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Jagsi R, Griffith KA, Harris EE, Wright JL, Recht A, Taghian AG, Lee L, Moran MS, Small W, Johnstone C, Rahimi A, Freedman G, Muzaffar M, Haffty B, Horst K, Powell SN, Sharp J, Sabel M, Schott A, El-Tamer M. Reply to G.B. Mann et al and S. Sorscher. J Clin Oncol 2024:JCO2400224. [PMID: 38489573 DOI: 10.1200/jco.24.00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Reshma Jagsi
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kent A Griffith
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Eleanor E Harris
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jean L Wright
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Abram Recht
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alphonse G Taghian
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lucille Lee
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Meena S Moran
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - William Small
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Candice Johnstone
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Asal Rahimi
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gary Freedman
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mahvish Muzaffar
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Bruce Haffty
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kathleen Horst
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Simon N Powell
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jody Sharp
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Michael Sabel
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Anne Schott
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mahmoud El-Tamer
- Reshma Jagsi, MD, DPhil, Emory University, Atlanta, GA, University of Michigan, Ann Arbor, MI; Kent A. Griffith, MS, University of Michigan, Ann Arbor, MI; Eleanor E. Harris, MD, St. Luke's University Health Network, Easton, PA; Jean L. Wright, MD, Johns Hopkins University, Baltimore, MD; Abram Recht, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Alphonse G. Taghian, MD, PhD, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Lucille Lee, MD, Northwell, Lake Success, NY; Meena S. Moran, MD, Yale University, New Haven, CT; William Small Jr, MD, Loyola University Chicago, Maywood, IL; Candice Johnstone, MD, Medical College of Wisconsin, Milwaukee, WI; Asal Rahimi, MD, University of Texas, Southwestern, Dallas, TX; Gary Freedman, MD, University of Pennsylvania, Philadelphia, PA; Mahvish Muzaffar, MD, East Carolina University, Greenville, NC; Bruce Haffty, MD, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; Kathleen Horst, MD, Stanford University, Stanford, CA; Simon N. Powell, MD, PhD, Memorial Sloan-Kettering Cancer Center, New York, NY; Jody Sharp, BS, Michael Sabel, MD, and Anne Schott, MD, University of Michigan, Ann Arbor, MI; Mahmoud El-Tamer, MD, Memorial Sloan-Kettering Cancer Center, New York, NY
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Jagsi R, Griffith KA, Harris EE, Wright JL, Recht A, Taghian AG, Lee L, Moran MS, Small W, Johnstone C, Rahimi A, Freedman G, Muzaffar M, Haffty B, Horst K, Powell SN, Sharp J, Sabel M, Schott A, El-Tamer M. Omission of Radiotherapy After Breast-Conserving Surgery for Women With Breast Cancer With Low Clinical and Genomic Risk: 5-Year Outcomes of IDEA. J Clin Oncol 2024; 42:390-398. [PMID: 38060195 DOI: 10.1200/jco.23.02270] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE Multiple studies have shown a low risk of ipsilateral breast events (IBEs) or other recurrences for selected patients age 65-70 years or older with stage I breast cancers treated with breast-conserving surgery (BCS) and endocrine therapy (ET) without adjuvant radiotherapy. We sought to evaluate whether younger postmenopausal patients could also be successfully treated without radiation therapy, adding a genomic assay to classic selection factors. METHODS Postmenopausal patients age 50-69 years with pT1N0 unifocal invasive breast cancer with margins ≥2 mm after BCS whose tumors were estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor receptor 2-negative with Oncotype DX 21-gene recurrence score ≤18 were prospectively enrolled in a single-arm trial of radiotherapy omission if they consented to take at least 5 years of ET. The primary end point was the rate of locoregional recurrence 5 years after BCS. RESULTS Between June 2015 and October 2018, 200 eligible patients were enrolled. Among the 186 patients with clinical follow-up of at least 56 months, overall and breast cancer-specific survival rates at 5 years were both 100%. The 5-year freedom from any recurrence was 99% (95% CI, 96 to 100). Crude rates of IBEs for the entire follow-up period for patients age 50-59 years and age 60-69 years were 3.3% (2/60) and 3.6% (5/140), respectively; crude rates of overall recurrence were 5.0% (3/60) and 3.6% (5/140), respectively. CONCLUSION This trial achieved a very low risk of recurrence using a genomic assay in combination with classic clinical and biologic features for treatment selection, including postmenopausal patients younger than 60 years. Long-term follow-up of this trial and others will help determine whether the option of avoiding initial radiotherapy can be offered to a broader group of women than current guidelines recommend.
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Affiliation(s)
- Reshma Jagsi
- Emory University, Atlanta, GA
- University of Michigan, Ann Arbor, MI
| | | | | | | | - Abram Recht
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Asal Rahimi
- University of Texas, Southwestern, Dallas, TX
| | | | | | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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3
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Dharmapuri S, Özbek U, Jethra H, Jun T, Marron TU, Saeed A, Huang YH, Muzaffar M, Pinter M, Balcar L, Fulgenzi C, Amara S, Weinmann A, Personeni N, Scheiner B, Pressiani T, Navaid M, Bengsch B, Paul S, Khan U, Bettinger D, Nishida N, Mohamed YI, Vogel A, Gampa A, Korolewicz J, Cammarota A, Kaseb A, Galle PR, Pillai A, Wang YH, Cortellini A, Kudo M, D’Alessio A, Rimassa L, Pinato DJ, Ang C. Baseline neutrophil-lymphocyte ratio and platelet-lymphocyte ratio appear predictive of immune treatment related toxicity in hepatocellular carcinoma. World J Gastrointest Oncol 2023; 15:1900-1912. [DOI: 10.4251/wjgo.v15.i11.1900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/14/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND A well-recognized class effect of immune checkpoint inhibitors (ICI) is immune-related adverse events (IrAEs) ranging from low grade toxicities to life-threatening end organ damage requiring permanent discontinuation of ICI. Deaths are reported in < 5% of patients treated with ICI. There are, however, no reliable markers to predict the onset and severity of IrAEs. We tested the association between neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) at baseline with development of clinically significant IrAEs (grade ≥ 2) in hepatocellular carcinoma (HCC) patients treated with ICI.
AIM To test the association between NLR and PLR at baseline with development of clinically significant IrAEs (grade ≥ 2) in HCC patients treated with ICI.
