and post-op timepoints, 94% of patients had detectable ctHPVDNA pre-op and 41% post-op. RFS at 18 months was 83% (95% CI: 47-95%) for patients with detectable post-op ctHPVDNA compared to 100% for patients with undetectable post-op ctHPVDNA (p=.094).In an exploratory analysis of non-paired post-op samples, ctHPVDNA was detectable in 26% (41 of 159) of patients (median of 22 days post-op). Age (1.06, p=0.025), LVSI (OR 3.17, p=0.011) and ENE (OR=5.67, p=0.001) were associated with detectable ctHPVDNA after surgery. Detectable post-op ctHPVDNA was significantly associated with RFS (p<0.001). CONCLUSION Amongst patients with detectable pre-op ctHPVDNA, a significant proportion have detectable post-op ctHPVDNA in paired post-op samples, collected prior to the initiation of adjuvant radiation therapy. Future prospective study is warranted to investigate the association of detectable post-op ctHPVDNA with recurrence, including in comparison to established clinical and pathologic risk factors.
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Affiliation(s)
- D M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
| | - S Kumar
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - B S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - K R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - K M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - K Frechette
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - T DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - M Golafshar
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Phoenix AZ, USA
| | - J J Garcia
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester MN, USA
| | - D L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - J L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - S H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix AZ, USA
| | | | - N L Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - K A Price
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA
| | - M C Liu
- Division of Medical Oncology, Mayo Clinic, Rochester MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN, USA
| | - R L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - E J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester MN, USA
| | - G P Gupta
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - D J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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Klein EA, Richards D, Cohn A, Tummala M, Lapham R, Cosgrove D, Chung G, Clement J, Gao J, Hunkapiller N, Jamshidi A, Kurtzman KN, Seiden MV, Swanton C, Liu MC. Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Ann Oncol 2021; 32:1167-1177. [PMID: 34176681 DOI: 10.1016/j.annonc.2021.05.806] [Citation(s) in RCA: 298] [Impact Index Per Article: 99.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A multi-cancer early detection (MCED) test used to complement existing screening could increase the number of cancers detected through population screening, potentially improving clinical outcomes. The Circulating Cell-free Genome Atlas study (CCGA; NCT02889978) was a prospective, case-controlled, observational study and demonstrated that a blood-based MCED test utilizing cell-free DNA (cfDNA) sequencing in combination with machine learning could detect cancer signals across multiple cancer types and predict cancer signal origin (CSO) with high accuracy. The objective of this third and final CCGA substudy was to validate an MCED test version further refined for use as a screening tool. PATIENTS AND METHODS This pre-specified substudy included 4077 participants in an independent validation set (cancer: n = 2823; non-cancer: n = 1254, non-cancer status confirmed at year-one follow-up). Specificity, sensitivity, and CSO prediction accuracy were measured. RESULTS Specificity for cancer signal detection was 99.5% [95% confidence interval (CI): 99.0% to 99.8%]. Overall sensitivity for cancer signal detection was 51.5% (49.6% to 53.3%); sensitivity increased with stage [stage I: 16.8% (14.5% to 19.5%), stage II: 40.4% (36.8% to 44.1%), stage III: 77.0% (73.4% to 80.3%), stage IV: 90.1% (87.5% to 92.2%)]. Stage I-III sensitivity was 67.6% (64.4% to 70.6%) in 12 pre-specified cancers that account for approximately two-thirds of annual USA cancer deaths and was 40.7% (38.7% to 42.9%) in all cancers. Cancer signals were detected across >50 cancer types. Overall accuracy of CSO prediction in true positives was 88.7% (87.0% to 90.2%). CONCLUSION In this pre-specified, large-scale, clinical validation substudy, the MCED test demonstrated high specificity and accuracy of CSO prediction and detected cancer signals across a wide diversity of cancers. These results support the feasibility of this blood-based MCED test as a complement to existing single-cancer screening tests. CLINICAL TRIAL NUMBER NCT02889978.
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Affiliation(s)
- E A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA.
| | | | - A Cohn
- The US Oncology Network, Denver, USA
| | - M Tummala
- Mercy Clinic Cancer Center, Springfield, USA
| | - R Lapham
- Spartanburg Regional Healthcare System, Spartanburg, USA
| | | | - G Chung
- The Christ Hospital Health Network, Cincinnati, USA
| | - J Clement
- Hartford HealthCare Cancer Institute, Hartford, USA
| | - J Gao
- GRAIL, Inc., Menlo Park, USA
| | | | | | | | - M V Seiden
- US Oncology Research, The Woodlands, USA
| | - C Swanton
- The Francis Crick Institute, London, UK; University College London Cancer Institute, London, UK
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Du L, Yau C, Brown-Swigart L, Gould R, Krings G, Hirst GL, Bedrosian I, Layman RM, Carter JM, Klein M, Venters S, Shad S, van der Noordaa M, Chien AJ, Haddad T, Isaacs C, Pusztai L, Albain K, Nanda R, Tripathy D, Liu MC, Boughey J, Schwab R, Hylton N, DeMichele A, Perlmutter J, Yee D, Berry D, Van't Veer L, Valero V, Esserman LJ, Symmans WF. Predicted sensitivity to endocrine therapy for stage II-III hormone receptor-positive and HER2-negative (HR+/HER2-) breast cancer before chemo-endocrine therapy. Ann Oncol 2021; 32:642-651. [PMID: 33617937 DOI: 10.1016/j.annonc.2021.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND We proposed that a test for sensitivity to the adjuvant endocrine therapy component of treatment for patients with stage II-III breast cancer (SET2,3) should measure transcription related to estrogen and progesterone receptors (SETER/PR index) adjusted for a baseline prognostic index (BPI) combining clinical tumor and nodal stage with molecular subtype by RNA4 (ESR1, PGR, ERBB2, and AURKA). PATIENTS AND METHODS Patients with clinically high-risk, hormone receptor-positive (HR+), human epidermal growth factor receptor 2 (HER2)-negative (HR+/HER2-) breast cancer received neoadjuvant taxane-anthracycline chemotherapy, surgery with measurement of residual cancer burden (RCB), and then adjuvant endocrine therapy. SET2,3 was measured from pre-treatment tumor biopsies, evaluated first in an MD Anderson Cancer Center (MDACC) cohort (n = 307, 11 years' follow-up, U133A microarrays), cut point was determined, and then independent, blinded evaluation was carried out in the I-SPY2 trial (n = 268, high-risk MammaPrint result, 3.8 years' follow-up, Agilent-44K microarrays, NCI Clinical Trials ID: NCT01042379). Primary outcome measure was distant relapse-free survival. Multivariate Cox regression models tested prognostic independence of SET2,3 relative to RCB and other molecular prognostic signatures, and whether other prognostic signatures could substitute for SETER/PR or RNA4 components of SET2,3. RESULTS SET2,3 added independent prognostic information to RCB in the MDACC cohort: SET2,3 [hazard ratio (HR) 0.23, P = 0.004] and RCB (HR 1.77, P < 0.001); and the I-SPY2 trial: SET2,3 (HR 0.27, P = 0.031) and RCB (HR 1.68, P = 0.008). SET2,3 provided similar prognostic information irrespective of whether RCB-II or RCB-III after chemotherapy, and in both luminal subtypes. Conversely, RCB was most strongly prognostic in cancers with low SET2,3 status (MDACC P < 0.001, I-SPY2 P < 0.001). Other molecular signatures were not independently prognostic; they could effectively substitute for RNA4 subtype within the BPI component of SET2,3, but they could not effectively substitute for SETER/PR index. CONCLUSIONS SET2,3 added independent prognostic information to chemotherapy response (RCB) and baseline prognostic score or subtype. Approximately 40% of patients with clinically high-risk HR+/HER2- disease had high SET2,3 and could be considered for clinical trials of neoadjuvant endocrine-based treatment.
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Affiliation(s)
- L Du
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C Yau
- Department of Surgery, University of California, San Francisco, USA
| | - L Brown-Swigart
- Department of Pathology, University of California, San Francisco, USA
| | - R Gould
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Krings
- Department of Pathology, University of California, San Francisco, USA
| | - G L Hirst
- Department of Surgery, University of California, San Francisco, USA
| | - I Bedrosian
- Department of Breast Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - R M Layman
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J M Carter
- Department of Pathology, Mayo Clinic, Rochester, USA
| | - M Klein
- Department of Pathology, University of Minnesota, Minneapolis, USA
| | - S Venters
- Department of Surgery, University of California, San Francisco, USA
| | - S Shad
- Department of Surgery, University of California, San Francisco, USA
| | | | - A J Chien
- Department of Medicine, University of California, San Francisco, USA
| | - T Haddad
- Department of Medicine, Mayo Clinic, Rochester, USA
| | - C Isaacs
- Department of Medicine, Georgetown University, Washington, USA
| | - L Pusztai
- Department of Medicine, Yale University School of Medicine, New Haven, USA
| | - K Albain
- Department of Medicine, Loyola University, Chicago, USA
| | - R Nanda
- Department of Medicine, University of Chicago, Chicago, USA
| | - D Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - M C Liu
- Department of Medicine, Mayo Clinic, Rochester, USA
| | - J Boughey
- Department of Surgery, Mayo Clinic, Rochester, USA
| | - R Schwab
- Department of Medicine, University of California, San Diego, USA
| | - N Hylton
- Department of Radiology, University of California, San Francisco, USA
| | - A DeMichele
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, San Philadelphia, USA
| | | | - D Yee
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - D Berry
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L Van't Veer
- Department of Pathology, University of California, San Francisco, USA
| | - V Valero
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - L J Esserman
- Department of Surgery, University of California, San Francisco, USA
| | - W F Symmans
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Pathology, The University of Texas MD Anderson Cancer Center, San Francisco, USA.
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Liu MC, Oxnard GR, Klein EA, Swanton C, Seiden MV. Sensitive and specific multi-cancer detection and localization using methylation signatures in cell-free DNA. Ann Oncol 2020; 31:745-759. [PMID: 33506766 PMCID: PMC8274402 DOI: 10.1016/j.annonc.2020.02.011] [Citation(s) in RCA: 631] [Impact Index Per Article: 157.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/13/2020] [Accepted: 02/16/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Early cancer detection could identify tumors at a time when outcomes are superior and treatment is less morbid. This prospective case-control sub-study (from NCT02889978 and NCT03085888) assessed the performance of targeted methylation analysis of circulating cell-free DNA (cfDNA) to detect and localize multiple cancer types across all stages at high specificity. PARTICIPANTS AND METHODS The 6689 participants [2482 cancer (>50 cancer types), 4207 non-cancer] were divided into training and validation sets. Plasma cfDNA underwent bisulfite sequencing targeting a panel of >100 000 informative methylation regions. A classifier was developed and validated for cancer detection and tissue of origin (TOO) localization. RESULTS Performance was consistent in training and validation sets. In validation, specificity was 99.3% [95% confidence interval (CI): 98.3% to 99.8%; 0.7% false-positive rate (FPR)]. Stage I-III sensitivity was 67.3% (CI: 60.7% to 73.3%) in a pre-specified set of 12 cancer types (anus, bladder, colon/rectum, esophagus, head and neck, liver/bile-duct, lung, lymphoma, ovary, pancreas, plasma cell neoplasm, stomach), which account for ∼63% of US cancer deaths annually, and was 43.9% (CI: 39.4% to 48.5%) in all cancer types. Detection increased with increasing stage: in the pre-specified cancer types sensitivity was 39% (CI: 27% to 52%) in stage I, 69% (CI: 56% to 80%) in stage II, 83% (CI: 75% to 90%) in stage III, and 92% (CI: 86% to 96%) in stage IV. In all cancer types sensitivity was 18% (CI: 13% to 25%) in stage I, 43% (CI: 35% to 51%) in stage II, 81% (CI: 73% to 87%) in stage III, and 93% (CI: 87% to 96%) in stage IV. TOO was predicted in 96% of samples with cancer-like signal; of those, the TOO localization was accurate in 93%. CONCLUSIONS cfDNA sequencing leveraging informative methylation patterns detected more than 50 cancer types across stages. Considering the potential value of early detection in deadly malignancies, further evaluation of this test is justified in prospective population-level studies.
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Affiliation(s)
- M C Liu
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, USA
| | - G R Oxnard
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, USA
| | - E A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA
| | - C Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute; Cancer Evolution and Genome Instability Laboratory, University College London Cancer Institute, London, UK
| | - M V Seiden
- US Oncology Research, US Oncology, The Woodlands, USA.
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Han H, Hamilton E, Irie H, Isakoff S, Jelovac D, Liem A, Liu MC, Milillo A, Nangia J, Page D, Reeves J, Santa-Maria C, Duncan M, Graham JR, Chen J, Dezube BJ, Spring L. Abstract OT3-03-01: Open-label, single-arm study evaluating the antitumor activity and safety of niraparib as neoadjuvant treatment in patients with localized, HER2-negative, BRCA-mutant breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-03-01] [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: Neoadjuvant chemotherapy is administered to patients with operable breast cancer to downstage the tumor to allow for less extensive surgery and to provide prognostic information about drug efficacy and risk of disease recurrence. Patients who achieve a pathological complete response (pCR) following neoadjuvant treatment have a more favorable outcome than patients with residual invasive disease. Single-agent poly(ADP-ribose) polymerase (PARP) inhibitors have clinical efficacy in BRCA-mutated breast cancer. Niraparib, a potent and selective PARP1/2 inhibitor, is approved for maintenance treatment of patients with recurrent ovarian cancer and has demonstrated strong antitumor activity in in vivo studies with BRCA1-mutant breast cancer. The objective of this study is to evaluate the antitumor activity of single-agent niraparib in the neoadjuvant treatment of patients with localized, human epidermal growth factor receptor 2 (HER2)-negative, BRCAmut breast cancer.
Trial Design: This is an open-label, single-arm pilot study with a target enrollment of 20 evaluable patients. Eligible patients are those ≥18 years old with histologically-confirmed HER2-negative localized breast cancer and either a BRCA1 or BRCA2 mutation (germline or somatic) and no prior anti-cancer therapies for the current malignancy. Patients will receive 200 mg of oral niraparib once daily for 2 months, after which they may either proceed directly to surgery or receive chemotherapy at the discretion of the physician. The primary endpoint is tumor response rate based on the change in tumor volume as measured by breast MRI after 2 months of treatment with niraparib; a response is defined as ≥30% reduction of tumor volume from baseline. Secondary endpoints include pCR rate, tumor response rate based on the change in tumor volume as measured by breast ultrasound, and safety and tolerability. Data will be summarized in a descriptive nature by frequency distributions (number and percentage of patients) for categorical variables and by the mean, median, and standard deviation for continuous variables. Tumor response rate will be tabulated together with its 95% binomial exact confidence interval.
Funding: TESARO, Inc., Waltham, MA, USA sponsored the study.
Citation Format: Han H, Hamilton E, Irie H, Isakoff S, Jelovac D, Liem A, Liu MC, Milillo A, Nangia J, Page D, Reeves J, Santa-Maria C, Duncan M, Graham JR, Chen J, Dezube BJ, Spring L. Open-label, single-arm study evaluating the antitumor activity and safety of niraparib as neoadjuvant treatment in patients with localized, HER2-negative, BRCA-mutant 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 OT3-03-01.
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Affiliation(s)
- H Han
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - E Hamilton
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - H Irie
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - S Isakoff
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - D Jelovac
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - A Liem
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - MC Liu
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - A Milillo
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - J Nangia
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - D Page
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - J Reeves
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - C Santa-Maria
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - M Duncan
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - JR Graham
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - J Chen
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - BJ Dezube
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
| | - L Spring
- Moffitt Cancer Center-McKinley Outpatient Clinic, Tampa, FL; Tennessee Oncology, Nashville, TN; Icahn School of Medicine at Mount Sinai, New York, NY; Massachusetts General Hospital, Boston, MA; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Pacific Shores Medical Group, Long Beach, CA; Mayo Clinic Rochester, Rochester, MN; Memorial Health Care System, Hollywood, FL; Baylor College of Medicine, Houston, TX; Providence Portland Medical Center, Portland, OR; Florida Cancer Specialists-South, Fort Myers, FL; TESARO, Inc., Waltham, MA
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Leon-Ferre RA, Polley MY, Liu H, Kalari KR, Boughey JC, Liu MC, Cafourek V, Negron V, Ingle JN, Thompson KJ, Tang X, Barman P, Carlson E, Visscher DW, Carter JC, Couch FJ, Goetz MP. Abstract P3-08-01: Characteristics, outcomes and prognostic factors of luminal androgen receptor (LAR) triple-negative breast cancer (TNBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-08-01] [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: The LAR subtype is a genomically distinct subset of TNBC. Using a large cohort of non-metastatic TNBC patients (pts) with long term follow-up, we sought to further characterize the clinicopathologic features and outcomes of LAR vs non-LAR TNBC.