METHODS Data was extracted from an international database from a consortium of 11 tertiary-care referral centers. NLR = absolute neutrophil count/absolute lymphocyte count (ALC) and PLR = platelet count/ALC. Cutoff of 5 was used for NLR and 300 for PLR based on literature. We also tested the association between antibiotic and steroid exposure to IrAEs.
RESULTS Data was collected from 361 patients treated between 2016-2020 across the United States (67%), Asia (14%) and Europe (19%). Most patients received Nivolumab (n = 255, 71%). One hundred sixty-seven (46%) patients developed at least one IrAE, highest grade 1 in 80 (48%), grade ≥ 2 in 87 (52%) patients. In a univariable regression model PLR > 300 was significantly associated with a lower incidence of grade ≥ 2 IrAEs (OR = 0.40; P = 0.044). Similarly, a trend was observed between NLR > 5 and lower incidence of grade ≥ 2 IrAEs (OR = 0.58; P = 0.097). Multivariate analyses confirmed PLR > 300 as an independent predictive marker of grade ≥ 2 IrAEs (OR = 0.26; P = 0.011), in addition to treatment with programmed cell death ligand 1 (PD-1)/cytotoxic T lymphocyte-associated protein-4 (OR = 2.57; P = 0.037) and PD-1/tyrosine kinase inhibitor (OR = 3.39; P = 0.01) combinations. Antibiotic use was not associated with IrAE incidence (OR = 1.02; P = 0.954). Patients treated with steroids had a > 2-fold higher incidence of grade ≥ 2 IrAEs (OR = 2.74; P < 0.001), although 74% were prescribed steroids for the treatment of IrAEs.
CONCLUSION Given that high baseline NLR and PLR are associated with a decreased incidence of IrAEs, lower baseline NLR and PLR may be predictive biomarkers for the appearance of IrAEs in HCC treated with ICI. This finding is in keeping with several studies in solid tumors that have shown that baseline NLR and PLR appear predictive of IrAEs.
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Affiliation(s)
- Sirish Dharmapuri
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Umut Özbek
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Hiren Jethra
- Department of Data Analytics Harrisburg, Harrisburg University of Science and Technology, Harrisburd, PA 17101, United States
| | - Tomi Jun
- SEMA4, Stamford, CT 06902, United States
| | - Thomas U Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Anwaar Saeed
- Division of Medical Oncology Kansas, University of Kansas Cancer Center, Kansas, MO 66160, United States
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Mahvish Muzaffar
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Matthias Pinter
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Lorenz Balcar
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Claudia Fulgenzi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Suneetha Amara
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Arndt Weinmann
- Department of Hepatology, Johannes Gutenberg-University Medical Centre, Niedersachsen 30625, Germany
| | - Nicola Personeni
- Medical Oncology Unit, ASST Garda, Via Lungomella Valsecchi, Brescia, Manerbio 25025, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
| | - Bernhard Scheiner
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
| | - Musharraf Navaid
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Bertram Bengsch
- Department of Medicine II, Univ Med Ctr Freiburg, Hugstetter Str 55, University Hospital Freiburg, Freiburg D-79106, Germany
| | - Sonal Paul
- Department of Oncology Baltimore, LifeBridge Health, Baltimore, MD 21215, United States
| | - Uqba Khan
- Division of Hematology and Oncology, Weill Cornell Medical College, NY 10065, United States
| | - Dominik Bettinger
- Department of Medicine II, Univ Med Ctr Freiburg, Hugstetter Str 55, University Hospital Freiburg, Freiburg D-79106, Germany
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 577-8502, Japan
| | - Yehia Ibrahim Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Arndt Vogel
- Department of Gastroenterology Hepatology and Endocrinology, HannoverArndt Vogel, Medical School Hannover, Carl-Neubergstr., Hannover 30659, Germany
| | - Anuhya Gampa
- Department of Hepatology, Rush University Medical Group 1725 W Harrison St Ste 158, Chicago, IL 60612, United States
| | - James Korolewicz
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Antonella Cammarota
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan, Pieve Emanuele 20072, Italy
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Peter R Galle
- Department of Internal Medicine I and Cirrhosis Center Mainz, University Medical Center Mainz, Johannes Gutenberg Univ Mainz, Med Klin and Poliklin, Mainz D-55131, Germany
| | - Anjana Pillai
- Department of Gastroenterology, Hepatology, and Nutrition, University of Chicago Medical Center, Chicago, IL 60637, United States
| | - Ying-Hong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 577-8502, Japan
| | - Antonio D’Alessio
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Milan, Pieve Emanuele 20072, Italy
| | - David James Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London W12 0HS, United Kingdom
| | - Celina Ang
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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4
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Joerg V, Scheiner B, D´Alessio A, Fulgenzi CA, Schönlein M, Kocheise L, Lohse AW, Huber S, Wege H, Kaseb A, Wang Y, Mathew A, Kuang A, Muzaffar M, Abugabal YI, Chamseddine S, Phen S, Cheon J, Lee PC, Balcar L, Krall A, Ang C, Wu L, Saeed A, Huang YH, Bengsch B, Rimassa L, Weinmann A, Stauber R, Korolewicz J, Pinter M, Singal AG, Chon HJ, Pinato DJ, Schulze K, von Felden J. Efficacy and safety of atezolizumab/bevacizumab in patients with HCC after prior systemic therapy: A global, observational study. Hepatol Commun 2023; 7:e0302. [PMID: 37889520 PMCID: PMC10615429 DOI: 10.1097/hc9.0000000000000302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/03/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Since the introduction of the combination treatment of anti-programmed death-ligand 1 antibody atezolizumab and anti-VEGF antibody bevacizumab (AB), median overall survival in HCC has drastically improved. However, evidence on the efficacy and safety of the novel treatment standard in patients with prior exposure to systemic treatment is scarce. The aim of this global, multicenter, observational study was to evaluate the efficacy and safety of AB in patients after previous systemic therapy. METHODS We screened our global, multicenter, prospectively maintained registry database for patients who received any systemic therapy before AB. The primary end point was overall survival; secondary end points were time-to-progression, progression-free survival, objective response rate, and safety (rate and severity of adverse events). RESULTS Among 493 patients who received AB for unresectable HCC, 61 patients received prior systemic therapy and were included in this analysis. The median age of the study population was 66 years, with 91.8% males. Predominant risk factors for HCC were viral hepatitis (59%) and alcohol (23%). Overall survival for AB was 16.2 (95% CI, 14.5-17.9) months, time-to-progression and progression-free survival were 4.1 (95% CI, 1.5-6.6) and 3.1 (95% CI, 1.1-5.1) months, respectively. The objective response rate was 38.2% (7.3% with complete and 30.9% with partial response). Overall survival was not influenced by treatment line (2nd vs. >2nd) or previous systemic treatment modality (tyrosine kinase inhibitors vs. immune checkpoint inhibitors). Treatment-related adverse events of all grades according to Common Terminology Criteria for Adverse Events were documented in 42.6% of patients, with only 13.1% of grade ≥3, including one death. CONCLUSION In this observational study, AB emerges as a safe and efficacious treatment option in patients with HCC previously treated with other systemic therapy.
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Affiliation(s)
- Vincent Joerg
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernhard Scheiner
- Department of Surgery & Cancer, Imperial College London, UK
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
| | | | - Claudia A.M. Fulgenzi
- Department of Surgery & Cancer, Imperial College London, UK
- Division of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lorenz Kocheise
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W. Lohse
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samuel Huber
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Wege
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology & Nutrition, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Antony Mathew
- Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Andrew Kuang
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mahvish Muzaffar
- Division of Hematology and Oncology, East Carolina University, Greenville, North Carolina, USA
| | - Yehia I. Abugabal
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Shadi Chamseddine
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Samuel Phen
- Department of Internal Medicine, Southwestern Medical Center, University of Texas, USA
| | - Jaekyung Cheon
- Department of Internal Medicine, Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Pei-Chang Lee
- Department of Medicine, Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei
| | - Lorenz Balcar
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
| | - Anja Krall
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, New York, USA
| | - Linda Wu
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, New York, USA
| | - Anwaar Saeed
- Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh (UPMC), Pittsburgh, Pennsylvania, USA
| | - Yi-Hsiang Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine; Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Partner Site Freiburg, German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Rudolf Stauber
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | | | - Matthias Pinter
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Austria
| | - Amit G. Singal
- Department of Internal Medicine, Southwestern Medical Center, University of Texas, USA
| | - Hong Jae Chon
- Department of Internal Medicine, Medical Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - David J. Pinato
- Department of Surgery & Cancer, Imperial College London, UK
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Kornelius Schulze
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Naqash AR, McCallen JD, Mi E, Iivanainen S, Marie MA, Gramenitskaya D, Clark J, Koivunen JP, Macherla S, Jonnalagadda S, Polsani S, Jiwani RA, Hafiz M, Muzaffar M, Brunetti L, Stroud CRG, Walker PR, Wang K, Chung Y, Ruppin E, Lee SH, Yang LV, Pinato DJ, Lee JS, Cortellini A. Increased interleukin-6/C-reactive protein levels are associated with the upregulation of the adenosine pathway and serve as potential markers of therapeutic resistance to immune checkpoint inhibitor-based therapies in non-small cell lung cancer. J Immunother Cancer 2023; 11:e007310. [PMID: 37852738 PMCID: PMC10603340 DOI: 10.1136/jitc-2023-007310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Systemic immune activation, hallmarked by C-reactive protein (CRP) and interleukin-6 (IL-6), can modulate antitumor immune responses. In this study, we evaluated the role of IL-6 and CRP in the stratification of patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs). We also interrogated the underlying immunosuppressive mechanisms driven by the IL-6/CRP axis. METHODS In cohort A (n=308), we estimated the association of baseline CRP with objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) in patients with NSCLC treated with ICIs alone or with chemo-immunotherapy (Chemo-ICI). Baseline tumor bulk RNA sequencing (RNA-seq) of lung adenocarcinomas (LUADs) treated with pembrolizumab (cohort B, n=59) was used to evaluate differential expression of purine metabolism, as well as correlate IL-6 expression with PFS. CODEFACS approach was applied to deconvolve cohort B to characterize the tumor microenvironment by reconstructing the cell-type-specific transcriptome from bulk expression. Using the LUAD cohort from The Cancer Genome Atlas (TCGA) we explored the correlation between IL-6 expression and adenosine gene signatures. In a third cohort (cohort C, n=18), plasma concentrations of CRP, adenosine 2a receptor (A2aR), and IL-6 were measured using ELISA. RESULTS In cohort A, 67.2% of patients had a baseline CRP≥10 mg/L (CRP-H). Patients with CRP-H achieved shorter OS (8.6 vs 14.8 months; p=0.006), shorter PFS (3.3 vs 6.6 months; p=0.013), and lower ORR (24.7% vs 46.3%; p=0.015). After adjusting for relevant clinical variables, CRP-H was confirmed as an independent predictor of increased risk of death (HR 1.51, 95% CI: 1.09 to 2.11) and lower probability of achieving disease response (OR 0.34, 95% CI: 0.13 to 0.89). In cohort B, RNA-seq analysis demonstrated higher IL-6 expression on tumor cells of non-responders, along with a shorter PFS (p<0.05) and enrichment of the purinergic pathway. Within the TCGA LUAD cohort, tumor IL-6 expression strongly correlated with the adenosine signature (R=0.65; p<2.2e-16). Plasma analysis in cohort C demonstrated that CRP-H patients had a greater median baseline level of A2aR (6.0 ng/mL vs 1.3 ng/mL; p=0.01). CONCLUSIONS This study demonstrates CRP as a readily available blood-based prognostic biomarker in ICI-treated NSCLC. Additionally, we elucidate a potential link of the CRP/IL-6 axis with the immunosuppressive adenosine signature pathway that could drive inferior outcomes to ICIs in NSCLC and also offer novel therapeutic avenues.