Methods: From a cohort of 9982 women with surgically-treated non-metastatic breast cancer, 605 met criteria for TNBC (ER/PR<1% and HER2-negative) by central pathology. RNA extracted from 304 FFPE tumor specimens using the HighPure RNA extraction kit was subjected to TruSeq RNA Access library preparation and sequencing on a HiSeq2500. Adequate RNA was available for 283 pts. Tumors were classified as LAR or non-LAR using a shrunken centroid model, CABAL (Clustering Among BAsal and Luminal androgen receptor). In addition to previously described analyses [Leon-Ferre et al, Breast Cancer Res Treat 2017], immunohistochemical (IHC) androgen receptor (AR) staining was performed and the impact of various parameters on invasive disease-free survival (IDFS) and overall survival (OS) was assessed using Cox proportional hazards models.
Results: 58 (20%) tumors were classified as LAR and 225 (80%) as non-LAR. Compared to non-LAR, LAR pts were older (mean age 65 vs 54) and more often postmenopausal (79%vs53%), both p=0.01. Apocrine histology was more common among LAR tumors (21%vs0%), which were also lower grade (grade3: 69%vs95%) and had lower Ki-67 (Ki-67>15%: 64%vs82%), all p<0.01. Additionally, LAR tumors had lower median stromal tumor infiltrating lymphocytes (TILs, 20%vs25%) and were less frequently lymphocyte-predominant [≥50% stromal or intratumoral TILs (19%vs32%)], although neither reached statistical significance. AR IHC was available for 223 of 283 tumors. Median AR IHC score in LAR was 65% (range 0-100%) vs 0% (range 0-90%) in non-LAR. T/N stage, surgery type, and receipt of adjuvant chemotherapy (AdjCT) or radiotherapy were similar between LAR and non-LAR. LAR pts had shorter IDFS and OS compared to non-LAR (5.6 vs 11.8 yrs and 10.8 vs 20.8 yrs, respectively), although this did not reach statistical significance. Test of proportional hazard assumption was not significant for IDFS or OS (p = 0.30 and 0.09). IDFS estimates were numerically higher in LAR vs non-LAR (80.2%vs70.5%,p = 0.92) at 3yrs post-diagnosis; whereas the opposite was true (40.9%vs55.6%,p = 0.07) after 10yrs. OS estimates at 3 and 5yrs were similar between LAR and non-LAR, but at 10yrs OS was inferior in LAR (40.9%vs66.4%,p = 0.24). In a univariate analysis including both LAR and non-LAR, older age, higher N stage, lower TILs and absence of AdjCT were associated with poorer IDFS and OS. In a multivariate analysis, higher N stage and absence of AdjCT remained associated with both poorer IDFS and OS; while lower stromal TILs were associated with poorer IDFS (p=0.01), and with a trend towards poorer OS (p=0.07).
Conclusions: LAR TNBCs occurred in older women, were lower grade, and had lower TIL density than nonLAR tumors. While significant differences in IDFS or OS were not demonstrated, LAR pts exhibited a numerically lower risk of a disease event at 3yrs, but higher risk by 10yrs compared to nonLAR pts. In the entire cohort, higher N stage, absence of AdjCT and lower TILs were independently associated with poorer outcomes.
Citation Format: Leon-Ferre RA, Polley M-Y, Liu H, Kalari KR, Boughey JC, Liu MC, Cafourek V, Negron V, Ingle JN, Thompson KJ, Tang X, Barman P, Carlson E, Visscher DW, Carter JC, Couch FJ, Goetz MP. Characteristics, outcomes and prognostic factors of luminal androgen receptor (LAR) triple-negative breast cancer (TNBC) [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 P3-08-01.
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Affiliation(s)
| | | | - H Liu
- Mayo Clinic, Rochester, MN
| | | | | | - MC Liu
- Mayo Clinic, Rochester, MN
| | | | | | | | | | - X Tang
- Mayo Clinic, Rochester, MN
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9
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Silverstein J, Suleiman L, Yau C, Price ER, Singhrao R, Yee D, DeMichele A, Isaacs C, Albain KS, Chien AJ, Forero-Torres A, Wallace AM, Pusztai L, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Leyland-Jones B, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Berry DA, Asare SM, Esserman LJ, Boughey JC, Mukhtar RA. Abstract P2-14-01: The impact of local therapy on locoregional recurrence in women with high risk breast cancer in the neoadjuvant I-SPY2 TRIAL. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-14-01] [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: 11/16/2022]
Abstract
Abstract
Background: In women with breast cancer receiving neoadjuvant chemotherapy, residual cancer burden (RCB) predicts distant recurrence and survival. In those with high risk tumors, locoregional recurrence (LRR) remains a concern, and has been associated with type of local therapy received. We evaluated the impact of local therapy on LRR in the ISPY-2 TRIAL.
Methods: Data were analyzed in Stata 14.2, using Chi2 test, log rank test, and a Cox proportional hazards model. RCB was considered a categorical variable (0/1 versus 2/3), as described in prior publications. Breast surgery categories were lumpectomy +/- radiotherapy, or mastectomy +/- radiotherapy. Axillary surgery was defined as sentinel lymph node (SLN) surgery (≤6 nodes removed) or axillary dissection (>6 nodes).
Results: Follow up data from the I-SPY2 TRIAL were available for 630 patients (median follow up 2.76 yrs, range 0.4-7.2). Type of local therapy was significantly associated with clinical stage at presentation, with stage III patients most frequently undergoing mastectomy + radiation (p<0.001). Women with higher RCB were more likely to undergo mastectomy than those with lower RCB (61.3% vs 48.8% mastectomy rate, p=0.002), and more likely to receive adjuvant radiotherapy (62.0% vs 53.9%, p=0.048). There was no association between clinical stage, type of surgery, or radiotherapy and LRR (Table). Higher RCB was significantly associated with LRR, with 3 year locoregional recurrence free rate of 95.1% in RCB 0/1 versus 89.9% in RCB 2/3 (p=0.003).
In a Cox model adjusting for clinical stage, tumor subtype, surgical therapy, RCB status, nodal radiation, and age, significant predictors for LRR were tumor subtype and RCB status. Hazard ratio (HR) for LRR in those with RCB 0/1 was 0.39 compared to those with RCB 2/3 (95% CI 0.17-0.87, p=0.021). There was no difference in LRR between breast conservation and mastectomy; within the breast conservation group, those who had lumpectomy alone had higher hazard of LRR compared to those having lumpectomy + radiation (HR 3.1, 95% CI 1.1-9.2, p=0.043).
Conclusions: Extent of surgical therapy was not associated with local tumor control, regardless of advanced tumor stage at presentation. Rather, tumor biology and response to therapy were the best predictors of LRR. These data highlight the opportunity to minimize the morbidity of extensive surgical therapy for patients with excellent response to systemic therapy.
LRR rates by clinical features and treatment status FrequencyLRR RateP valueClinical Stage 0.5I240 (47.5%)5.8% II185 (36.6%)8.7% III80 (15.8%)6.3% Tumor Subtype 0.014ER+PR+Her2-161 (26.4%)3.1% ER+PR-Her2-56 (9.2%)3.6% Her2+176 (28.9%)6.3% Triple negative216 (35.5%)11.1% Local therapy 0.169Lumpectomy85 (13.5%)11.8% Lumpectomy with radiation198 (31.4%)5.6% Mastectomy173 (27.5%)5.2% Mastectomy with radiation174 (27.6%)8.6% Axillary surgery 0.23None5 (0.8%)20% SLN329 (52.2%)5.8% ALND296 (47%)8.5% Axillary radiation 0.535Yes42 (6.7%)9.5% No588 (93.3%)7.0% Axillary management 0.2No surgery or radiation5 (0.8%)20.0% SLN312 (50%)5.3% SLN+Axillary radiation17 (2.7%)8.3% ALND271 (43%)10.3% ALND+Axillary radiation25 (4%)5.4% RCB 0.0020/1293 (50.1%)3.8% 2/3292 (49.9%)10.3%
Citation Format: Silverstein J, Suleiman L, Yau C, Price ER, Singhrao R, Yee D, DeMichele A, Isaacs C, Albain KS, Chien AJ, Forero-Torres A, Wallace AM, Pusztai L, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Leyland-Jones B, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, I-SPY 2 TRIAL Consortium, Berry DA, Asare SM, Esserman LJ, Boughey JC, Mukhtar RA. The impact of local therapy on locoregional recurrence in women with high risk breast cancer in the neoadjuvant I-SPY2 TRIAL [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 P2-14-01.
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Affiliation(s)
- J Silverstein
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Suleiman
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - C Yau
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - ER Price
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Singhrao
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - D Yee
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - A DeMichele
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - C Isaacs
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - KS Albain
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AJ Chien
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - A Forero-Torres
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AM Wallace
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Pusztai
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - ED Ellis
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AD Elias
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JE Lang
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - J Lu
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - HS Han
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - AS Clark
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - L Korde
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Nanda
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DW Northfelt
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - QJ Khan
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - RK Viscusi
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DM Euhus
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - KK Edmiston
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SY Chui
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - K Kemmer
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - WC Wood
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JW Park
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - MC Liu
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - O Olopade
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - B Leyland-Jones
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - D Tripathy
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SL Moulder
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - HS Rugo
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - R Schwab
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - S Lo
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - T Helsten
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - H Beckwith
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - DA Berry
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - SM Asare
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - LJ Esserman
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - JC Boughey
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
| | - RA Mukhtar
- University of California, San Francisco, San Francisco, CA; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Loyola University, Maywood, IL; University of Alabama at Birmingham, Birmingham, AL; University of California, San Diego, La Jolla, CA; Yale Cancer Center, New Haven, CT; Swedish Cancer Institute, Seattle, WA; University of Colorado, Denver, Aurora, CO; University of Southern California, Los Angeles, CA; Moffitt Cancer Center, Tampa, FL; CTEP, National Cancer Institute, Bethesda, MD; The University of Chicago Medical Center, Chicago, IL; Mayo Clinic, Scottsdale, Scottsdale, AZ; University of Kansas, Westwood, KS; University of Arizona, Tucson, AZ; Johns Hopkins Medicine, Dallas, TX; Inova Health System, Fairfax, VA; Genentech, Portland, OR; Oregon Health & Science University, Portland, OR; Emory University, Atlanta, GA; Mayo Clinic, Rochester, Rochester, MN; Avera Cancer Institute Center for Precision
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Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen YY, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Abstract P2-07-03: Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-07-03] [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: Patients achieving a pathologic complete response (pCR) following neoadjuvant therapy have significantly improved event-free survival relative to those who do not; and pCR is an FDA-accepted endpoint to support accelerated approval of novel agents/combinations in the neoadjuvant treatment of high risk early stage breast cancer. Previous studies have shown that recurrence risk increased with increasing burden of residual disease (as assessed by the RCB index). As well, these studies suggest that patients with minimum residual disease (RCB-I class) also have favorable outcomes (comparable to those achieving a pCR) within high risk tumor subtypes. In this study, we assess whether integrating RCB with MRI functional tumor volume (FTV), which in itself is prognostic, can improve prediction of distant recurrence free survival (DRFS); and identify a subset of patients with minimal residual disease with comparable DRFS as those who achieved a pCR. Imaging tools can then be used to identify the subset that will do well early and guide the timing of surgical therapy.
Method: We performed a pooled analysis of 596 patients from the I-SPY2 TRIAL with RCB, pre-surgical MRI FTV data and known follow-up (median 2.5 years). We first assessed whether FTV predicts residual disease (pCR or pCR/RCB-I) using ROC analysis. We applied a power transformation to normalize the pre-surgical FTV distribution; and assessed its association with DRFS using a bi-variate Cox proportional hazard model adjusting for HR/HER2 subtype. We also fitted a bivariate Cox model of RCB index adjusting for subtype; and assessed whether adding pre-surgical FTV to this model further improves association with DRFS using a likelihood ratio (LR) test. For the Cox modeling, penalized splines approximation of the transformed FTV and RCB index with 2 degrees of freedom was used to allow for non-linear effects of FTV and RCB on DRFS.
Result: Pre-surgical MRI FTV is significantly associated with DRFS (Wald p<0.00001), and more effective at predicting pCR/RCB-I than predicting pCR alone (AUC: 0.72 vs. 0.65). Larger pre-surgical FTV remains associated with worse DRFS adjusting for subtype (Wald p <0.00001). The RCB index is also significantly associated with DRFS adjusting for subtype (Wald p<0.00001). Adding FTV to a model containing RCB and subtype further improves association with DRFS (LR p=0.0007). RCB-I patients have excellent DRFS (94% at 3 years compared to 95% in the pCR group). Efforts are underway to identify an optimal threshold for dichotomizing pre-surgical FTV and FTV change measures for use in combination with pCR/RCB-I class to generate integrated RCB (iRCB) groups as a composite predictor of DRFS.
Conclusion: Pre-surgical MRI FTV is effective at predicting minimal residual disease (RCB0/I) in the I-SPY 2 TRIAL. Despite the association between FTV and RCB, FTV appears to provide independent added prognostic value (to RCB and subtype), suggesting that integrating MRI volume measures and RCB into a composite predictor may improve DRFS prediction.
Citation Format: Hylton NM, Symmans WF, Yau C, Li W, Hatzis C, Isaacs C, Albain KS, Chen Y-Y, Krings G, Wei S, Harada S, Datnow B, Fadare O, Klein M, Pambuccian S, Chen B, Adamson K, Sams S, Mhawech-Fauceglia P, Magliocco A, Feldman M, Rendi M, Sattar H, Zeck J, Ocal I, Tawfik O, Grasso LeBeau L, Sahoo S, Vinh T, Yang S, Adams A, Chien AJ, Ferero-Torres A, Stringer-Reasor E, Wallace A, Boughey JC, Ellis ED, Elias AD, Lang JE, Lu J, Han HS, Clark AS, Korde L, Nanda R, Northfelt DW, Khan QJ, Viscusi RK, Euhus DM, Edmiston KK, Chui SY, Kemmer K, Wood WC, Park JW, Liu MC, Olopade O, Tripathy D, Moulder SL, Rugo HS, Schwab R, Lo S, Helsten T, Beckwith H, Haugen PK, van't Veer LJ, Perlmutter J, Melisko ME, Wilson A, Peterson G, Asare AL, Buxton MB, Paoloni M, Clennell JL, Hirst GL, Singhrao R, Steeg K, Matthews JB, Sanil A, Berry SM, Abe H, Wolverton D, Crane EP, Ward KA, Nelson M, Niell BL, Oh K, Brandt KR, Bang DH, Ojeda-Fournier H, Eghtedari M, Sheth PA, Bernreuter WK, Umphrey H, Rosen MA, Dogan B, Yang W, Joe B, I-SPY 2 TRIAL Consortium, Yee D, Pusztai L, DeMichele A, Asare SM, Berry DA, Esserman LJ. Refining neoadjuvant predictors of three year distant metastasis free survival: Integrating volume change as measured by MRI with residual cancer burden [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 P2-07-03.