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Affiliation(s)
- Abdul Rafeh Naqash
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Justin D McCallen
- Department of Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Emma Mi
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Sanna Iivanainen
- Oncology and Radiation Department, Oulu University Hospital, University of Oulu, MRC Oulu, Oulu, Finland
| | - Mona A Marie
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Daria Gramenitskaya
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - James Clark
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | - Jussi Pekka Koivunen
- Oncology and Radiation Department, Oulu University Hospital, University of Oulu, MRC Oulu, Oulu, Finland
| | - Shravanti Macherla
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Sweta Jonnalagadda
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Shanker Polsani
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Rahim Ali Jiwani
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Maida Hafiz
- Division of Pulmonary Critical Care, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Division of Pulmonary and Critical Care, East Carolina University, Greenville, NC, USA
| | - Mahvish Muzaffar
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - Leonardo Brunetti
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy, Italy
| | | | - Paul R Walker
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
- Circulogene, Birmingham, Alabama, USA
| | - Kun Wang
- Cancer Data Science Lab, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Youngmin Chung
- Department of Artificial Intelligence, Sungkyunkwan University, Suwon, Reuplic of Korea
| | - Eytan Ruppin
- Cancer Data Science Lab, National Cancer Institute, National Institute of Health, Bethesda, Maryland, USA
| | - Se-Hoon Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Li V Yang
- Hematology / Oncology Division, East Carolina University, Greenville, South Carolina, USA
| | - David J Pinato
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Joo Sang Lee
- Department of Artificial Intelligence, Sungkyunkwan University, Suwon, Reuplic of Korea
- Department of Precision Medicine, School of Medicine, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Alessio Cortellini
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy, Italy
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6
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Vithayathil M, D'Alessio A, Fulgenzi CAM, Nishida N, Schönlein M, von Felden J, Schulze K, Wege H, Saeed A, Wietharn B, Hildebrand H, Wu L, Ang C, Marron TU, Weinmann A, Galle PR, Bettinger D, Bengsch B, Vogel A, Balcar L, Scheiner B, Lee PC, Huang YH, Amara S, Muzaffar M, Naqash AR, Cammarota A, Zanuso V, Pressiani T, Pinter M, Cortellini A, Kudo M, Rimassa L, Pinato DJ, Sharma R. Impact of body mass index in patients receiving atezolizumab plus bevacizumab for hepatocellular carcinoma. Hepatol Int 2023; 17:904-914. [PMID: 37005953 PMCID: PMC10386929 DOI: 10.1007/s12072-023-10491-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Atezolizumab plus bevacizumab (Atezo/Bev) is first line-treatment for unresectable hepatocellular carcinoma (HCC). Body mass index (BMI) has demonstrated predictive value for response to immunotherapy in non-HCC cancer types. Our study investigated the effect of BMI on safety and efficacy of real-life use of Atezo/Bev for unresectable HCC. METHODS 191 consecutive patients from seven centres receiving Atezo/Bev were included in the retrospective study. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in overweight (BMI ≥ 25) and non-overweight (BMI < 25) patients. Treatment-related adverse events (trAEs) were evaluated. RESULTS Patients in the overweight cohort (n = 94) had higher rates of non-alcoholic fatty liver disease (NAFLD) and lower rates of Hepatitis B compared to non-overweight cohort (n = 97). Baseline Child-Pugh class and Barcelona Clinic Liver Cancer stage were similar between cohorts, with lower rates of extrahepatic spread in the overweight group. Overweight patients had similar OS compared to non-overweight (median OS 15.1 vs. 14.9 months; p = 0.99). BMI did not influence median PFS (7.1 vs. 6.1 months; p = 0.42), ORR (27.2% vs. 22.0%; p = 0.44) and DCR (74.1% vs. 71.9%; p = 0.46). There were higher rates of atezolizumab-related fatigue (22.3% vs. 10.3%; p = 0.02) and bevacizumab-related thrombosis (8.5% vs. 2.1%; p = 0.045) in the overweight patients, but overall trAEs and treatment discontinuation were comparable between cohorts. CONCLUSION Atezo/Bev has comparable efficacy in overweight HCC patients, with an increase in treatment-related fatigue and thrombosis. Combination therapy is safe and efficacious to use in overweight patients, including those with underlying NAFLD.
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Affiliation(s)
- Mathew Vithayathil
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Claudia Angela Maria Fulgenzi
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
- Division of Medical Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation With Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann von Felden
- Department of Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kornelius Schulze
- Department of Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Wege
- Department of Gastroenterology and Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anwaar Saeed
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, USA
| | - Brooke Wietharn
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, USA
| | - Hannah Hildebrand
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, USA
| | - Linda Wu
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Celina Ang
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Thomas U Marron
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Arndt Weinmann
- I. Medical Department, University Medical Center Mainz, Mainz, Germany
| | - Peter R Galle
- I. Medical Department, University Medical Center Mainz, Mainz, Germany
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany
- University of Freiburg, Signalling Research Centers BIOSS and CIBSS, Freiburg, Germany
- German Cancer Consortium (DKTK), Partner Site, Freiburg, Germany
| | | | - Lorenz Balcar
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Suneetha Amara
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, USA
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, USA
| | - Abdul Rafeh Naqash
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, USA
- Medical Oncology/TSET Phase 1 Program, Stephenson Cancer Center, University of Oklahoma, Norman, OK, USA
| | - Antonella Cammarota
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valentina Zanuso
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Rohini Sharma
- Department of Surgery & Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0HS, UK.
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Larson KL, Mathews HF, Melendez CR, Hupp T, Estrada M, Moye JP, Passwater CC, Muzaffar M. Original Research: Can a Palliative Care Lay Health Advisor-Nurse Partnership Improve Health Equity for Latinos with Cancer? Am J Nurs 2023; 123:18-27. [PMID: 37345777 DOI: 10.1097/01.naj.0000944912.42194.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
PURPOSE A palliative care infrastructure is lacking for Latinos with life-threatening illness, especially in rural regions of the United States. The purpose of this study was to develop and evaluate a community-based palliative care lay health advisor (LHA) intervention for rural-dwelling Latino adults with cancer. METHODS An exploratory mixed-methods participatory action research design was carried out by an interprofessional research team that included community and academic members. Fifteen Latino community leaders completed a 10-hour palliative care training program and then served as palliative care LHAs. Although 45 Latinos with cancer initially agreed to participate, four withdrew or died and six were not reachable by the LHAs, for a final total of 35 patient participants.The trained palliative care LHAs delivered information on home symptom management and advance care planning to assigned participants. Palliative care nurses led the training and were available to the LHAs for consultation throughout the study. The LHAs made an average of three telephone calls to each participant. The Edmonton Symptom Assessment System-Revised (ESAS-r) and the four-item Advance Care Planning Engagement Survey (ACPES-4) were administered pre- and postintervention to determine the intervention's effectiveness. Encounter forms were transcribed, coded, and analyzed using case comparison. RESULTS The major finding was that significant improvements were shown for all four items of the ACPES-4 among both the LHAs (posttraining) and the participants (postintervention). Information on advance care planning was shared with 74.3% of the 35 participants. Participants showed clinical improvement in physical symptom scores and clinical deterioration in emotional symptom scores following the intervention, although these changes did not reach statistical significance. The advisors noted that participants were anxious about how to explain cancer to children, the uncertainty of their prognosis, and medical expenses. This sample was younger than those of other cancer studies; 51.4% were under age 50 and 73.1% had at least one child in the home. CONCLUSIONS A community-based palliative care LHA-nurse partnership was shown to be a feasible way to engage in conversations and deliver information about advance care planning to rural-dwelling Latino adults with cancer. The positive results led to the regional cancer center's decision to select "cultural care" as its 2022 goal for maintaining its accreditation with the Commission on Cancer.
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Affiliation(s)
- Kim L Larson
- Kim L. Larson is a professor of nursing and Carlos R. Melendez is an assistant professor of biostatistics at the East Carolina University (ECU) College of Nursing, Greenville, where Teresa Hupp is a BSN graduate. Holly F. Mathews is professor emeritus in the Department of Anthropology at ECU's Thomas Harriot College of Arts and Sciences. Michelle Estrada is a cooperative extension agent at North Carolina State University, Goldsboro. Janet P. Moye is a consultant, Chelsea C. Passwater is a clinical instructor, and Mahvish Muzaffar is an oncologist at ECU Health, Greenville. This study was funded by a grant from the Rita and Alex Hillman Foundation, a national organization that supports nurse-driven innovations in health care. Contact author: Kim L. Larson, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Pasli M, Kannaiyan R, Namireddy P, Walker P, Muzaffar M. Impact of Race on Outcomes of Advanced Stage Non-Small Cell Lung Cancer Patients Receiving Immunotherapy. Curr Oncol 2023; 30:4208-4221. [PMID: 37185434 PMCID: PMC10136836 DOI: 10.3390/curroncol30040321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The impact of race in advanced stage non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs) is conflicting. Our study sought to examine racial disparities in time to treatment initiation (TTI), overall survival (OS), and progression-free survival (PFS) using a population that was almost equally black and white. METHODS This was a retrospective cohort study of stage IV NSCLC patients > 18 years receiving immunotherapy at our center between 2014 and 2021. Kaplan-Meier curves and the multivariate Cox proportional hazards model determined the predictors of OS and PFS. Analyses were undertaken using IBM PSAW (SPSS v.28). RESULTS Out of 194 patients who met the inclusion criteria, 42.3% were black (n = 82). In the multivariate analysis, there was no difference in PFS (HR: 0.96; 95% CI: 0.66,1.40; p = 0.846) or OS (HR: 0.99; 95% CI: 0.66, 1.48; p = 0.966). No difference in treatment selection was observed between white and black patients (p = 0.363), nor was there a difference observed in median time to overall treatment initiation (p = 0.201). CONCLUSIONS No difference was observed in OS and PFS in black and white patients. Black patients' reception of timelier immunotherapy was an unanticipated finding. Future studies are necessary to better understand how race impacts patient outcomes.
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Affiliation(s)
- Melisa Pasli
- Brody School of Medicine at East Carolina University, Greenville, NC 27834, USA
| | - Radhamani Kannaiyan
- Division of Hospital Medicine, Eat Carolina University Health, 2100 Stantonsburg Road, Greenville, NC 27834, USA
| | - Praveen Namireddy
- Division of Hematology/Oncology, East Carolina University, Greenville, NC 27834, USA
| | | | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, NC 27834, USA
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Talbot T, D'Alessio A, Pinter M, Balcar L, Scheiner B, Marron TU, Jun T, Dharmapuri S, Ang C, Saeed A, Hildebrand H, Muzaffar M, Fulgenzi CAM, Amara S, Naqash AR, Gampa A, Pillai A, Wang Y, Khan U, Lee P, Huang Y, Bengsch B, Bettinger D, Mohamed YI, Kaseb A, Pressiani T, Personeni N, Rimassa L, Nishida N, Kudo M, Weinmann A, Galle PR, Muhammed A, Cortellini A, Vogel A, Pinato DJ. Progression patterns and therapeutic sequencing following immune checkpoint inhibition for hepatocellular carcinoma: An international observational study. Liver Int 2023; 43:695-707. [PMID: 36577703 PMCID: PMC10947007 DOI: 10.1111/liv.15502] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/11/2022] [Accepted: 12/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Different approaches are available after the progression of disease (PD) to immune checkpoint inhibitors (ICIs) for hepatocellular carcinoma (HCC), including the continuation of ICI, treatment switching to tyrosine kinase inhibitors (TKIs) and cessation of anticancer therapy. We sought to characterise the relationship between radiological patterns of progression and survival post-ICI, also appraising treatment strategies. METHODS We screened 604 HCC patients treated with ICIs, including only those who experienced PD by data cut-off. We evaluated post-progression survival (PPS) according to the treatment strategy at PD and verified its relationship with radiological patterns of progression: intrahepatic growth (IHG), new intrahepatic lesion (NIH), extrahepatic growth (EHG), new extrahepatic lesion (NEH) and new vascular invasion (nVI). RESULTS Of 604 patients, 364 (60.3%) experienced PD during observation. Median PPS was 5.3 months (95% CI: 4.4-6.9; 271 events). At the data cut-off, 165 patients (45%) received no post-progression anticancer therapy; 64 patients (17.6%) continued ICI beyond PD. IHG (HR 1.64 [95% CI: 1.21-2.22]; p = .0013) and nVI (HR 2.15 [95% CI: 1.38-3.35]; p = .0007) were associated with shorter PPS. Multivariate models adjusted for progression patterns, treatment line and albumin-bilirubin grade and Eastern Cooperative Oncology Group performance status at PD confirmed receipt of ICI beyond PD with (HR 0.17, 95% CI: 0.09-0.32; p < .0001) or without subsequent TKI (HR 0.39, 95% CI: 0.26-0.58; p < .0001) as predictors of prolonged PPS versus no anticancer therapy. CONCLUSIONS ICI-TKI sequencing is a consolidated option in advanced HCC. nVI and IHG predict a poorer prognosis. Despite lack of recommendation, the continuation of ICI beyond progression in HCC is adopted clinically: future efforts should appraise which patients benefit from this approach.