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Affiliation(s)
- NM Hylton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WF Symmans
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Yau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Li
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Hatzis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - C Isaacs
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KS Albain
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - Y-Y Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Krings
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Wei
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Harada
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Datnow
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Fadare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Klein
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Pambuccian
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Chen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Adamson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - P Mhawech-Fauceglia
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Magliocco
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Feldman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Rendi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Sattar
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Zeck
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - I Ocal
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Tawfik
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Grasso LeBeau
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Sahoo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Vinh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Adams
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AJ Chien
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Ferero-Torres
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - E Stringer-Reasor
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wallace
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JC Boughey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ED Ellis
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AD Elias
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JE Lang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Lu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Han
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AS Clark
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Korde
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Nanda
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DW Northfelt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - QJ Khan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - RK Viscusi
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DM Euhus
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KK Edmiston
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SY Chui
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Kemmer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WC Wood
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JW Park
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MC Liu
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - O Olopade
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Tripathy
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SL Moulder
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - HS Rugo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Schwab
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - S Lo
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - T Helsten
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Beckwith
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PK Haugen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ van't Veer
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - J Perlmutter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - ME Melisko
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Wilson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - G Peterson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - AL Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MB Buxton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Paoloni
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JL Clennell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - GL Hirst
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - R Singhrao
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Steeg
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - JB Matthews
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A Sanil
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Abe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Wolverton
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - EP Crane
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KA Ward
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Nelson
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - BL Niell
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - K Oh
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - KR Brandt
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DH Bang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Ojeda-Fournier
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - M Eghtedari
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - PA Sheth
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - WK Bernreuter
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - H Umphrey
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - MA Rosen
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Dogan
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - W Yang
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - B Joe
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - D Yee
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - L Pusztai
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - A DeMichele
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - SM Asare
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - DA Berry
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
| | - LJ Esserman
- Avera Cancer Institute Center for Precision Oncology, Sioux Falls, ND; Berry Consultants, LLC, Houston, TX; CTEP, National Cancer Institute, Bethesda, MD; Emory University, Atlanta, GA; Georgetown University, Washington, DC; Inova Health System, Fairfax, VA; Johns Hopkins Medicine, Baltimore, MD; Loyola University, Maywood, IL; Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Mayo Clinic, Rochester, MN; Moffitt Cancer Center, Tampa, FL; National Breast Cancer Coalition, Washington, DC; Oregon Health & Science University, Portland, OR; Quantum Leap Healthcare Collaborative, San Francisco, CA; Swedish Cancer Institute, Seattle, WA; The University of Chicago Medical Center, Chicago, IL; University of Alabama at Birmingham, Birmingham, AL; University of Arizona, Tuczon, AZ; University of California, San Diego, La Jolla, CA; University of California, San Francisco, San Francisco, CA; University of Colorado, Denver, Aurora, CO; University of Kansas, Westwood, KS; University of Pennsylvania, Philade
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Liu MC, Sun Y, Ramirez A, Campton D, George T, Haselkorn KE, Clein A, Gadi V, Sabath D, Kaldjian E. Abstract P3-01-11: A novel six-parameter assay for comprehensive phenotyping of circulating tumor cells. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-01-11] [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. The presence and number of circulating tumor cells (CTCs) are prognostic for breast cancer treatment outcome. Direct imaging assays traditionally employ four markers to identify canonical epithelial CTCs: nucleus, exclusion (CD45), and inclusion (EpCAM and cytokeratin). There is intense interest in the ability to phenotype CTCs in order to provide a noninvasive means by which to predict treatment benefit from endocrine therapy and/or HER2-directed therapy in breast cancer. To address this, a 6-parameter assay for detection of ER and HER2 expression on CTCs was developed. We applied this assay to four well characterized breast cancer cell lines representative of various ER and HER2 phenotypes. Methods. BT474, MCF-7, SKBR3, or MDA-MB-231 cells were spiked into peripheral blood from healthy donors and processed using the AccuCyte® sample preparation system; nucleated cells, including CTCs, are captured onto glass slides (8 slides per 7.5 mL blood sample) for subsequent immunofluorescent staining. Slides were stained using the combined epithelial marker and ER/HER2 CTC assay and then analyzed with the CyteFinder® imaging system. CTCs were identified as nucleated cells with positive EpCAM and/or cytokeratin staining, and negative CD45 staining. ER and HER2 expression were assessed as present or absent. Results. All cell lines expressed both cytokeratin and EpCAM, except for MDA-MB-231 which was EpCAM-negative. The ER / HER2 expression patterns observed were consistent with reported phenotype: BT474 (+/+), MCF-7 (+/–), SKBR3 (–/+), and MDA-MB-231 (–/–). Conclusions. Identification of epithelial CTCs and phenotypic characterization of ER and HER2 status are feasible in a combined assay applied to a single blood sample. This approach has implications for efficiency and cost effectiveness, which are of particular importance given the interest in longitudinal testing. Assay evaluation is currently underway using blood samples from breast cancer patients with known receptor status, treatment history, and clinical outcomes. Results will be available for presentation at the meeting.
Citation Format: Liu MC, Sun Y, Ramirez A, Campton D, George T, Haselkorn KE, Clein A, Gadi V, Sabath D, Kaldjian E. A novel six-parameter assay for comprehensive phenotyping of circulating tumor cells [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 P3-01-11.
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Affiliation(s)
- MC Liu
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - Y Sun
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - A Ramirez
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - D Campton
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - T George
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - KE Haselkorn
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - A Clein
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - V Gadi
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - D Sabath
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
| | - E Kaldjian
- Mayo Clinic, Rochester, MN; RareCyte, Inc., Seattle, WA; University of Washington, Seattle, WA
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12
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Clarke R, Dixon M, Jin L, Pearce D, Turnbull A, Selli C, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Sims A, Liu MC. Abstract P5-04-17: Local network topology differences between early and late recurrence in ER+ breast cancers. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-04-17] [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: Late recurrence is characteristic of ER+ breast cancers. Despite an apparently effective adjuvant endocrine therapy, many breast cancers recur years after their initial endocrine treatment. Why some tumors recur early (<3 years) and some recur later (>5 years) is poorly understood. If systemic endocrine therapies killed all cells, recurrence would reflect only the appearance of new disease. Thus, we hypothesized that cells that survive and lie dormant may be driven, in part, by altered wiring of their cell death signaling. We, therefore, studied how cell death signaling is differentially wired in primary tumors that will recur early versus those that will recur later.
Method: Genes involved in apoptosis, autophagy, ferroptosis, necrosis, and pyroptosis were identified from KEGG to initiate network feature analysis of gene expression data from public and our first in-house gene expression dataset. Data were collected from ER+ breast cancer pre-endocrine treatment samples with up to 20 years follow-up. Publicly available datasets used were GSE6532, GSE2034, GSE7390, GSE17705, GSE12093, and TCGA. We applied our Knowledge-fused Differential Dependency Network (KDDN) analysis tool to the public datasets; KDDN has provided powerful new insights into signaling in breast and other cancers. Common gene-gene interactions (edges) predicted in at least two different datasets were extracted from all KDDN analyses results. To strengthen the relevance of these features, predicted network edges that represent known protein-protein interactions (PPI) were identified from the STRING database, and these edges were noted in the signaling graphs. Final network graphs were constructed using the common edges from all overlaid networks. We conducted IPA analysis on all nodes in the final network and selected those incorporating network hubs. We took a similar approach to our second in-house dataset, which we used for independent testing. Here, patients were included if their tumor exhibited an initial reduction in volume of at least 40% by four months in response to neo-adjuvant Letrozole. Patients were then classified into two groups during follow-up of up to 3.7 years: i) initial tumor size reduction followed by continued response (expected to recur late); ii) initial reduction followed by tumor regrowth (expected to recur early). KDDN analysis was performed on pretreatment samples from these two groups and a network created annotated with PPI information.
Results: MAPK8 and CYCS (Molecular Mechanisms of Cancer, p=1.58E-52), TNFRSF1A Neuroinflammation Signaling Pathway, p=1.26E-54), RELA, and NFKB1 (Colorectal Cancer Metastasis Signaling, p=7.94E-35), were identified as hubs. Hubs may be critical signaling components driving the differences between tumors that will become dormant and recur late. Connections between SLC25A6 and SQSTM1 (p = 0.008), BIRC2 and GABARAP (p = 0.021) in the early group, and AKT3 and IRS2 (p = 0.014) in the late group, were shared between the two final networks. With longer follow-up time on the second in-house dataset, we will better define the two groups and identify additional common phenotype specific gene-gene interactions.
Citation Format: Clarke R, Dixon M, Jin L, Pearce D, Turnbull A, Selli C, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Sims A, Liu MC. Local network topology differences between early and late recurrence in ER+ breast cancers [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 P5-04-17.
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Affiliation(s)
- R Clarke
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - M Dixon
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - L Jin
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - D Pearce
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Turnbull
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - C Selli
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - R Hu
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Zwart
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - Y Wang
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - J Xuan
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - S Sengupta
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Sims
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
| | - MC Liu
- Georgetown University, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Breast Cancer Now Research Labs, Edinburgh, Scotland, United Kingdom; Virginia Tech Research Center, Arlington, VA; Mayo Clinic, Rochester, MN
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Wolf DM, Yau C, Wulfkuhle J, Petricoin E, Campbell M, Brown-Swigart L, Hirst G, Asare S, Zhu Z, Lee EP, Delson A, Pohlmann P, Hylton N, Liu MC, Symmans F, DeMichele A, Yee D, Berry D, Esserman L, van 't Veer L. Abstract P3-10-02: Identifying breast cancer molecular phenotypes to predict response in a modern treatment landscape: Lessons from ˜1000 patients across 10 arms of the I-SPY 2 TRIAL. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The explosion in new treatment options targeting immune checkpoints, HER signaling, DNA repair deficiency, AKT, and other pathways calls for updated breast cancer subtypes beyond HR and HER2 status to predict which patients will respond to which treatments. Here we leverage the I-SPY 2 TRIAL biomarker program over the past 8 years across 10 treatment arms to elucidate a minimal set of biomarkers that may improve response prediction in a modern treatment context, and to investigate which new patient phenotypes are identified by these response-predictive biomarkers.
Methods: 986 patients were considered in this analysis. Treatments included paclitaxel alone (or with trastuzumab (H) in HER2+) or combined with investigational agents: veliparib/carboplatin (VC); neratinib; MK2206; ganitumab; ganetespib; AMG386; TDM1/pertuzumab (P); H/P; and pembrolizumab (Pembro). 24 prospectively defined, mechanism-of-action and pathway-based expression and phospho-protein signatures/biomarkers assayed from pre-treatment biopsies were previously found to be predictive in a particular agent/arm in pre-specified analysis. Here we evaluate these biomarkers in all patients. We assessed association between each biomarker and response in the population as a whole and within each arm and HR/HER2 subtype using a logistic model. To identify optimal dichotomizing thresholds for select biomarkers, 2-fold cross-validation was repeated 500 times. Our analysis is exploratory and does not adjust for multiplicities.
Results: Our initial set of 24 predictive biomarkers reflects DNA repair deficiency (n=2), immune activation (n=7), ER signaling (n=2), HER2 signaling (n=4), proliferation (n=2), phospho-activation of AKT/mTOR (n=2), and ANG/TIE2 (n=1) pathways, among others. Biomarkers reflecting similar biology are correlated and cluster together. We make use of this correlation structure to reduce the dimensionality of the biomarker set to five predictive signals: proliferation, DNA repair deficiency (DRD), immune-engaged (Immune+), luminal/ER (lum), and HER2-activated. These biomarkers, when dichotomized, identify patient groups with differential predicted sensitivities to I-SPY 2 agents and are present at different proportions within receptor subtypes. For instance, in the HER2- subset, Immune+/DRD+ patients are predicted sensitive to both VC and Pembro, and account for 39% of TN, but only 12% of HR+HER2-. On the other end of the spectrum, only 17% of TN are Immune-/DRD-, compared to the majority (56%) of HR+HER2-. There are also subsets of patients positive for only one marker. For the HER2+ subset, 67% are HER2-activated+, and 25% lum+; of these HER2-activated+ patients are more likely to be Immune+ (44%), vs 23% in lum+. HER2-activated+/Immune+ patients have higher predicted sensitivity to HER2-targeted agents than lum+ or Immune- patients.
In all, these molecular phenotypes predict sensitivity to one or more I-SPY 2 investigational agents for 75% of the ˜ 1000 patients.
Conclusion: Molecular phenotypes reflecting proliferation, immune engagement, HER2-activation, luminal/ER-signaling, and DNA repair deficiency may provide a roadmap to guide treatment prioritization for emerging therapeutics.
Citation Format: Wolf DM, Yau C, Wulfkuhle J, Petricoin E, Campbell M, Brown-Swigart L, Hirst G, Asare S, Zhu Z, Lee EP, Delson A, Pohlmann P, I-SPY 2 TRIAL Consortium, Hylton N, Liu MC, Symmans F, DeMichele A, Yee D, Berry D, Esserman L, van 't Veer L. Identifying breast cancer molecular phenotypes to predict response in a modern treatment landscape: Lessons from ˜1000 patients across 10 arms of the I-SPY 2 TRIAL [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 P3-10-02.
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Affiliation(s)
- DM Wolf
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - C Yau
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - J Wulfkuhle
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - E Petricoin
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - M Campbell
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - L Brown-Swigart
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - G Hirst
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - S Asare
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - Z Zhu
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - EP Lee
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - A Delson
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - P Pohlmann
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - N Hylton
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - MC Liu
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - F Symmans
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - A DeMichele
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - D Yee
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - D Berry
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - L Esserman
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
| | - L van 't Veer
- University of California, San Francisco; George Mason University, Fairfax; QuantumLeap Healthcare Collaborative, San Francisco; University of Texas, MD Anderson, Houston; University of Pennsylvania, Philadelphia; University of Minnesota, Minneapolis; Berry Consultants, LLC, Austin; Mayo Clinic, Rochester; Georgetown University, Washington, DC
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Liu MC, Peng KW, Federspiel MJ, Russell SJ, Brunton BA, Zhou Y, Packiriswamy N, Hubbard JM, Loprinzi CL, Peethambaram PP, Ruddy KJ, Allred JB, Galanis E, Okuno SH. Abstract P6-21-03: Phase I trial of intratumoral (IT) administration of a NIS-expressing derivative manufactured from a genetically engineered strain of measles virus (MV). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-21-03] [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: The live attenuated non-pathogenic Edmonston MV vaccine strain has advantages as an oncolytic platform given its tumor specificity, potent bystander effect, and ability to be engineered and retargeted. MV-NIS expresses the human thyroidal sodium-iodide symporter (NIS) and is selectively oncolytic, entering tumor cells through CD46 (overexpressed on many cancers, including breast cancer of all subtypes) and Nectin-4. NIS expression in MV-NIS infected cells permits noninvasive monitoring of virus spread by SPECT-CT imaging of Tc-99m pertechnetate or I-123 uptake.
Methods: NCT01846091 is a standard 3+3 phase I trial of a single IT administration of MV-NIS in pts with recurrent/metastatic squamous cell carcinoma of the head and neck (SCCHN) or metastatic breast cancer (MBC). Primary objectives are (a) safety and tolerability and (b) maximally tolerated single dose. The secondary clinical objective is to preliminarily assess antitumor efficacy at and away from the MV injection site. Key eligibility criteria were: absence of standard therapy with life prolonging intent; at least one lesion >1 cm amenable to percutaneous injection; and no impending visceral crisis. MV-NIS was administered on D1 with mandatory SPECT-CT at baseline (BL) and on D3&D8; repeat SPECT-CT on D15&D21 if the prior result was positive; mandatory tumor biopsies on D3&D21; optional tumor biopsies on D8&D15; assessments for viremia and viral shedding at BL and on D3,D8,D15,D21; and standard imaging for restaging at BL,D21,W6,W12.
Results: Accrual completed with 12 evaluable pts (6 SCCHN and 6 MBC) at 3 dose levels (108, 3x108, 109 TCID50). The MBC group included 5 HR+/HER2- pts and 1 pt with mixed HR+/HER2- and HR+/HER2+ disease. 5 pts had evidence of disease progression prior to study participation. No dose limiting toxicities were observed among the MBC pts; AEs possibly related to MV-NIS in this group were gr2 fatigue, gr1 flu-like illness, gr2 lymphopenia (all n=1). No SCCHN responses were observed. Best response for the MBC pts was: stable disease (SD) >6 wks, n=4; clinical response, n=1; progression, n=1. One MBC pt with SD for 12 wks had positive SPECT/CT imaging at and away from the injection site on D3&D8 and was the only pt seronegative for measles IgG antibodies prior to MV-NIS exposure. The MBC pt who responded after initial MV-NIS exposure was the only pt with low viral RNA in blood (D3); she received additional doses at W9&W13 without toxicity through an expanded access protocol exemption and had disease progression by W19. No viral shedding was detected from mouth rinse or urine in any pt. MV was detected in tumor samples from all pts treated at the highest dose level. Additional blood and tissue analyses are in progress.
Conclusion: These results demonstrate the safety of IT MV-NIS administration, provide early evidence of biologic activity in MBC, and support the possibility of viral replication in tumors remote from the IT injection site. A MV strain encoding the immunomodulatory neutrophil activating protein transgene has been constructed (MV-s-NAP) with preclinical evidence of improved antitumor activity and immunogenicity. The phase I MV-s-NAP trial will start recruitment in Fall 2018.