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Affiliation(s)
- Thomas Talbot
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Lorenz Balcar
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Thomas U. Marron
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | | | - Sirish Dharmapuri
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Celina Ang
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Anwaar Saeed
- Division of Medical Oncology, Department of MedicineKansas University Cancer CenterWestwoodKansasUSA
| | - Hannah Hildebrand
- Division of Medical Oncology, Department of MedicineKansas University Cancer CenterWestwoodKansasUSA
| | - Mahvish Muzaffar
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Claudia A. M. Fulgenzi
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
- Department of Medical OncologyUniversity Campus Bio‐MedicoRomeItaly
| | - Suneetha Amara
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Abdul Rafeh Naqash
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMarylandUSA
| | - Anuhya Gampa
- Section of GastroenterologyHepatology & Nutrition, the University of Chicago MedicineChicagoIllinoisUSA
| | - Anjana Pillai
- Section of GastroenterologyHepatology & Nutrition, the University of Chicago MedicineChicagoIllinoisUSA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology & NutritionThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Uqba Khan
- Division of Hematology and OncologyWeill Cornell Medicine/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Pei‐Chang Lee
- Division of Gastroenterology and Hepatology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yi‐Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Institute of Clinical MedicineNational Yang Ming Chiao Tung University School of MedicineTaipeiTaiwan
| | - Bertram Bengsch
- Department of Medicine II, Faculty of MedicineMedical Center University of Freiburg, University of FreiburgFreiburgGermany
| | - Dominik Bettinger
- Department of Medicine II, Faculty of MedicineMedical Center University of Freiburg, University of FreiburgFreiburgGermany
| | - Yehia I. Mohamed
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Nicola Personeni
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Lorenza Rimassa
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
- Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalMilanItaly
| | - Naoshi Nishida
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka‐SayamaJapan
| | - Masatoshi Kudo
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka‐SayamaJapan
| | - Arndt Weinmann
- 1st Department of Internal Medicine, Gastroenterology and HepatologyUniversity Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Peter R. Galle
- 1st Department of Internal Medicine, Gastroenterology and HepatologyUniversity Medical Center of the Johannes Gutenberg‐University MainzMainzGermany
| | - Ambreen Muhammed
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany
| | - David J. Pinato
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
- Division of Oncology, Department of Translational MedicineUniversity of Piemonte Orientale “A. Avogadro”NovaraItaly
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Ahmad S, Muzaffar M, Ardhanari S. CANCER THERAPY-RELATED ATRIAL FIBROSIS DIAGNOSED WITH MULTI-MODALITY IMAGING: A CASE REPORT. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04233-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Wu YL, van Hyfte G, Özbek U, Reincke M, Gampa A, Mohamed YI, Nishida N, Wietharn B, Amara S, Lee PC, Scheiner B, Balcar L, Pinter M, Vogel A, Weinmann A, Saeed A, Pillai A, Rimassa L, Naqash AR, Muzaffar M, Huang YH, Kaseb AO, Kudo M, Pinato DJ, Ang C. Outcomes of beta blocker use in advanced hepatocellular carcinoma treated with immune checkpoint inhibitors. Front Oncol 2023; 13:1128569. [PMID: 36865801 PMCID: PMC9971987 DOI: 10.3389/fonc.2023.1128569] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
Background In patients with cirrhosis, portal hypertension increases intestinal permeability, dysbiosis, and bacterial translocation, promoting an inflammatory state that can lead to the progression of liver disease and development of hepatocellular carcinoma (HCC). We aimed to investigate whether beta blockers (BBs), which can mediate portal hypertension, conferred survival benefits in patients treated with immune checkpoint inhibitors (ICIs). Methods We conducted a retrospective, observational study of 578 patients with unresectable HCC treated with ICI from 2017 to 2019 at 13 institutions across three continents. BB use was defined as exposure to BBs at any time during ICI therapy. The primary objective was to assess the association of BB exposure with overall survival (OS). Secondary objectives were to evaluate the association of BB use with progression-free survival (PFS) and objective response rate (ORR) according to RECIST 1.1 criteria. Results In our study cohort, 203 (35%) patients used BBs at any point during ICI therapy. Of these, 51% were taking a nonselective BB. BB use was not significantly correlated with OS (hazard ratio [HR] 1.12, 95% CI 0.9-1.39, P = 0.298), PFS (HR 1.02, 95% CI 0.83-1.26, P = 0.844) or ORR (odds ratio [OR] 0.84, 95% CI 0.54-1.31, P = 0.451) in univariate or multivariate analyses. BB use was also not associated with incidence of adverse events (OR 1.38, 95% CI 0.96-1.97, P = 0.079). Specifically, nonselective BB use was not correlated with OS (HR 0.94, 95% CI 0.66-1.33, P = 0.721), PFS (HR 0.92, 0.66-1.29, P = 0.629), ORR (OR 1.20, 95% CI 0.58-2.49, P = 0.623), or rate of adverse events (OR 0.82, 95% CI 0.46-1.47, P = 0.510). Conclusion In this real-world population of patients with unresectable HCC treated with immunotherapy, BB use was not associated with OS, PFS or ORR.