Citation Format: Liu MC, Peng K-W, Federspiel MJ, Russell SJ, Brunton BA, Zhou Y, Packiriswamy N, Hubbard JM, Loprinzi CL, Peethambaram PP, Ruddy KJ, Allred JB, Galanis E, Okuno SH. Phase I trial of intratumoral (IT) administration of a NIS-expressing derivative manufactured from a genetically engineered strain of measles virus (MV) [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 P6-21-03.
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Affiliation(s)
- MC Liu
- Mayo Clinic, Rochester, MN
| | | | | | | | | | - Y Zhou
- Mayo Clinic, Rochester, MN
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Vidula N, Goga A, Hwang J, Liu MC, Park BH, Nanda R, Pohlmann PR, Storniolo AM, Brufsky A, Abramson V, Rugo HS. Abstract OT3-04-04: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease, with immunologic and genomic correlative studies. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-04-04] [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: Thirty percent of patients with breast cancer may experience chest wall recurrence, which is associated with a higher risk of developing distant metastases and a poor prognosis. Cancer cells may evade immune rejection through the programmed cell death 1 (PD-1) pathway. Pembrolizumab, an anti-PD-1 antibody, binds PD-1 and inhibits its interaction with the programmed death ligand 1 (PD-L1) to facilitate tumor immune rejection. We hypothesize that pembrolizumab may be an effective therapy in chest wall recurrence, given the inflammatory nature, and the high expression of PD-1 in tumors with lymphovascular invasion. Platinum agents may enhance anti-tumor immunity in a synergistic manner, and the combination of pembrolizumab and carboplatin has demonstrated efficacy in advanced lung cancer. In this study, the combination of pembrolizumab and carboplatin is being evaluated in breast cancer patients with chest wall disease.
Methods: This is a randomized phase II study of breast cancer patients with advanced, unresectable breast cancer involving the chest wall, being conducted through the Translational Breast Cancer Research Consortium (TBCRC). Patients may have hormone resistant disease (at least 2 prior lines of hormone therapy), triple negative breast cancer, or refractory HER2+ disease for enrollment. They may have other sites of distant metastases, have received any number of prior lines of therapy, have had prior surgery, but prior chest wall radiation is not necessary. Eighty-four patients at 7 TBCRC sites will be randomized 2:1 to treatment with pembrolizumab 200 mg IV and carboplatin AUC 5 IV every 3 weeks followed by pembrolizumab 200 mg IV alone every 3 weeks (Arm A, n=56) or carboplatin AUC 5 IV every 3 weeks (Arm B, n=28), with an option for patients in Arm B to cross-over to single agent pembrolizumab 200 mg IV every 3 weeks (arm Bx) on progression. Patients will undergo imaging with CT chest, abdomen, and pelvis at baseline and every 2 cycles of treatment for response evaluation. The primary endpoint is the disease control rate in the chest wall and distant sites at 18 weeks of treatment, and this study is powered to determine a 20% difference in disease control rates between arms A and B (hazard ratio of 0.52, α= 0.10, β= 0.20). After 18 patients are enrolled into Arm B, an interim analysis for futility will be conducted to enable early closure of that arm for lack of efficacy. Secondary endpoints in the study are toxicity, progression free survival, and response based on PD-L1 expression and irRECIST. Exploratory endpoints, which will be studied using peripheral blood testing and chest wall tumor biopsies at baseline and after 2 cycles of treatment, include determining associations of response with changes in tumor and peripheral blood immune composition, soluble PD-L1 expression, circulating tumor cells, cell free DNA, and tumor PD-L1 and MYC genomic expression. Ultimately this study promises to improve our understanding of checkpoint inhibition and chemotherapy for chest wall disease, and the underlying mechanism of action. This study is open for enrollment and 2 patients are currently enrolled. (NCT03095352).
Citation Format: Vidula N, Goga A, Hwang J, Liu MC, Park BH, Nanda R, Pohlmann PR, Storniolo AM, Brufsky A, Abramson V, Rugo HS. A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease, with immunologic and genomic correlative studies [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 OT3-04-04.
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Affiliation(s)
- N Vidula
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - A Goga
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - J Hwang
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - MC Liu
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - BH Park
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - R Nanda
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - PR Pohlmann
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - AM Storniolo
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - A Brufsky
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - V Abramson
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - HS Rugo
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
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Leon-Ferre RA, Polley MY, Liu H, Gilbert J, Cafourek V, Hillman D, Negron V, Boughey JC, Liu MC, Ingle JN, Kalari K, Couch FJ, Visscher DW, Goetz MP. Abstract P3-05-06: Prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and its relation to stromal tumor infiltrating lymphocytes (sTILs) in triple negative breast cancer (TNBC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-05-06] [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: While TNBC remains the most aggressive type of breast cancer (BC), substantial heterogeneity in biology and outcomes exists among TNBC subtypes. Historically, risk stratification of TNBC has been based on anatomic factors such as tumor size, nodal involvement and presence of distant metastases. However, these features alone fail to accurately predict outcomes. Tumor immune infiltration (sTILs) and distribution of immune cell subsets in the perip heral blood (NLR) have emerged as variables reported to be associated with outcomes in TNBC. We sought to evaluate whether NLR and sTILs provided independent prognostic information in TNBC.
Methods: From a cohort of 9,982 women who underwent BC surgery at Mayo Clinic, Rochester, MN between Jan 1985 and Dec 2012, we identified 605 centrally-confirmed TNBC tumors. Patients (pts) with prior BC, bilateral BC, non-invasive disease, stage IV, neoadjuvant therapy, endocrine therapy, or adenoid cystic histology were excluded. For eligible tumors, clinical and pathologic variables were evaluated, including peripheral blood NLR and central assessment of sTILs per the 2014 International TILs Working Group recommendations. We calculated the Pearson correlation coefficient (PCC) between NLR and sTILs and constructed Cox Proportional Hazards Models to evaluate their association with invasive-disease free (IDFS) and overall survival (OS). NLR and sTILs were both analyzed as continuous variables.
Results: Most pts had T1-2 (95%) and N0-1 disease (86%). Median OS follow-up was 10.6yrs. Median IDFS was 12yrs (95%CI 10.2-16.7) and median OS was 18.8yrs (95%CI 15.6-20.8). NLR and sTILs were available in 408 and 599 pts, respectively. The median NLR and sTIL content were 2.29 (0.14-10.50) and 20% (0-90%), respectively. NLR and sTILs were poorly correlated (PCC 0.0237). On univariate analysis (UVA), a higher NLR was associated with worse IDFS (HR 1.13; 95%CI 1.02-1.26, p=0.02) and OS (HR 1.17; 95%CI 1.04-1.31, p=0.01). Each 1% increment in sTILs was associated with improved IDFS (HR 0.99; 95%CI 0.98-0.99, p<0.001) and OS (HR 0.99, 95%CI 0.98-1.00, p<0.001). Among pts with high sTILs (≥20%), a higher NLR remained significantly associated with worse IDFS (HR 1.21; 95%CI 1.05-1.38, p=0.007) and OS (HR 1.25; 95%CI 1.09-1.44, p=0.001). In contrast, among pts with low sTILs (<20%), NLR was not associated with IDFS (HR 1.07; 95%CI 0.89-1.28, p=0.49) or OS (HR 1.07; 95%CI 0.88-1.30, p=0.49). The interaction test between NLR and sTILs did not reach statistical significance. A multivariate analysis (MVA; including age, menopausal status, histologic subtype, grade, tumor size, nodal stage, Ki-67, NLR, sTILs, adjuvant chemotherapy, type of surgery and adjuvant radiation) showed that sTILs remained independently associated with IDFS (HR 0.99, 95%CI 0.97-1.0, p=0.019) and OS (HR 0.99, 95% CI 0.97-1.0, p=0.044), whereas NLR did not.
Conclusions: A lower NLR and a higher sTIL content were each associated with improved IDFS and OS among pts with nonmetastatic TNBC on UVA. However, when evaluated on a MVA, only sTILs remained independently associated with IDFS and OS. Our data suggest that the effect of sTILs on outcomes may not be modified by the NLR.
Citation Format: Leon-Ferre RA, Polley M-Y, Liu H, Gilbert J, Cafourek V, Hillman D, Negron V, Boughey JC, Liu MC, Ingle JN, Kalari K, Couch FJ, Visscher DW, Goetz MP. Prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and its relation to stromal tumor infiltrating lymphocytes (sTILs) in triple negative breast cancer (TNBC) [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 P3-05-06.
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Affiliation(s)
| | | | - H Liu
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - MC Liu
- Mayo Clinic, Rochester, MN
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Clarke R, Dixon MJ, Jin L, Turnbull A, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Renshaw L, Sims A, Liu MC. Abstract P4-04-10: Molecular features of dormancy in ER+ breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-04-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Late recurrence (emergence from dormancy) is characteristic of ER+ breast cancers. Despite adjuvant endocrine therapy, many breast cancers recur decades after their initial diagnosis and treatment. Why this occurs is poorly understood.
Methods: We studied 2 independent datasets of endocrine treated, ER+ breast cancers with up to 20 years follow-up. The 1st comprised matched samples from the primary tumor pretreatment at diagnosis and the first recurrence after or during adjuvant endocrine therapy (all FFPE). The 2nd dataset comprised pretreatment biopsies only (all snap frozen). For both datasets, high quality RNA was amplified, labelled, and subjected to transcriptome analysis using the Affymetrix technology (U133 Plus 2.0). Low quality data were identified using 'simpleaffy' and 'ffpe', and removed; all tools were from the R package unless otherwise noted. Remaining data were normalized using 'frma'. Genes differentially expressed between early (≤3 years) and late (≥ 5 years) were selected using limma. Unsupervised hierarchical clustering and PCA explored the structure of the data.
A similar molecular analysis was done on the 2nd dataset. A classification scheme that robustly separated early from late recurrences was validated in an independent public dataset of comparable patients, array platform, and frozen tissues. We also explored features in pretreatment samples that predetermined response duration.
Results: Genes that separated pretreatment specimens by recurrence time did not separate posttreatment specimens. Specimens did not cluster in patient pairs or by site of recurrence.
8245 genes were differentially expressed between early and late recurrences in the FFPE samples, while 2400 genes were significantly different in the same comparison in the frozen samples. Initial pathway analysis was done on each dataset independently using IPA (Ingenuity® Systems, www.ingenuity.com). 70 canonical pathways were identified in common between the two datasets (pretreatment). We then looked for genes regulated in both datasets (ignores FFPE and frozen tissue as source). There were 279 genes in common that differentially regulated in the same direction (upregulated; downregulated). IPA analysis of these genes identified 49 canonical pathways. We also explored the differentially expressed gene sets using 'GSEA' (www.software.broadinstitute.org/gsea/index.jsp). Pathways consistently associated with early vs. late recurrence include integrin signaling, the unfolded protein response, endoplasmic reticulum stress, actin-based motility, and estrogen biosynthesis.
Conclusion: Analysis of pretreatment tumors can predict early recurrences from those that will remain dormant and recur much later. Recurrent tumors exhibit a remodeled molecular landscape that likely reflects the effects of treatments and/or a recreation of a niche with potentially common features at the site of recurrence. Changes in molecular signaling associated with duration of recurrence are consistent with our experimental model studies in vitro implicating UPR signaling as a major integrator of response to endocrine therapy and duration of survival. Additional data sets are being arrayed and more detailed molecular signaling studies are in progress.
Citation Format: Clarke R, Dixon MJ, Jin L, Turnbull A, Hu R, Zwart A, Wang Y, Xuan J, Sengupta S, Renshaw L, Sims A, Liu MC. Molecular features of dormancy in ER+ 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 P4-04-10.
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Affiliation(s)
- R Clarke
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - MJ Dixon
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - L Jin
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Turnbull
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - R Hu
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Zwart
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - Y Wang
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - J Xuan
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - S Sengupta
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - L Renshaw
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - A Sims
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
| | - MC Liu
- Georgetown University Medical Center, Washington, DC; University of Edinburgh, Edinburgh, Scotland, United Kingdom; Virginia Tech, Arlington, VA; Mayo Clinic, Rochester, MN
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Liu MC, Cummings S, Vachon CM, Kerlikowske K, Couch FJ, Morris EA, Olson JE, Polley EC, Conners AL, Ellis RL, Patel B, Maimone S, Zhang N, Hamilton S, Clarke CA, Allen BA, Maddala T, Hartman AR. Abstract OT3-02-01: Development of cell-free nucleic acid-based tests for early detection of breast cancer: The STRIVE study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-02-01] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Abstract
Background:
Mammography (digital 2D or digital 3D/tomosynthesis) is the cornerstone of current screening strategies for breast cancer, but new approaches are needed to further reduce the proportion of cancers diagnosed at advanced stages and more effectively identify those women in need of additional testing and biopsies. Circulating cell-free nucleic acids (cfNAs) shed from tumors, isolated from peripheral blood, and analyzed with ultra-deep and broad sequencing of cancer-associated genes, have great potential for early cancer detection. The ultimate goal is to develop blood cfNA cancer screening tests for use in conjunction with established risk factors and/or radiographic features for improved cancer detection. Development of these tests requires large, well-annotated cohorts of asymptomatic participants with adequate volumes of prediagnostic blood. The STRIVE Study cohort was recently established to train and validate cfNA-based tests for early detection of breast cancer.
Eligibility criteria and trial design: The STRIVE Study is a new prospective, multi-ethnic mammography cohort that will recruit 120,000 subjects from 15+ US breast cancer screening centers (including Mayo Clinic and Sutter Health sites). Eligibility criteria require only that a participant has a scheduled routine screening mammogram at a participating center and has not received a biopsy prior to the research blood draw. Participants are recruited within 28 days of screening mammography (digital or tomosynthesis), consent electronically, provide blood samples, and complete an on-line risk factor questionnaire. Participants will be followed for all cancer diagnoses, cancer recurrences, and death for at least 5 years. Pertinent medical record information, imaging findings (including breast density), and follow-up data will be transferred electronically to a central database throughout the study period. Additional blood samples will be collected from participants with abnormal mammogram results, or who are diagnosed with cancer, to document and better understand the evolution of cfNA signals. Recruitment began in February 2017.
Primary Aims: To train and validate a cfNA blood-based test to identify breast cancer overall in a cohort of women undergoing screening mammography.
Statistical Methods: The study will be divided into a training phase (1/3 of participants) and an independent clinical validation phase (remaining 2/3 of participants). In the training phase, statistical machine learning techniques will be used to develop algorithms incorporating cfNA signals, clinical characteristics, or radiological features. In the validation phase, the prespecified locked algorithm developed from the training phase will be clinically validated in an independent group of women.
Contact information for people with a specific interest in the trial: Additional details regarding the STRIVE Study are available on the ClinicalTrials.gov website (NCT03085888). For site-specific questions, please call 844-366-9738 for the Mayo Clinic and 1-855-578-7483 for Sutter Health.
Citation Format: Liu MC, Cummings S, Vachon CM, Kerlikowske K, Couch FJ, Morris EA, Olson JE, Polley EC, Conners AL, Ellis RL, Patel B, Maimone IV S, Zhang N, Hamilton S, Clarke CA, Allen BA, Maddala T, Hartman A-R. Development of cell-free nucleic acid-based tests for early detection of breast cancer: The STRIVE study [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 OT3-02-01.
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Affiliation(s)
- MC Liu
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - S Cummings
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - CM Vachon
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - K Kerlikowske
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - FJ Couch
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - EA Morris
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - JE Olson
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - EC Polley
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - AL Conners
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - RL Ellis
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - B Patel
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - S Maimone
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - N Zhang
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - S Hamilton
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - CA Clarke
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - BA Allen
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - T Maddala
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
| | - A-R Hartman
- Mayo Clinic, Rochester, MN; CPMC Research Institute, Sutter Health, University of California, San Francisco, CA; University of California, San Francisco, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Mayo Clinic Health Systems, La Crosse, WI; Mayo Clinic, Phoenix, AZ; Mayo Clinic, Jacksonville, FL; GRAIL Inc., Menlo Park, CA
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Modi S, Pusztai L, Forero A, Mita M, Miller KD, Weise A, Krop I, Burris H, Kalinsky K, Tsai M, Liu MC, Hurvitz SA, Wilks S, Ademuyiwa F, Diab S, Han HS, Kato G, Nanda R, O'Shaughnessy J, Kostic A, Li M, Specht J. Abstract PD3-14: Phase 1 study of the antibody-drug conjugate SGN-LIV1A in patients with heavily pretreated triple-negative metastatic breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd3-14] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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
LIV-1, a transmembrane protein and downstream target of STAT3, is highly expressed in breast cancer cells. It is associated with lymph node involvement and metastatic progression. SGN-LIV1A is an anti-LIV-1 antibody conjugated via a protease-cleavable linker to monomethyl auristatin E (MMAE). Upon binding to cell-surface LIV-1, SGN-LIV1A is internalized and releases MMAE, which disrupts microtubulin and induces apoptosis.
Methods
This ongoing, phase 1 study evaluates safety, tolerability, pharmacokinetics, and antitumor activity of SGN-LIV1A (q3wks IV) in women with LIV-1-positive, unresectable, locally advanced or metastatic breast cancer (LA/MBC) (NCT01969643). Patients (pts) with measurable disease and ≥2 prior cytotoxic regimens for LA/MBC are eligible. Pts with ≥ Grade 2 neuropathy are excluded. Response is assessed per RECIST v1.1; pts with stable disease (SD) or better can continue treatment until disease progression or intolerable toxicity. At completion of dose escalation in hormone receptor-positive/HER2-negative (HR+/HER2–) and triple-negative (TN) pts, expansion cohorts were opened to further evaluate safety and antitumor activity of monotherapy in TN pts. Tumor biopsies are evaluated for LIV-1 expression.
Results
To date, 69 pts (18 HR+/HER2–, 51 TN) have received a median of 3 cycles (range, 1–12) of SGN-LIV1A at doses of 0.5–2.8 mg/kg. Median age was 56 yrs. Pts had a median of 3 prior cytotoxic regimens for LA/MBC; 58 had visceral disease and 37 had bone metastases. No dose-limiting toxicities (DLTs) occurred in 19 DLT-evaluable pts; maximum tolerated dose was not exceeded at 2.8 mg/kg. Expansion cohorts of TN pts were opened at 2.0 and 2.5 mg/kg. Treatment-emergent adverse events (AEs) reported in ≥25% of pts were fatigue (59%), nausea (51%), peripheral neuropathy (44%), alopecia (36%), decreased appetite (33%), constipation (30%), abdominal pain, diarrhea, and neutropenia (25% each). Most AEs were Grade 1/2; AEs ≥ Grade 3 included neutropenia (25%) and anemia (15%). Febrile neutropenia occurred in 2 pts whose total dose exceeded 200 mg per cycle, including 1 treatment-related death due to sepsis. No other treatment-related deaths occurred on-study. Seven pts discontinued treatment due to AEs. In dose escalation, activity was observed in 17 efficacy evaluable (EE) HR+/HER2- pts, with a disease control rate (DCR= CR+PR+SD) of 59% (10 SD), including 1 pt with SD ≥24 wks. Among the 44 EE TN pts (dose escalation plus expansion cohorts), the objective response rate (ORR) was 32% (14 PR) with a confirmed PR rate of 21%, DCR was 64% (14 PR, 14 SD), and clinical benefit rate (CBR=CR+PR+SD ≥24 wks) was 36% (16 pts). For TN pts, median PFS was 11.3 wks (95% CI: 6.1, 17.1); 10 pts remain on treatment.
Of 631 MBC tumor samples of all clinical subtypes evaluated for LIV-1, 91% were positive; 75% had moderate-to-high expression (H-score ≥100).
Conclusions
LIV-1 is expressed in almost all MBC tumors. SGN-LIV1A monotherapy was generally well tolerated and showed encouraging antitumor activity in heavily pretreated TN MBC, with a PR rate of 32%, confirmed PR rate of 21%, and CBR (≥24 wks) of 36%. Response duration data continue to evolve. Enrollment continues in the TN monotherapy expansion cohort.
Citation Format: Modi S, Pusztai L, Forero A, Mita M, Miller KD, Weise A, Krop I, Burris III H, Kalinsky K, Tsai M, Liu MC, Hurvitz SA, Wilks S, Ademuyiwa F, Diab S, Han HS, Kato G, Nanda R, O'Shaughnessy J, Kostic A, Li M, Specht J. Phase 1 study of the antibody-drug conjugate SGN-LIV1A in patients with heavily pretreated triple-negative metastatic breast cancer [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 PD3-14.
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Affiliation(s)
- S Modi
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - L Pusztai
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - A Forero
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - M Mita
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - KD Miller
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - A Weise
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - I Krop
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - H Burris
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - K Kalinsky
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - M Tsai
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - MC Liu
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - SA Hurvitz
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - S Wilks
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - F Ademuyiwa
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - S Diab
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - HS Han
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - G Kato
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - R Nanda
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - J O'Shaughnessy
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - A Kostic
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - M Li
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
| | - J Specht
- Memorial Sloan Kettering Cancer Center, New York, NY; Yale Cancer Center, Yale School of Medicine, New Haven, CT; University of Alabama at Birmingham, Birmingham, AL; Cedars-Sinai Medical Center, Los Angeles, CA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN; Karmanos Cancer Institute, Detroit, MI; Dana-Farber Cancer Institute, Boston, MA; Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Columbia University Medical Center, New York, New York, NY; Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN; Mayo Clinic, Rochester, MN; University of California, Los Angeles, Los Angeles, CA; Texas Oncology, San Antonio, TX; Washington University in St. Louis, St. Louis, MO; US Oncology Denver, Denver, CO; Moffitt Cancer Center, Tampa, FL; Virginia G. Piper Cancer Care Network, Scottsdale, AZ; University of Chicago, Chicago, IL; Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX; Seattle Genetics, Inc., Bothell, WA; Seattle Cancer Care Allia
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Polley MYC, Leon-Ferre RA, Liu H, Gilbert J, Cafourek V, Hillman DW, Negron V, Boughey JC, Liu MC, Ingle JN, Kalari K, Couch F, Visscher DW, Goetz MP. Abstract P1-06-07: Mayo clinic TNBC outcome calculator: A clinical calculator to predict disease relapse and survival in women with triple-negative breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-07] [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
Purpose: Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype with substantial risks of disease recurrence. While cytotoxic chemotherapy is commonly administered and reduces recurrence, disease outcomes vary considerably and few prognostic tools are available for risk stratification for TNBC patients. We constructed and validated clinical calculators for invasive-disease free survival (IDFS) and overall survival (OS) for TNBC and compared their performance against AJCC-based models which include only tumor size and nodal status.
Methods: From a surgical cohort of 9,982 patients who underwent breast cancer surgery at Mayo Clinic between January 1985 and December 2012, 605 centrally reviewed TNBC patients were identified and used to construct Cox models for IDFS and OS. Patients treated with neoadjuvant chemotherapy were excluded. Variables considered included age, menopausal status, tumor size, nodal status, Nottingham grade, type of breast surgery (mastectomy vs. lumpectomy), adjuvant radiation therapy, adjuvant chemotherapy, Ki67, stromal tumor infiltrating lymphocytes (sTILs), and neutrophil-to-lymphocyte ratio (NLR). Missing values were imputed using single imputation with all variables (including outcomes) included in the imputation model. Backward step-down procedure was used for model selections. The final models were internally validated for calibration and discrimination using bootstrapping methods and compared with AJCC-based models.
Results: For both IDFS and OS, higher sTIL's, less extensive nodal involvement, use of adjuvant chemotherapy, and lower NLR were significant predictors of improved clinical outcomes. Premenopausal status and younger age were additionally predictive of improved IDFS and OS, respectively. Models for IDFS and OS have good calibration and are associated with bias-corrected C-indices of 0.68 and 0.71, respectively, as compared with C-indices of 0.59 and 0.62 for AJCC-based models.
Conclusions: Our data indicate that a clinical calculator that includes sTIL's, NLR, menopausal status, age, nodal involvement as well as chemotherapy use can provide significantly greater prediction of clinical risk than tumor size and nodal status alone. These tools may be used to identify TNBC patients at elevated risk of disease relapse and to aid physician's communication with patients regarding their long-term disease outlook and planning treatment strategies. External validation is required to further evaluate broader applicability of this tool, which was developed utilizing a single-institutional experience.
Citation Format: Polley M-YC, Leon-Ferre RA, Liu H, Gilbert J, Cafourek V, Hillman DW, Negron V, Boughey JC, Liu MC, Ingle JN, Kalari K, Couch F, Visscher DW, Goetz MP. Mayo clinic TNBC outcome calculator: A clinical calculator to predict disease relapse and survival in women with triple-negative breast cancer [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 P1-06-07.
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Affiliation(s)
| | | | - H Liu
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - MC Liu
- Mayo Clinic, Rochester, MN
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Liu MC, Xiao HQ, Breslin LM, Bochner BS, Schroeder JT. Enhanced antigen presenting and T cell functions during late-phase allergic responses in the lung. Clin Exp Allergy 2017; 48:334-342. [PMID: 29105205 DOI: 10.1111/cea.13054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Allergic inflammation is a common feature of asthma and may contribute to both development and perpetuation of disease. The interaction of antigen-presenting cells (APC) with sensitized helper T lymphocytes (TC) producing Th2 cytokines may determine the inflammatory response. Recruitment of APC and TC to the lung during allergic responses has been demonstrated, but functional studies in humans have been limited. OBJECTIVE This study examined the function of APC and TC accumulating at sites of inflammation after segmental allergen challenge (SAC). METHODS Fifteen allergic patients underwent SAC, and cells from bronchoalveolar lavage (BAL) were collected after 24 hours. APC and TC from the blood and BAL were purified based on expression of the monocyte marker, CD14; the plasmacytoid dendritic cell (pDC) marker, BDCA4, identifying neuropilin-1 (NRP1); and the helper T cell marker, CD4. Functional activity was assessed using allergen-induced T cell proliferation. Flow cytometry identified cells expressing CD14 and NRP1. RESULTS SAC resulted in a 12-fold increase in mononuclear cells having the morphologic appearance of blood monocytes. Most of these cells co-expressed CD14 and NRP1. After saline challenge, BAL mononuclear cells demonstrated little APC function. Following SAC, BAL mononuclear cells showed function equal to pDC from blood and greater than blood monocytes. Purified NRP1+ cells from BAL had even greater function than pDC cells from blood (P = .008). Using consistent sources of APC, enhanced proliferation of TC from lung compared to blood was also demonstrated (P = .002). CONCLUSIONS The marked increase in APC function for allergen-specific TC proliferation during allergic inflammation is largely due to the recruitment of monocytes and dendritic cells. There is also an enhanced response in the lung TC population, consistent with recruitment of allergen-specific T cells. Interactions between recruited APC and TC may occur as an early event promoting allergic airway inflammation.
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Affiliation(s)
- M C Liu
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - H Q Xiao
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - L M Breslin
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - B S Bochner
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - J T Schroeder
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Hsu YY, Lee SY, Liu CY, Liu MC. 1039 SLEEP, FATIGUE, AND DEPRESSIVE SYMPTOMS AMONG GYNECOLOGICAL CANCER POSTSURGICAL TREATMENT PATIENTS IN TAIWAN. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Paoletti C, Regan MM, Liu MC, Marcom PK, Hart LL, Smith JW, Tedesco KL, Amir E, Krop IE, DeMichele AM, Goodwin PJ, Block M, Aung K, Cannell EM, Darga EP, Baratta PJ, Brown ME, McCormack RT, Hayes DF. Abstract P1-01-01: Circulating tumor cell number and CTC-endocrine therapy index predict clinical outcomes in ER positive metastatic breast cancer patients: Results of the COMETI Phase 2 trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-01-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Only half of hormone receptor positive (HR+) metastatic breast cancer (MBC) patients (pts) benefit from endocrine therapy (ET). Circulating tumor cells (CTC) are prognostic in pts with MBC using CellSearch® technology. The CTC-endocrine therapy index (CTC-ETI) provides semi-quantitative analyses of CTC-ER (estrogen receptor), BCL2, HER2, and Ki67 expression. We hypothesized that CTC-ETI high (elevated CTC number and/or low expression of ER and BCL2, and high expression of HER2 and Ki-67) might predict resistance to ET in a prospective, multi-institutional clinical trial: COMETI-P2-2012.0 (NCT01701050).
Methods: 121 pts with ER+, HER2 negative (-), and progressive MBC after one or more lines of ET or within 12 months (mos) of completing adjuvant ET, who were initiating a new ET, were enrolled after informed consent. CTC and CTC-ETI were determined as previously reported (Paoletti C et al, CCR 2015) at baseline (BL), 1, 2, 3, and 12 mos, and/or at the time of progression. Imaging was performed every 3 mos. Association of CTC levels and CTC-ETI with patient outcomes (progression free survival (PFS); rapid progression (RP) defined as progression within 3 mos) was assessed using logrank and Fisher's exact tests. Trial design estimated 85 PFS and 51 RP events, providing >90% power (2-sided a=0.05); pts with unsuccessful BL CTC-ETI or ineligible were unevaluable. Only baseline (BL) data are reported in this abstract.
Results: 32% of enrolled pts had progression within 12 mos of completing adjuvant ET, whereas 40%, 20%, and 8% had 1, 2, ≥3 lines of ET for MBC. CTC-ETI was successfully determined in 93% of pts (90% CI, 88% to 97%). CTC were ≥5 CTC/7.5 ml whole blood in 37/108 (34%) pts evaluable for clinical validity. Elevated CTC was associated with worse PFS (median (m) PFS: 3.3 vs. 5.9 mos; P<0.01). Low, intermediate, and high CTC-ETI were observed in 75 (69%), 6 (6%), and 27 (25%) pts, respectively. CTC-ETI was associated with PFS (logrank P<0.01): pts with low, intermediate, and high CTC-ETI had mPFS of 5.7, 8.5, and 2.8 mos, respectively. In the 96 pts eligible for determination, elevated CTC was associated with RP, (65.6% vs. 42.2%; P=0.05) as was CTC-ETI (P=0.003): 79.2% (95% CI, 57.8% to 92.9%) of pts with high CTC-ETI had RP versus 41.2% (95% CI, 29.4% to 53.8%) with low CTC-ETI; in the small group with intermediate CTC-ETI 1 of 4 pts (25%) had RP.
Conclusions: In this multi-institutional, prospective study, CTC-ETI was accurately determined, confirming the previously established analytical validity of the assay, meeting the primary objective of the trial. Elevated CTC and CTC-ETI high compared to low were associated with poor outcomes to ET. CTC-ETI distribution resulted in a small number of patients assigned to the intermediate group, restricting our ability to associate this group with outcomes. These results suggest that CTC-biomarker phenotype and enumeration have clinical validity. CTC-ETI may identify ER+ HER2– MBC pts who are unlikely to benefit from ET and might be better treated with ET in combination with other therapies or proceed to chemotherapy. Further analyses including CTC-ETI at serial time points during ET are planned.
Citation Format: Paoletti C, Regan MM, Liu MC, Marcom PK, Hart LL, Smith II JW, Tedesco KL, Amir E, Krop IE, DeMichele AM, Goodwin PJ, Block M, Aung K, Cannell EM, Darga EP, Baratta PJ, Brown ME, McCormack RT, Hayes DF. Circulating tumor cell number and CTC-endocrine therapy index predict clinical outcomes in ER positive metastatic breast cancer patients: Results of the COMETI Phase 2 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-01-01.
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Affiliation(s)
- C Paoletti
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - MM Regan
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - MC Liu
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - PK Marcom
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - LL Hart
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - JW Smith
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - KL Tedesco
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - E Amir
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - IE Krop
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - AM DeMichele
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - PJ Goodwin
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - M Block
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - K Aung
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - EM Cannell
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - EP Darga
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - PJ Baratta
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - ME Brown
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - RT McCormack
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
| | - DF Hayes
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Dana-Farber Cancer Institute, Boston, MA; Mayo Clinic, Rochester, MN; Duke University, Duke Cancer Center, Durham, NC; Florida Cancer Specialist (South Division), Fort Myers, FL; Northwest Cancer Specialists, Portland, OR; New York Oncology Hematology, US Oncology Research, Albany, NY; Princess Margaret Hospital, Toronto, ON, Canada; University of Pennsylvania, Philadelphia, PA; Mt. Sinai Hospital-Toronto, Toronto, ON, Canada; Nebraska Cancer Specialists, Omaha, NE; Janssen Pharmaceuticals, Inc., Raritan, NJ
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Liu MC, Symmans WF, Yau C, Chen YY, Rugo HS, Olopade OF, Datnow B, Chen B, Feldman M, Kallakury B, Hasteh F, Tickman R, Ritter J, Troxel M, Mhawech-Fauceglia P, Duan X, Berry D, Esserman L, DeMichele A. Abstract P3-07-49: Residual cancer burden (RCB) with veliparib/carboplatin in the I-SPY2 trial. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: I-SPY2 is a multicenter phase 2 trial in high risk stage II/III breast cancer (BC) using adaptive randomization within biomarker subtypes to evaluate novel agents added to standard neoadjuvant chemotherapy. The first regimen to graduate based on the predicted probability of a higher pCR rate within predefined subsets was veliparib/carboplatin + paclitaxel (VC+T→AC vs T→AC) in triple negative BC (TNBC). In TNBC the residual cancer burden (RCB) is prognostic, whether as a continuous index or grouped into classes, with pCR (RCB-0) and RCB-I classes having identical survival. Therefore, we evaluated the use of RCB to further discriminate between investigational and control arms.