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Affiliation(s)
- Y. Linda Wu
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Grace van Hyfte
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Umut Özbek
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marlene Reincke
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Anuhya Gampa
- Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago Medical Center, Chicago, IL, United States
| | - Yehia I. Mohamed
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Brooke Wietharn
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, United States
| | - Suneetha Amara
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, United States
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anwaar Saeed
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Kansas City, KS, United States
| | - Anjana Pillai
- Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago Medical Center, Chicago, IL, United States
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy,Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | - Abdul Rafeh Naqash
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, United States
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, NC, United States
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Ahmed O. Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital London, London, United Kingdom
| | - Celina Ang
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States,*Correspondence: Celina Ang,
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Marie MA, McCallen JD, Hamedi ZS, Naqash AR, Hoffman A, Atwell D, Amara S, Muzaffar M, Walker PR, Yang LV. Case Report: Peripheral blood T cells and inflammatory molecules in lung cancer patients with immune checkpoint inhibitor-induced thyroid dysfunction: Case studies and literature review. Front Oncol 2022; 12:1023545. [PMID: 36568170 PMCID: PMC9768626 DOI: 10.3389/fonc.2022.1023545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Immunotherapy has changed the paradigm of cancer treatment, yet immune checkpoint inhibitors (ICIs) such as PD-1/PD-L1 monoclonal antibodies may cause immune-related adverse events (irAEs) in some patients. In this report, two non-small cell lung cancer (NSCLC) patients treated with nivolumab presented with checkpoint inhibitor-induced thyroid dysfunction (CITD), followed by a second irAE of pneumonitis and intestinal perforation, respectively. Increases in peripheral CD8+ T cells correlated with the onset of CITD in the patients. Intriguingly, common inflammatory biomarkers, including C-reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR), were not consistently increased during the onset of CITD but were substantially increased during the onset of pneumonitis and intestinal perforation irAEs. The observations suggest that unlike other irAEs such as pneumonitis, CRP levels and NLR were non-contributory in diagnosing CITD, whereas T cell expansion may be associated with immunotherapy-induced thyroiditis.
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Affiliation(s)
- Mona A. Marie
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Justin D. McCallen
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Zahra S. Hamedi
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Abdul Rafeh Naqash
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,Department of Internal Medicine, College of Medicine, University of Oklahoma, Oklahoma City, OK, United States
| | - Alexander Hoffman
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Druid Atwell
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Suneetha Amara
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Mahvish Muzaffar
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Paul R. Walker
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,Circulogene, Birmingham, AL, United States,*Correspondence: Li V. Yang, ; Paul R. Walker,
| | - Li V. Yang
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States,*Correspondence: Li V. Yang, ; Paul R. Walker,
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13
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You B, Purdy C, Copeland LJ, Swisher EM, Bookman MA, Fleming G, Coleman R, Randall LM, Tewari KS, Monk BJ, Mannel RS, Walker JL, Cappuccini F, Cohn D, Muzaffar M, Mutch D, Wahner-Hendrickson A, Martin L, Colomban O, Burger RA. Identification of Patients With Ovarian Cancer Experiencing the Highest Benefit From Bevacizumab in the First-Line Setting on the Basis of Their Tumor-Intrinsic Chemosensitivity (KELIM): The GOG-0218 Validation Study. J Clin Oncol 2022; 40:3965-3974. [PMID: 36252167 PMCID: PMC9746742 DOI: 10.1200/jco.22.01207] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/30/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In patients with high-grade ovarian cancer, predictors of bevacizumab efficacy in first-line setting are needed. In the ICON-7 trial, a poor tumor intrinsic chemosensitivity (defined by unfavorable modeled cancer antigen-125 [CA-125] ELIMination rate constant K [KELIM] score) was a predictive biomarker. Only the patients with high-risk disease (suboptimally resected stage III, or stage IV) exhibiting unfavorable KELIM score < 1.0 had overall survival (OS) benefit from bevacizumab (median: 29.7 v 20.6 months; hazard ratio [HR], 0.78). An external validation study in the GOG-0218 trial was performed. METHODS In GOG-0218, 1,873 patients were treated with carboplatin-paclitaxel ± concurrent-maintenance bevacizumab/placebo. Patient KELIM values were calculated with CA-125 kinetics during the first 100 chemotherapy days by the Lyon University team. The association between KELIM score (favorable ≥ 1.0, or unfavorable < 1.0) and bevacizumab benefit for progression-free survival (PFS)/OS was independently assessed by NGR-GOG using univariate/multivariate analyses. RESULTS KELIM was assessable in 1,662 patients with ≥ 3 CA-125 available values. An unfavorable KELIM score was associated with bevacizumab benefit compared with placebo (PFS: HR, 0.70; 95% CI, 0.59 to 0.82; OS: HR, 0.87; 95% CI, 0.73 to 1.03), whereas a favorable KELIM was not (PFS: HR, 0.96; 95% CI, 0.79 to 1.17; OS: HR, 1.11; 95% CI, 0.89 to 1.39). The highest benefit was observed in patients with a high-risk disease exhibiting unfavorable KELIM, for PFS (median: 9.1 v 5.6 months; HR, 0.64; 95% CI, 0.53 to 0.78), and for OS (median: 35.1 v 29.1 months; HR, 0.79; 95% CI, 0.65 to 0.97). CONCLUSION This GOG-0218 trial investigation validates ICON-7 findings about the association between poor tumor chemosensitivity and benefit from concurrent-maintenance bevacizumab, suggesting that bevacizumab may mainly be effective in patients with poorly chemosensitive disease. Bevacizumab may be prioritized in patients with a high-risk and poorly chemosensitive disease to improve their PFS/OS (patient KELIM score calculator available on the Biomarker Kinetics website).