Methods: Site pathologists reported RCB for 99% of subjects in the primary efficacy analysis based on pCR (n=114/115). We compared the distribution of RCB reported as a continuous index in each treatment-subset combination to matched concurrently randomized controls using the Wilcoxon rank sum test for RCB index, and Fisher's Exact test for RCB classes (RCB-0/I vs RCB-II/III). The statistics are descriptive rather than inferential, and given the small sample size have no claim on generalizability. We modified the Bayesian model used to compute the estimated probability of success in a future, randomized, phase 3 trial of 300 subjects, if response were defined by either pCR or RCB-I (RCB0/I), or separately if it were defined by pCR alone.
Results: VC+T→AC led to a significantly lower RCB index than T→AC in TNBC (p=0.0021), with a near-significant trend when those with pCR were excluded (p=0.06). There was no significant difference in RCB distributions in the other breast cancer subtypes treated. In TNBC, the odds ratio (OR) for achieving RCB-0/I in the VC+T→AC arm vs control was 8.2 (95% confidence interval (CI): 2.1–35), whereas the OR for achieving pCR was 4.56 (95% CI: 1.25–19.53). The simulations using response information from I-SPY2 to predict the probability of success for VC+T→AC for TNBC in a future phase 3 trial estimated this probability to be 0.99 if modeled using RCB-0/I as the response endpoint, and 0.90 if modeled using pCR as the response endpoint.
Conclusions: Use of RCB index and classes provided additional insight into the effect of adding VC to T, appearing to magnify the improved treatment response that had been observed with pCR rates in TNBC. It will be important to test in randomized trials whether a decrease in the RCB index relative to controls, and/or increased rates of RCB-0/I class, are predictive of survival benefit in TNBC.
Citation Format: Liu MC, Symmans WF, Yau C, Chen Y-Y, Rugo HS, Olopade OF, Datnow B, Chen B, Feldman M, Kallakury B, Hasteh F, Tickman R, Ritter J, Troxel M, Mhawech-Fauceglia P, Duan X, Berry D, Esserman L, DeMichele A. Residual cancer burden (RCB) with veliparib/carboplatin in the I-SPY2 trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-49.
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Affiliation(s)
- MC Liu
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - WF Symmans
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - C Yau
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - Y-Y Chen
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - HS Rugo
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - OF Olopade
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - B Datnow
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - B Chen
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - M Feldman
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - B Kallakury
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - F Hasteh
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - R Tickman
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - J Ritter
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - M Troxel
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - P Mhawech-Fauceglia
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - X Duan
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - D Berry
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - L Esserman
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
| | - A DeMichele
- Mayo Clinic, Rochester, MN; MD Anderson, Houston, TX; Buck Institute for Research on Aging, Novato, CA; University of California, San Francisco, CA; University of Chicago, Chicago, IL; University of San Diego, San Diego, CA; University of Pennsylvania, Philadelphia, PA; Georgetown University, Washington, DC; Swedish Medical Center, Seattle, WA; University of Minnesota, Minneapolis, MN; OHSU, Portland, OR; Keck Hospital of USC, Los Angeles, CA; Loyola University Health System, Mayowood, IL
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Iankov ID, Kurokawa CB, D'Assoro AB, Ingle JN, Domingo-Musibay E, Allen C, Crosby CM, Nair AA, Liu MC, Aderca I, Federspiel MJ, Galanis E. Inhibition of the Aurora A kinase augments the anti-tumor efficacy of oncolytic measles virotherapy. Cancer Gene Ther 2015; 22:438-44. [PMID: 26272026 PMCID: PMC4589445 DOI: 10.1038/cgt.2015.36] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/03/2015] [Accepted: 06/19/2015] [Indexed: 12/20/2022]
Abstract
Oncolytic measles virus (MV) strains have demonstrated broad spectrum preclinical anti-tumor, including breast cancer. Aurora A kinase controls mitotic spindle formation and plays a critical role in malignant transformation. We hypothesized that, by causing mitotic arrest, the Aurora A kinase inhibitor MLN8237 (alisertib) can increase MV oncolytic effect and efficacy. Alisertib enhanced MV oncolysis in vitro and significantly improved outcome in vivo against breast cancer xenografts. In a disseminated MDA-231-lu-P4 lung metastatic model, the MV/alisertib combination treatment markedly increased median survival to 82.5 days with 20% of the animals being long term survivors vs. 48 days median survival for the control animals. Similarly, in a pleural effusion model of advanced breast cancer, the MV/alisertib combination significantly improved outcome with a 74.5 day median survival versus the single agent groups (57 and 40 days respectively). Increased viral gene expression and IL-24 upregulation were demonstrated, representing possible mechanisms for the observed increase in antitumor effect. Inhibiting Aurora A kinase with alisertib represents a novel approach to enhance measles virus-mediated oncolysis and antitumor effect. Both oncolytic MV strains and alisertib are currently tested in clinical trials, this study therefore provides the basis for translational applications of this combinatorial strategy in the treatment of patients with advanced breast cancer.
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Affiliation(s)
- I D Iankov
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - C B Kurokawa
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - A B D'Assoro
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - J N Ingle
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - C Allen
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - C M Crosby
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - A A Nair
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - M C Liu
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - I Aderca
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - M J Federspiel
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - E Galanis
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Oncology, Mayo Clinic, Rochester, MN, USA
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27
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Prat A, Lluch A, Albanell J, Barry WT, Fan C, Chacón JI, Parker JS, Calvo L, Plazaola A, Arcusa A, Seguí-Palmer MA, Burgues O, Ribelles N, Rodriguez-Lescure A, Guerrero A, Ruiz-Borrego M, Munarriz B, López JA, Adamo B, Cheang MCU, Li Y, Hu Z, Gulley ML, Vidal MJ, Pitcher BN, Liu MC, Citron ML, Ellis MJ, Mardis E, Vickery T, Hudis CA, Winer EP, Carey LA, Caballero R, Carrasco E, Martín M, Perou CM, Alba E. Predicting response and survival in chemotherapy-treated triple-negative breast cancer. Br J Cancer 2014; 111:1532-41. [PMID: 25101563 PMCID: PMC4200088 DOI: 10.1038/bjc.2014.444] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 06/26/2014] [Accepted: 07/13/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In this study, we evaluated the ability of gene expression profiles to predict chemotherapy response and survival in triple-negative breast cancer (TNBC). METHODS Gene expression and clinical-pathological data were evaluated in five independent cohorts, including three randomised clinical trials for a total of 1055 patients with TNBC, basal-like disease (BLBC) or both. Previously defined intrinsic molecular subtype and a proliferation signature were determined and tested. Each signature was tested using multivariable logistic regression models (for pCR (pathological complete response)) and Cox models (for survival). Within TNBC, interactions between each signature and the basal-like subtype (vs other subtypes) for predicting either pCR or survival were investigated. RESULTS Within TNBC, all intrinsic subtypes were identified but BLBC predominated (55-81%). Significant associations between genomic signatures and response and survival after chemotherapy were only identified within BLBC and not within TNBC as a whole. In particular, high expression of a previously identified proliferation signature, or low expression of the luminal A signature, was found independently associated with pCR and improved survival following chemotherapy across different cohorts. Significant interaction tests were only obtained between each signature and the BLBC subtype for prediction of chemotherapy response or survival. CONCLUSIONS The proliferation signature predicts response and improved survival after chemotherapy, but only within BLBC. This highlights the clinical implications of TNBC heterogeneity, and suggests that future clinical trials focused on this phenotypic subtype should consider stratifying patients as having BLBC or not.
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Affiliation(s)
- A Prat
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035 Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - A Lluch
- Department of Medical Oncology and Department of Pathology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - J Albanell
- Department of Medical Oncology, Hospital del Mar, IMIM, 08003 Barcelona, Spain
- Department of Medical Oncology, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
| | - W T Barry
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - C Fan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - J I Chacón
- Department of Medical Oncology, Hospital Virgen de la Salud, 45004 Toledo, Spain
| | - J S Parker
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27519, USA
| | - L Calvo
- Department of Medical Oncology, Complexo Hospitalario Universitario de A Coruña, 15002 A Coruña, Spain
| | - A Plazaola
- Department of Medical Oncology, Onkologikoa, 20014 San Sebastián, Spain
| | - A Arcusa
- Department of Medical Oncology, Consorci Sanitari de Terrassa, 08225 Barcelona, Spain
| | - M A Seguí-Palmer
- Department of Medical Oncology, Corporació Sanitària Parc Taulí, 08208 Sabadell, Spain
| | - O Burgues
- Department of Medical Oncology and Department of Pathology, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - N Ribelles
- Department of Medical Oncology and Department of Pathology, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | - A Rodriguez-Lescure
- Department of Medical Oncology, Hospital General de Elche, 03203 Alicante, Spain
| | - A Guerrero
- Department of Medical Oncology, Instituto Valenciano de Oncología (IVO), 46009 Valencia, Spain
| | - M Ruiz-Borrego
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - B Munarriz
- Department of Medical Oncology, Hospital Universitario La Fe, 46026 Valencia, Spain
| | - J A López
- Department of Medical Oncology, Hospital San Camilo, 28006 Madrid, Spain
| | - B Adamo
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - M C U Cheang
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - Y Li
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - Z Hu
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - M L Gulley
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - M J Vidal
- Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Pg Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - B N Pitcher
- Alliance Statistical and Data Center, Duke University, Durham, NC 27708, USA
| | - M C Liu
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - M L Citron
- ProHEALTH Care Associates, LLP, Lake Success, NY 11803, USA
| | - M J Ellis
- Department of Oncology, Washington University, St. Louis, MO 63130, USA
| | - E Mardis
- Department of Oncology, Washington University, St. Louis, MO 63130, USA
| | - T Vickery
- Department of Oncology, Washington University, St. Louis, MO 63130, USA
| | - C A Hudis
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - E P Winer
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - L A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
| | - R Caballero
- GEICAM (Spanish Breast Cancer Research Group), 28700 Madrid, Spain
| | - E Carrasco
- GEICAM (Spanish Breast Cancer Research Group), 28700 Madrid, Spain
| | - M Martín
- GEICAM (Spanish Breast Cancer Research Group), 28700 Madrid, Spain
- Department of Medical Oncology, Instituto de Investigación Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, 28007 Madrid, Spain
| | - C M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27519, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC 27519, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27519, USA
| | - E Alba
- Department of Medical Oncology and Department of Pathology, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
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Lo YC, Chen WC, Huang WT, Lin YC, Liu MC, Kuo HW, Chuang JH, Yang JR, Liu MT, Wu HS, Yang CH, Chou JH, Chang FY. Surveillance of avian influenza A(H7N9) virus infection in humans and detection of the first imported human case in Taiwan, 3 April to 10 May 2013. Euro Surveill 2013. [DOI: 10.2807/ese.18.20.20479-en] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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
On 3 April 2013, suspected and confirmed cases of influenza A(H7N9) virus infection became notifiable in the primary care sector in Taiwan, and detection of the virus became part of the surveillance of severe community-acquired pneumonia. On 24 April, the first imported case, reported through both surveillance systems, was confirmed in a man returning from China by sequencing from endotracheal aspirates after two negative throat swabs. Three of 139 contacts were ill and tested influenza A(H7N9)-negative.
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Affiliation(s)
- Y C Lo
- Centers for Disease Control, Taipei, Taiwan
| | - W C Chen
- Centers for Disease Control, Taipei, Taiwan
| | - W T Huang
- Centers for Disease Control, Taipei, Taiwan
| | - Y C Lin
- Centers for Disease Control, Taipei, Taiwan
| | - M C Liu
- Centers for Disease Control, Taipei, Taiwan
| | - H W Kuo
- Centers for Disease Control, Taipei, Taiwan
| | - J H Chuang
- Centers for Disease Control, Taipei, Taiwan
| | - J R Yang
- Centers for Disease Control, Taipei, Taiwan
| | - M T Liu
- Centers for Disease Control, Taipei, Taiwan
| | - H S Wu
- Centers for Disease Control, Taipei, Taiwan
| | - C H Yang
- Centers for Disease Control, Taipei, Taiwan
| | - J H Chou
- Centers for Disease Control, Taipei, Taiwan
| | - F Y Chang
- Centers for Disease Control, Taipei, Taiwan
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29
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Lo YC, Chen WC, Huang WT, Lin YC, Liu MC, Kuo HW, Chuang JH, Yang JR, Liu MT, Wu HS, Yang CH, Chou JH, Chang FY. Surveillance of avian influenza A(H7N9) virus infection in humans and detection of the first imported human case in Taiwan, 3 April to 10 May 2013. Euro Surveill 2013; 18:20479. [PMID: 23725865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
On 3 April 2013, suspected and confirmed cases of influenza A(H7N9) virus infection became notifiable in the primary care sector in Taiwan, and detection of the virus became part of the surveillance of severe community-acquired pneumonia. On 24 April, the first imported case, reported through both surveillance systems, was confirmed in a man returning from China by sequencing from endotracheal aspirates after two negative throat swabs. Three of 139 contacts were ill and tested influenza A(H7N9)-negative.
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Affiliation(s)
- Y C Lo
- Centers for Disease Control, Taipei, Taiwan
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30
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Gucalp A, Tolaney S, Isakoff SJ, Ingle J, Liu MC, Carey L, Blackwell KL, Rugo H, Nabell L, Forero A, Stearns V, Momen L, Gonzalez J, Akhtar A, Giri DD, Patil S, Feigin KN, Hudis CA, Traina TA. Abstract P6-05-02: Endocrine biomarkers in response to AR-inhibition with bicalutamide for the treatment of AR(+), ER/PR(−) metastatic breast cancer (MBC) (TBCRC011). Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-05-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Our group and others have identified a subset of ER/PR(−) breast cancers characterized by expression of the androgen receptor (AR) and androgen-dependent growth (Doane 2006). We conducted a proof-of-concept multicenter phase II study to test the efficacy of the AR-antagonist, bicalutamide for the treatment of AR(+) ER/PR(−) MBC (NCT00468715). Results of the primary endpoint, clinical benefit rate (CBR), were presented at ASCO (Gucalp 2012). Data for the impact of bicalutamide on circulating hormone levels in women are limited. Elevations in serum testosterone (T) and estradiol (E) have been observed for men treated with bicalutamide. We hypothesized comparable patterns of change in circulating endocrine markers in response to bicalutamide for women with MBC.
Methods: Patients (pts) with AR(+) (IHC ≥10%), ER/PR(−) (IHC <10%) MBC were eligible for treatment (tx) if ECOG performance status ≤2 and normal organ function regardless of menopausal status. There was no limit to prior tx except prior trastuzumab required if HER2(+). Tx consisted of bicalutamide 150mg orally daily in 28-day cycles (C). Toxicity assessed q4 weeks, response q12wks. Primary endpoint was CBR. Peripheral blood was collected for total and free T, E and sex hormone binding globulin (SHBG) at baseline, start of C2 (C2) and at end of study (EOS). Standard institutional assays were used. A Wilcoxon signed-rank test was done to compare baseline to C2 and EOS values.
Results: 26 patients with AR(+) ER/PR(−) MBC were treated on study. Evaluable number (n) of pts at baseline, C2 and EOS are 26, 26 and 19 respectively. Two pts remain on study. Menopausal status: pre=2, post=24. Baseline median total and free T and estradiol were consistent with expected norms, however a wide range was observed (Table). There were no significant differences observed for median free T, total T, E or SHBG between baseline and C2 or baseline and EOS. Changes in hormone levels could not be stratified by menopausal status or response to bicalutamide given small sample size. Given the wide range of baseline values, we examined the percent change for each endocrine biomarker from baseline to C2 and EOS. As shown in the Table, there was no difference in median percent change observed across time points for each biomarker.
Conclusions: No discernible patterns of change in T, E or SHBG were observed in response to bicalutamide therapy when given to women for the treatment of AR(+), ER/PR(−) MBC. These circulating hormones require further evaluation for use as a pharmacodynamic marker.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-05-02.
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Affiliation(s)
- A Gucalp
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - S Tolaney
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - SJ Isakoff
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - J Ingle
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - MC Liu
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - L Carey
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - KL Blackwell
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - H Rugo
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - L Nabell
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - A Forero
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - V Stearns
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - L Momen
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - J Gonzalez
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - A Akhtar
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - DD Giri
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - S Patil
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - KN Feigin
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - CA Hudis
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
| | - TA Traina
- Memorial Sloan-Kettering Cancer Center; Dana Farber/Harvard Cancer Center; Mayo Clinic Cancer Center; Lombardi Comprehensive Cancer Center at Georgetown University; University of North Carolina Lineberger Cancer Center; University of California San Francisco Comprehensive Cancer Center; Duke University Medical Cancer Center; University of Alabama Comprehensive Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University
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Liu MC, Sakakibara Y, Suiko M. Role of a putative tyrosine-O-sulfate receptor in the targeting and/or intracellular transport of tyrosine-sulfated proteins. Cytotechnology 2012; 23:143-9. [PMID: 22358530 DOI: 10.1023/a:1007903315687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
By employing the affinity gel fraction technique, we have detected a 175 kDa tyrosine-O-sulfate (TyrS)-binding protein in sodium choleate extracts of the microsomal membrane fractions of bovine liver and pancreas, as well as canine liver and pancreas. Western blot analysis revealed the presence of the bovine liver TyrS-binding protein in complexes with tyrosine-sulfated proteins both in vivo and in vitro, suggesting the putative role of the former being the receptor for the latter. Using filter-grown Madin-Darby canine kidney (MDCK) cells as a model, it was demonstrated that the tyrosine-sulfated proteins synthesized were predominantly secreted into the apical medium. The results further indicate the production and differential polarized secretion of different sulfated forms of the two major secretory proteins produced by MDCK cells, fibronectin (FN) and an 80 kDa glycoprotein (gp 80), with their tyrosine-sulfated forms being predominantly secreted from the apical surface. Treatment of filter-grown MDCK cells with glycosylation inhibitors, swainsonine and 1-deoxymannojirimycin, appeared to enhance the apical secretion of tyrosine-sulfated FN and gp 80. A similar 175 kDa membrane-bound 'TyrS receptor', cross-reactive toward antiserum against the canine liver TyrS receptor, was shown to be present in MDCK cells. Pulse-chase experiments revealed its presence in complexes with newly synthesized FN and gp 80. A hypothetical model for TyrS residues serving as an apical targeting signal during the biosynthetic transport of tyrosine-sulfated proteins, as mediated by the TyrS receptor, in MDCK cells is proposed.
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Affiliation(s)
- M C Liu
- Department of Biochemistry, University of Texas Health Center at Tyler, Tyler, TX, 75710, USA
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Fogarty SP, Shiffert MT, Berezowski K, Hartmann D, Cabrera MC, Sidawy MK, Furth PA, Liu MC. P5-11-03: Real-Time Imaging of Human Breast Tissue with Reflectance Confocal Microscopy: Correlation with Routine Pathology. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-11-03] [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: Near-infrared reflectance confocal microscopy (RCM) allows for immediate noninvasive 3-D optical sectioning of opaque objects, such as human tissue, without using the potentially destructive staining and fixing methods used with routine pathology. Recently, RCM has been used to differentiate between malignant and non-malignant dermatologic conditions. We hypothesize that this technique can be used to efficiently and reliably evaluate human breast tissue for the presence of malignancy without compromising the ability to perform routine immunohistochemical (IHC) analyses that accompany the diagnosis of invasive breast cancer.
Methods: 45 core needle breast biopsies (12mmx2mm) were collected under sonographic guidance. Biopsy specimens were immediately placed in phosphate buffered saline, injected with 5% acetic acid to enhance reflectivity of the nuclei, and imaged within 5–10 minutes. Digital images of the nuclear and cellular morphology from each intact specimen were acquired and catalogued within 1 hour of biopsy using the VivaCell 5000. Tissue samples were then formalin-fixed and sectioned for routine H&E evaluation or IHC assays. A board certified pathologist trained on 16 paired RCM images and H&E slides was given the blinded test set created from these 45 breast biopsies and asked to evaluate the RCM images for the presence of carcinoma. Preliminary evaluation was also done on 5 biopsy samples with known estrogen receptor (ER) and progesterone receptor (PR) status to determine the feasibility of assessing ER/PR on tissue treated with acetic acid for RCM.
Results: Routine H&E staining identified invasive carcinoma 10/45 biopsy samples (9 invasive ductal [IDC], 1 invasive lobular [ILC]); 2 specimens with IDC also contained ductal carcinoma in situ (DCIS). Evaluation of the RCM images led to the same diagnosis of invasive carcinoma vs. not in all 45 samples and correctly identified 6/9 IDC and 1/1 ILC. RCM correctly identified 1/2 specimens known to contain DCIS. RCM misclassified 3 IDC as DCIS (1), ILC (1), or lobular carcinoma in situ (1), and 1 DCIS as ILC. With respect to the determination of ER/PR status, RCM accurately assessed positivity for both receptors in all 5 specimens.
Conclusions: RCM is comparable to standard microscopy for the reliable identification of carcinoma, and the ability to evaluate breast tissue for malignancy using this technology allows for real-time pathology and may negate the need for repeat diagnostic biopsies to ensure adequate sampling for diagnosis. Importantly, the ability to perform routine IHC for ER/PR status after tissue processing for RCM appears to be preserved. Further evaluation applying the existing technology to a larger sample size for histopathologic correlation, assessment of ER/PR status, and evaluation for HER2 status are planned. These encouraging findings support interest in tailoring RCM for breast tissue to improve the ability to distinguish between invasive vs. in situ disease, and ductal vs. lobular histology.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-11-03.
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Affiliation(s)
| | | | | | | | | | - MK Sidawy
- 1Georgetown University, Washington, DC
| | - PA Furth
- 1Georgetown University, Washington, DC
| | - MC Liu
- 1Georgetown University, Washington, DC
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Liu MC, Xiao HQ, Brown AJ, Ritter CS, Schroeder J. Association of vitamin D and antimicrobial peptide production during late-phase allergic responses in the lung. Clin Exp Allergy 2011; 42:383-91. [PMID: 22092530 DOI: 10.1111/j.1365-2222.2011.03879.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/05/2011] [Accepted: 08/30/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D may play important roles in regulating immune responses and in defence against infectious diseases by effects on both innate and adaptive immune responses. Little is known regarding activation of vitamin D within airway tissues and its relationship to inflammation and antimicrobial responses. OBJECTIVE The objective of this study was to investigate the activation of vitamin D within the airways and to define relationships between vitamin D metabolites and measures of inflammatory and antimicrobial responses assessed by bronchoalveolar lavage (BAL) during late-phase responses following allergen challenge of allergic subjects. METHODS Segmental allergen challenge was performed with saline and allergen in 16 adult allergic subjects. BAL was performed in both saline and allergen-challenged sites 20-24 h. after challenge. Following extraction from BAL fluids, levels of 25-hydroxy-vitamin D (25(OH)D) and 1,25-dihydroxy-vitamin D (1,25(OH)(2)D) were assayed by specific radioimmunoassays. The cleavage product of cathelicidin, LL-37, was assayed by ELISA. Cellular constituents and albumin were measured. RESULTS Levels of vitamin D metabolites were increased in concentrated BAL fluids after allergen compared to saline challenge. Levels of 1,25(OH)(2)D increased from largely undetectable to 2.5 pm (median; range: 1-29.5; P = 0.005) while 25(OH)D increased from 3.2 (0.8-6.2) to 6.2 (1.5-184.9) nm (P = 0.0006). Levels of LL-37 increased from 2.1 (1.4-4.1) to 14.5 (2.2-106.7) ng/mL BAL (P = 0.0005). Levels of LL-37, 1,25(OH)(2)D, and 25(OH)D following allergen challenge were correlated with each other (P < 0.0001), cellular changes, and levels of albumin (P < 0.001). CONCLUSIONS AND CLINICAL RELEVANCE Levels of vitamin D metabolites, particularly 1,25(OH)(2)D, were low within the airways and increased after allergen challenge. The increases correlated with the magnitude of inflammation and increases in cathelicidin. Normalization to albumin suggested plasma exudation as a mechanism for the increases. The findings support a role for vitamin D in allergic and innate immune responses in the lung.
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Affiliation(s)
- M C Liu
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Asthma & Allergy Center, Baltimore, MD 21224, USA.
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Isakoff SJ, Goss PE, Mayer EL, Traina TA, Carey LA, Krag K, Rugo HS, Liu MC, Stearns V, Come SE, Borger DR, Quadrino CA, Finkelstein D, Garber JE, Ryan PD, Winer EP, Ellisen LW. TBCRC009: A multicenter phase II study of cisplatin or carboplatin for metastatic triple-negative breast cancer and evaluation of p63/p73 as a biomarker of response. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Symmans WF, Andre F, Liu MC, Delacruz J, Peintinger F, Borstnar S, Wang H, Regitnig P, Ota M, Seevaratnam S, Delaloge S, Hatzis C. Blinded validation study of genomic predictions for survival following adjuvant sequential anthracycline-docetaxel chemotherapy with or without endocrine therapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1030] [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: 11/20/2022] Open
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Liu MC, Mego M, Nakamura S, Nole F, Pierga J, Toi M, Munzone E, Yagata H, Sandri MT, Bidard F, Wang H, Hayes DF, Cristofanilli M. Clinical validity of circulating tumor cell (CTC) enumeration in 841 subjects with metastatic breast cancer (MBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gucalp A, Tolaney SM, Isakoff SJ, Ingle JN, Liu MC, Carey LA, Blackwell KL, Rugo HS, Nabell L, Abbruzzi A, Gonzalez J, Giri DD, Patil S, Feigin K, D'Andrea G, Theodoulou M, Drullinsky P, Sklarin NT, Hudis C, Traina TA. TBCRC 011: Targeting the androgen receptor (AR) for the treatment of AR+/ER-/PR- metastatic breast cancer (MBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Forero-Torres A, Lin NU, Liu MC, Rugo HS, Puhalla S, Nanda R, Mayer IA, Storniolo AM, Traina TA, Hayes DF, Rimawi MF, Goetz MP, Esteva FJ, Irvin WJ, Wolff AC. TBCRC 019: An open-label, randomized, phase II trial of nanoparticle albumin-bound paclitaxel with or without the anti-death receptor 5 (DR5) monoclonal antibody tigatuzumab in patients with metastatic, triple-negative (ER, PR, and HER2-negative) breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps128] [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: 11/20/2022] Open
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Anders CK, Nanda R, Liu MC, Blackwell KL, Van Poznak CH, Abramson VG, Storniolo AM, Lin NU, Stearns V, Melhem A, Puhalla S, Carpenter JT, Melisko ME, Deal AM, Hudis C, Winer EP, Perou CM, Bradley CR, Wolff AC, Carey LA. TBCRC 018: Phase II study of iniparib plus chemotherapy to treat triple-negative breast cancer (TNBC) brain metastases (BM). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
BACKGROUND A laboratory investigation was designed to test the hypothesis that acids increase the rate of wear caused by attrition on dentine. METHODS Dentine sections from 10 teeth were polished, cleaned in an ultrasonic bath and divided into 8 equally sized areas. The occlusal tip of a tooth, placed vertically in a wear machine and loaded at 150 N, was moved against each dentine section for 5000 return strokes with artificial saliva acting as a lubricant. Each dentine section was divided into 8 sections and half randomly immersed in a 1% citric acid solution (pH 2.3) for 20 minutes. The wear regime produced 8 wear scars in total per dentine sample. The volume of each wear scar was measured using a contacting digitizing profilometer. RESULTS A total of 80 wear scars were produced with 40 treated with acid and 40 acting as controls. The mean for wear volume of the dentine scars with acid was 4.84 μm(3) (1.38) and for the non-acid surface 2.95 μm(3) (0.86). This difference was statistically significant (p < 0.05). CONCLUSIONS These results support the hypothesis that acids increase the rate of wear caused by attrition on dentine.
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Affiliation(s)
- H Li
- Hangzhou Dental Hospital, Second Clinical Medical Institute, Zhejiang Chinese Medical University, Hangzhou, China.
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Schroeder JT, Bieneman AP, Chichester KL, Breslin L, Xiao H, Liu MC. Pulmonary allergic responses augment interleukin-13 secretion by circulating basophils yet suppress interferon-alpha from plasmacytoid dendritic cells. Clin Exp Allergy 2010; 40:745-54. [PMID: 20184608 DOI: 10.1111/j.1365-2222.2010.03456.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergic inflammatory processes may have the capacity to propagate systemically through the actions of circulating leucocytes. Consequently, basophils from allergic individuals are often 'primed', as evidenced by their hyperresponsiveness in vitro. IFN-alpha secreted predominantly by plasmacytoid dendritic cells (pDCs), suppresses basophil priming for IL-13 production in vitro. OBJECTIVE This study sought in vivo correlates arising during experimental allergen challenge that support an 'axis-interplay' between basophils and pDCs. METHODS Using segmental allergen challenge (SAC) in the lung, the immune responses of both cell types from the blood were investigated in volunteers (n=10) before and 24 h after allergen exposure. These responses were then correlated with inflammatory parameters measured in bronchoalveolar lavage fluids (BALF). RESULTS In the blood, SAC significantly augmented IL-13 secretion by basophils induced by IL-3 (P=0.009), yet reduced IFN-alpha secreted by pDCs stimulated with CpG (P=0.018). Both parameters were negatively correlated (P=0.0015), at least among those subjects that secreted the latter. Circulating basophil IL-13 responses further correlated with post-SAC bronchoalveolar lavage (BAL) parameters including IL-13 protein (P=0.04), basophil (P=0.051), eosinophil (P=0.0018), and total cell counts (P<0.003). Basophil and IL-13 levels in BAL correlated likewise (P=0.0002). CONCLUSIONS These results support a mechanism of immune regulation whereby an allergen reduces innate immune responses and IFN-alpha production by pDCs, resulting in an enhanced inflammation and basophil cytokine production at sites of allergen exposure.
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Affiliation(s)
- J T Schroeder
- The Department of Medicine, Divisions of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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Liu MC, Zhang B, Xiong J, Zwart A, Xuan J, Wang Y, Clarke R. Time-dependent gene expression changes in a xenograft model of docetaxel cytotoxicity. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-2009] [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
Abstract #2009
Background: The antitumor effects of docetaxel primarily result from mitotic arrest with impaired cell proliferation. However, the key molecular pathways affected by this agent are largely unknown, and alternative mechanisms of action are likely. Knowledge of these pathways and mechanisms will guide the rational design of more effective treatment schedules and drug combinations. We hypothesize that the molecular analysis of treated human breast cancer xenografts will allow for an evaluation of time-dependent alterations in the expression of genes involved in key cell processes related to docetaxel cytotoxicity.
 Methods: Gene expression profiles were generated from MDA-MB-231 breast cancer xenografts after a single intravenous dose of docetaxel. Tumors were harvested at 1, 6, 12, and 24 hours (hr) after drug administration; a control group of untreated tumors (0hr) was included. RNA was extracted, assessed for concentration and quality, and used to generate probes for hybridization to the Affymetrix Human U133A oligonucleotide gene chip. Gene expression levels were explored with MAS 5.0 software and in-house algorithms. Subsequent data analysis included cross-experiment normalization, differential gene selection, gene clustering, and peak-time latency analysis. Consistency between the in-house in vivo dataset and a public in vitro dataset (Oncogene. 26:2902) was investigated.
 Results: 5087 responsive genes were selected using both SAM and EDGE. Among these genes, 3009 were down-regulated and 190 were up-regulated by at least 2-fold. Compared with 0h, the most significant changes in gene expression took place 6h after drug administration (2023 down-regulated and 655 up-regulated genes). Gene clustering revealed the sequence of up-regulation or down-regulation of different gene groups. Apoptosis-related genes and cell cycle-related genes in various stages showed different time latency patterns. For example, most of the M phase genes (total of 65 from Gene Ontology) were down-regulated 6h and 12h after docetaxel treatment and recovered by 24h. In addition, 1489 of 3009 down-regulated genes and 55 of 190 up-regulated genes were found in a public in vitro dataset; these datasets share 282 down-regulated genes (18.9%) and 17 up-regulated genes (30.9%).
 Discussion: Analysis of serial gene expression changes in docetaxel sensitive breast cancer xenografts demonstrates that time-dependent changes in specific cell processes occur. These findings will be expanded to distinguish between early and late molecular mechanisms of docetaxel responsiveness. A parallel xenograft model of docetaxel nonresponsiveness is also under investigation. In this way, time-dependent pathways will be defined that will include predictive biomarkers and lead to the development of novel agents to overcome resistance or enhance sensitivity to docetaxel, one of the most effective agents available for the treatment of breast cancer.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2009.
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Affiliation(s)
- MC Liu
- 1 Dept of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - B Zhang
- 2 Dept of Electrical, Computer, and Biomedical Engineering, Virginia Polytechnic Institute and State University, Arlington, VA
| | - J Xiong
- 2 Dept of Electrical, Computer, and Biomedical Engineering, Virginia Polytechnic Institute and State University, Arlington, VA
| | - A Zwart
- 1 Dept of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - J Xuan
- 2 Dept of Electrical, Computer, and Biomedical Engineering, Virginia Polytechnic Institute and State University, Arlington, VA
| | - Y Wang
- 2 Dept of Electrical, Computer, and Biomedical Engineering, Virginia Polytechnic Institute and State University, Arlington, VA
| | - R Clarke
- 1 Dept of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Liu MC, Isaacs C, Warren R, Cohen P, Wilkinson M, Ottaviano Y, Rao S, Zhang Y, Gallagher A, Shields PG. Circulating tumor cells (CTC): A reliable predictor of treatment efficacy in metastatic breast cancer (MBC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.11018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Liu MC, Riese RJ, Van Gundy K, Norwood P, Sullivan BE, Schwartz PF, Teeter JG. Effects of inhaled human insulin on airway lining fluid composition in adults with diabetes. Eur Respir J 2008; 32:180-8. [PMID: 18321936 DOI: 10.1183/09031936.00129907] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inhaled human insulin (Exubera (human insulin of rDNA origin) Inhalation Powder) causes small, early and reversible changes in pulmonary function in subjects with diabetes mellitus. The present study assessed whether changes occur in cellular and soluble constituents of airway lining fluid consistent with inflammation as a possible cause for Exubera-associated lung function alterations. Two 31-week, open-label, sequential design phase 2 studies were conducted, one with 20 subjects with type 1 and one with 24 subjects with type 2 diabetes. After run-in, all subjects received subcutaneous insulin for 12 weeks, followed after 1 week by 12 weeks of Exubera. Bronchoalveolar lavage fluid cell counts and protein constituents were determined at baseline, after 12 weeks of subcutaneous insulin and after 12 weeks of Exubera. Baseline cellular and soluble constituents of lavage fluid were similar to those reported for nondiabetic adults. Exubera produced no consistent clinically or statistically significant changes in total or differential lavage fluid cell counts or protein concentrations, even though Exubera-associated changes in pulmonary function are known to be fully manifest within 12 weeks. Therefore, 12 weeks of Exubera treatment is not associated with evidence of pulmonary inflammation. The treatment effects on lung function observed in Exubera trials are not caused by lung inflammation.
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Affiliation(s)
- M C Liu
- Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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45
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Liu MC, Shields P, Isaacs C, Warren R, Cohen P, Wilkinson M, Zhang Y, Shen R, Luyegu K, Gallagher AL. Circulating tumor cells (CTC): Assessment of treatment efficacy in metastatic breast cancer (MBC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.10535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10535 Background: Preliminary data in MBC suggest that ≥5 CTC/7.5 mL blood is associated with worse progression free survival (PFS) and overall survival (OS), and that the persistence of ≥5 CTC/7.5 mL blood after the initiation of therapy predicts for treatment failure (NEJM 2004. 351:781.). We are conducting a prospective clinical research study to validate the prognostic and predictive significance of this serum biomarker in MBC. Methods: Serial CTC levels are obtained in patients starting a new systemic treatment regimen for progressive, radiographically measurable MBC. 10 mL samples of peripheral blood are collected before the start of treatment and then at 3–4 week intervals. All subjects are followed prospectively for PFS and OS, and they are offered the opportunity to continue CTC testing upon disease progression. CTC enumeration is performed on a 7.5 mL blood volume using the CellSearch technology (Veridex, LLC; Warren, NJ). Epithelial cells are immunomagnetically separated and fluorescently labeled, and nucleated (DAPI+) cells with the EpCAM+, cytokeratin 8/18/19+, and CD45- phenotype are counted as CTC. Clinical outcomes are based on radiographic studies and physical examination in accordance with RECIST criteria. Results: 46 of 100 subjects have been accrued, and 33 have completed at least one radiographic staging evaluation with a median follow up of 7 mos (range 2–18 mos). Treatment for the 33 evaluable patients includes chemotherapy (27%), endocrine therapy (46%), and combination therapy with a biologic agent (27%). At baseline, 85% (28/33) had at least 1 CTC/7.5 mL (range 1–78), and 27% (9/33) had ≥5 CTC/7.5 mL. Median PFS was 2.57 months and 6.77 months for subjects with ≥5 vs <5 CTC/7.5 mL at baseline, respectively (p=0.02). Conclusions: The current data validate the observation that baseline CTC levels correlate with PFS in patients with MBC and measurable disease. Patient accrual and data analysis are ongoing to confirm that persistent CTC levels ≥5/7.5 mL correlate with a lack of treatment efficacy and therefore are a reliable surrogate marker of disease responsiveness and PFS. [Table: see text]
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Affiliation(s)
- M. C. Liu
- Georgetown University Hospital, Washington, DC
| | - P. Shields
- Georgetown University Hospital, Washington, DC
| | - C. Isaacs
- Georgetown University Hospital, Washington, DC
| | - R. Warren
- Georgetown University Hospital, Washington, DC
| | - P. Cohen
- Georgetown University Hospital, Washington, DC
| | | | - Y. Zhang
- Georgetown University Hospital, Washington, DC
| | - R. Shen
- Georgetown University Hospital, Washington, DC
| | - K. Luyegu
- Georgetown University Hospital, Washington, DC
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46
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Tummala MK, Wajahath M, Kotlarewsky M, Aggarwal A, Muller D, Liu MC, McGuire WP, Ottaviano Y. Patterns of care regarding adjuvant hormonal agents and treatment of bone health in postmenopausal women with breast cancer in community and academic centers before and after the availability of ATAC (Adjuvant Tamoxifen, Armidex or Combination) study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6621 Background: Results from the ATAC trial comparing Tamoxifen to the Aromatase inhibitors (AIs) anastrozole in PM women with early stage breast cancer were initially presented in San Antonio, Texas, in December 2001. ASCO issued guidelines for the adjuvant use of AIs in 2002, updated in 2003. We compared patterns of usage of adjuvant hormonal agents and bone health management before and after availability of the ATAC data in community versus academic centers. Methods: We conducted a retrospective analysis of 432 patients between 1999–2005 from group practices affiliated with two large community hospitals and one academic center. Data were collected from tumor registries regarding demographics, first-line hormonal agent choice, and use of bone density studies, vitamin D/calcium supplements and bisphosphonates. Results: Demographics were identical in both groups before and after January 2002. Before 2002, 96% of the patients were prescribed Tamoxifen in both community and academic centers. After the initial presentation of the ATAC data, 55.08% (65/118) of patients from the community centers versus only 17.11% (19/111) from the academic center were prescribed AIs (p=0.0001). Of the 84 patients who received an AI after January 2002, similar proportions of patients had baseline bone density scans (38.5% community vs. 36.8% academic; p=0.89) and follow up annual/biannual scans (33 % vs. 32%; p=0.85). In addition, similar proportions of patients on AIs were prescribed calcium/vitamin D supplements (47.4% vs. 52.6%; p=0.69) and bisphosphonates (36.8% vs. 21.05%; p=0.20) in community and academic centers, respectively. Conclusions: Community oncologists adopted AIs into clinical practice sooner than academic physicians on the basis of unpublished clinical trial results, even before ASCO published guidelines. Although patients on AIs are deemed to be at higher risk for bone fractures, fewer than 40% were evaluated with baseline or surveillance bone density scans in both community and academic practices. Similar proportions of patients received calcium/vitamin D supplements or bisphosphonates among centers. No significant financial relationships to disclose.
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Affiliation(s)
- M. K. Tummala
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
| | - M. Wajahath
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
| | - M. Kotlarewsky
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
| | - A. Aggarwal
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
| | - D. Muller
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
| | - M. C. Liu
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
| | - W. P. McGuire
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
| | - Y. Ottaviano
- University of Maryland Baltimore, MD; Franklin Square Hospital, Baltimore, MD; Washington Hospital Center, Washington, DC; National Institute on Aging, Baltimore, MD; Georgetown University Hospital, Washington, DC
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Papa L, Hayes R, Robertson C, Jose P, Liu MC, Robinson G, Wang K, Oli M. Levels UCH-L1 in Human CSF and Severity of Injury Following Severe Traumatic Brain Injury. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.864] [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: 11/10/2022]
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Huang WL, George KJ, Ibba V, Liu MC, Averill S, Quartu M, Hamlyn PJ, Priestley JV. The characteristics of neuronal injury in a static compression model of spinal cord injury in adult rats. Eur J Neurosci 2007; 25:362-72. [PMID: 17284176 DOI: 10.1111/j.1460-9568.2006.05284.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Studies of spinal cord injury using contusion (impact) injury paradigms have shown that neuronal death is an acute event that is largely over within 24 h. However, much less is known about cell death following compression injury, despite compression being a key component of natural spinal injuries. We have therefore used neuronal nuclei (NeuN) immunostaining to examine the spatiotemporal pattern of neuronal loss after static compression injury in adult rats. 3D reconstruction was used to reveal the full effect of the injury. Neuronal loss at the injury epicentre, assessed by NeuN immunostaining, amounted to 44% at 1 day but increased to 73% at 3 days and 81% at 1 month. Neuronal loss was also seen 5 mm rostral and caudal to the epicentre, but was not significant until 3 days. NeuN loss was greatest in the ventral horns and in the intermediate grey matter, with the lateral dorsal horns relatively spared. Cystic cavities formed after injury, but were not evident until 4 weeks and were small in size. In contrast to the slow profile of neuronal loss, the compression injury also evoked a transient expression of activating transcription factor-3 (ATF3) and activated c-Jun in neurons. ATF3 expression peaked at 3 days and declined at 7 days. Our spatiotemporal analysis of compression injury shows that neuronal loss is much more protracted than in contusion injury, and highlights the potential for neuroprotective strategies. This study is also the first indication of ATF3 involvement in spinal cord injury.
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Affiliation(s)
- W L Huang
- Neuroscience Centre, Institute of Cell and Molecular Science, Queen Mary University of London, UK.
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Isaacs C, Wang A, Warren R, Wilkinson M, Grana G, Liu MC, Stearns V, Park YH, Novielli A. A phase II study of weekly gemcitabine and docetaxel in first and second line metastatic breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10668] [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
10668 Background: Combination chemotherapy for metastatic breast cancer has generally been demonstrated to be associated with a higher response rate than single agent therapy, however such therapy is often accompanied by increased toxicity. Thus there is a need to develop well-tolerated combination chemotherapy regimens. Gemcitabine and docetaxel are both active agents in the treatment of this disease, and are effective and well tolerated when administered on a weekly basis. The purpose of this study was to evaluate the therapeutic efficacy and toxicity of weekly gemcitabine and docetaxel as first or second line treatment of metastatic breast cancer (MBC). Methods: Patients with measurable MBC who had received no more than 1 prior chemotherapy regimen in the metastatic setting were treated with gemcitabine 800 mg/m2 and docetaxel 30 mg/m2 on days 1 and 8 every 21 days without growth factor support. Results: Thirty-one patients were enrolled. Twenty-nine patients were evaluable for toxicity and 25 for efficacy. Median age was 55 (range 30 to 79). Visceral disease was the dominant site in 74% of patients. Doxorubicin and paclitaxel were previously administered in 74% and 48% of patients respectively. The overall response rate was 56% (complete response in 1 patient and partial responses in 13 patients). Stable disease was evident in 10 additional patients (38.4%). The progression free survival was 35 weeks (range 9 to 101 weeks) and the median overall survival was 17 months. Treatment was well tolerated with the majority of toxicities being grade 1 or 2 (85%). The only grade 3 (G3) or 4 (G4) toxicities observed were neutropenia in 14 participants (G3 41%; G4 7%), anemia in 4 (13%), G3 elevated transaminases in 3 (10%), G3 thrombocytopenia in 1 (3%), G3 flu-like symptoms in 2 (7%) and G3 edema in 1 (3%). Conclusions: The regimen of gemcitabine 800 mg/m2 and docetaxel 30 mg/m2 given two weeks out of three for MBC showed excellent overall response of 56% with very good tolerability. The findings from our trial compare well to the response rates of 36% to 79% seen in prior phase II trials utilizing higher doses of this combination chemotherapy. [Table: see text]
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Affiliation(s)
- C. Isaacs
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - A. Wang
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - R. Warren
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - M. Wilkinson
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - G. Grana
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - M. C. Liu
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - V. Stearns
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - Y. H. Park
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
| | - A. Novielli
- Georgetown University, Washington, DC; Cooper University Hospital, Camden, NJ; Johns Hopkins School of Medicine, Baltimore, MD
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50
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Lin NU, Carey LA, Liu MC, Younger J, Come SE, Bullitt E, Van Den Abbeele AD, Li X, Hochberg FH, Winer EP. Phase II trial of lapatinib for brain metastases in patients with HER2+ breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.503] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
503 Background: One-third of women with HER2+ metastatic breast cancer develop central nervous system (CNS) metastases. This study evaluated the safety and efficacy of lapatinib, an oral inhibitor of EGFR and HER2, in patients with HER2+ brain metastases. Methods: Eligible patients (pts) had HER2+ breast cancer, new or progressive brain metastases, and at least one measurable (LD ≥1.0cm) lesion. Pts received lapatinib 750 mg PO BID. Tumor response was assessed by MRI every 8 wks. FDG-PET scans were performed at baseline, and repeated at wks 1 and 8. The primary endpoint was objective response (CR+PR) in the brain by RECIST. Secondary endpoints included safety, quality-of-life (QOL), and PET changes. Sample size was calculated using a 2-stage design to distinguish objective response of 5% (H0) vs 20% (HA); ≥ 4 objective responses were required to reject the null hypothesis. Results: 39 pts were enrolled, mean age 52 yrs (range 31–76). All pts developed CNS disease on trastuzumab; 38 progressed after prior radiation. Toxicity data are available for 38 pts; the most common AEs were diarrhea (grade 3, 21%), fatigue (grade 3, 16%), and rash (grade 3, 5%). Three pts remain on active treatment. Two pts achieved a PR by RECIST, and remained on study for 158 and 347 days. An additional pt achieved >30% decrease in LD of her CNS lesion but, upon central radiology review, did not meet RECIST criteria for measurable disease and was excluded from analysis of the primary endpoint. Five additional pts achieved SD≥16 wks. Median time to treatment failure was 3.2 mo (95% CI 2.3 to 3.8). Preliminary volumetric analysis of 20/39 pts demonstrates 5 pts with ≥30% volumetric decline in CNS lesions, and an additional 3 pts with 15–30% volumetric decline. Analyses of QOL and correlation of PET with clinical outcomes will be presented. Conclusion: Lapatinib is well-tolerated in this population. Although the study failed to demonstrate the hypothesized level of activity as assessed by RECIST, there is sufficient evidence of clinical effect, albeit preliminary, to suggest that lapatinib can penetrate the CNS. Further investigation of lapatinib in HER2+ CNS disease is warranted and ongoing. Acknowledgements: AVON PFP award; NCI-SPORE in Breast Cancer at DF/HCC(CA89393), UNC(CA58223), Georgetown; ASCO YIA. [Table: see text]
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Affiliation(s)
- N. U. Lin
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - L. A. Carey
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - M. C. Liu
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - J. Younger
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - S. E. Come
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - E. Bullitt
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - A. D. Van Den Abbeele
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - X. Li
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - F. H. Hochberg
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
| | - E. P. Winer
- Dana-Farber Cancer Institute, Boston, MA; University of North Carolina, Chapel Hill, NC; Georgetown University, Washington, DC; Massachusetts General Hospital, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA
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