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Affiliation(s)
- Benoit You
- Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, EMR UCBL/HCL 3738, Lyon, France GINECO, Paris, France
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, GINECO-GINEGEPS, Lyon, France
| | - Christopher Purdy
- Clinical Trial Development Division, Biostatistics and Bioinformatics Department, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Elizabeth M. Swisher
- Division of Gynecologic Oncology, Department of Ob/Gyn, University of Washington, Seattle, WA
| | - Michael A. Bookman
- Director, Gynecologic Oncology Therapeutics, Kaiser Permanente Northern California, San Francisco, CA
| | - Gini Fleming
- Hematology and Oncology, The University of Chicago Medicine, Chicago, IL
| | - Robert Coleman
- Chief Scientific Officer, US Oncology Research, The Woodlands, TX
| | - Leslie M. Randall
- Division of Gynecologic Oncology, Virginia Commonwealth University, School of Medicine, Richmond, VA
| | | | - Bradley J. Monk
- HonorHealth Research Institute, University of Arizona, Creighton University, Phoenix, AZ
| | | | | | | | - David Cohn
- The Ohio State University, James Cancer Hospital, Columbus, OH
| | | | - David Mutch
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | | | - Lainie Martin
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
- Mersana Therapeutics, Cambridge, MA
| | - Olivier Colomban
- Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon-Sud, EMR UCBL/HCL 3738, Lyon, France GINECO, Paris, France
- Medical Oncology, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), CITOHL, GINECO-GINEGEPS, Lyon, France
| | - Robert A. Burger
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
- Mersana Therapeutics, Cambridge, MA
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14
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Vithayathil M, D'Alessio A, Fulgenzi CAM, Nishida N, Schönlein M, von Felden J, Schulze K, Wege H, Saeed A, Wietharn B, Hildebrand H, Wu L, Ang C, Marron TU, Weinmann A, Galle PR, Bettinger D, Bengsch B, Vogel A, Balcar L, Scheiner B, Lee P, Huang Y, Amara S, Muzaffar M, Naqash AR, Cammarota A, Personeni N, Pressiani T, Pinter M, Cortellini A, Kudo M, Rimassa L, Pinato DJ, Sharma R. Impact of older age in patients receiving atezolizumab and bevacizumab for hepatocellular carcinoma. Liver Int 2022; 42:2538-2547. [PMID: 35986902 PMCID: PMC9825835 DOI: 10.1111/liv.15405] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS Combination atezolizumab/bevacizumab is the gold standard for first-line treatment of unresectable hepatocellular carcinoma (HCC). Our study investigated the efficacy and safety of combination therapy in older patients with HCC. METHODS 191 consecutive patients from eight centres receiving atezolizumab and bevacizumab were included. Overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR) defined by RECIST v1.1 were measured in older (age ≥ 65 years) and younger (age < 65 years) age patients. Treatment-related adverse events (trAEs) were evaluated. RESULTS The elderly (n = 116) had higher rates of non-alcoholic fatty liver disease (19.8% vs. 2.7%; p < .001), presenting with smaller tumours (6.2 cm vs 7.9 cm, p = .02) with less portal vein thrombosis (31.9 vs. 54.7%, p = .002), with fewer patients presenting with BCLC-C stage disease (50.9 vs. 74.3%, p = .002). There was no significant difference in OS (median 14.9 vs. 15.1 months; HR 1.15, 95% CI 0.65-2.02 p = .63) and PFS (median 7.1 vs. 5.5 months; HR 1.11, 95% CI 0.54-1.92; p = .72) between older age and younger age. Older patients had similar ORR (27.6% vs. 20.0%; p = .27) and DCR (77.5% vs. 66.1%; p = .11) compared to younger patients. Atezolizumab-related (40.5% vs. 48.0%; p = .31) and bevacizumab-related (44.8% vs. 41.3%; p = .63) trAEs were comparable between groups. Rates of grade ≥3 trAEs and toxicity-related treatment discontinuation were similar between older and younger age patients. Patients 75 years and older had similar survival and safety outcomes compared to younger patients. CONCLUSIONS Atezolizumab and bevacizumab therapy is associated with comparable efficacy and tolerability in older age patients with unresectable HCC.
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Affiliation(s)
- Mathew Vithayathil
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Antonio D'Alessio
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK,Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly
| | - Claudia A. M. Fulgenzi
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK,Division of Medical OncologyPoliclinico Universitario Campus Bio‐MedicoRomeItaly
| | - Naoshi Nishida
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of PneumologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Johann von Felden
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Kornelius Schulze
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Henning Wege
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Anwaar Saeed
- Division of Medical Oncology, Department of MedicineKansas University Cancer CenterKansas CityKansasUSA
| | - Brooke Wietharn
- Division of Medical Oncology, Department of MedicineKansas University Cancer CenterKansas CityKansasUSA
| | - Hannah Hildebrand
- Division of Medical Oncology, Department of MedicineKansas University Cancer CenterKansas CityKansasUSA
| | - Linda Wu
- Division of Hematology/Oncology, Department of MedicineTisch Cancer Institute, Mount Sinai HospitalNew YorkNew YorkUSA
| | - Celina Ang
- Division of Hematology/Oncology, Department of MedicineTisch Cancer Institute, Mount Sinai HospitalNew YorkNew YorkUSA
| | - Thomas U. Marron
- Division of Hematology/Oncology, Department of MedicineTisch Cancer Institute, Mount Sinai HospitalNew YorkNew YorkUSA
| | - Arndt Weinmann
- I. Medical DepartmentUniversity Medical Center MainzMainzGermany
| | - Peter R. Galle
- I. Medical DepartmentUniversity Medical Center MainzMainzGermany
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical CenterUniversity of FreiburgFreiburgGermany
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Faculty of Medicine, Freiburg University Medical CenterUniversity of FreiburgFreiburgGermany,University of FreiburgSignalling Research Centers BIOSS and CIBSSFreiburgGermany,German Cancer Consortium (DKTK), Partner SiteFreiburgGermany
| | | | - Lorenz Balcar
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Bernhard Scheiner
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Pei‐Chang Lee
- Division of Gastroenterology and Hepatology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yi‐Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Suneetha Amara
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Mahvish Muzaffar
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Abdul Rafeh Naqash
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA,Medical Oncology/TSET Phase 1 Program, Stephenson Cancer CenterUniversity of OklahomaNormanOklahomaUSA
| | - Antonella Cammarota
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly,Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoItaly
| | - Nicola Personeni
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly,Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoItaly
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoItaly
| | - Matthias Pinter
- Division of Gastroenterology & Hepatology, Department of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
| | - Masatoshi Kudo
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Lorenza Rimassa
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleItaly,Medical Oncology and Hematology Unit, Humanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoItaly
| | - David J. Pinato
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK,Division of Oncology, Department of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
| | - Rohini Sharma
- Department of Surgery & Cancer, Imperial College LondonHammersmith HospitalLondonUK
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15
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D’Alessio A, Fulgenzi CAM, Nishida N, Schönlein M, von Felden J, Schulze K, Wege H, Gaillard VE, Saeed A, Wietharn B, Hildebrand H, Wu L, Ang C, Marron TU, Weinmann A, Galle PR, Bettinger D, Bengsch B, Vogel A, Balcar L, Scheiner B, Lee P, Huang Y, Amara S, Muzaffar M, Naqash AR, Cammarota A, Personeni N, Pressiani T, Sharma R, Pinter M, Cortellini A, Kudo M, Rimassa L, Pinato DJ. Preliminary evidence of safety and tolerability of atezolizumab plus bevacizumab in patients with hepatocellular carcinoma and Child-Pugh A and B cirrhosis: A real-world study. Hepatology 2022; 76:1000-1012. [PMID: 35313048 PMCID: PMC9790703 DOI: 10.1002/hep.32468] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Atezolizumab plus bevacizumab (AtezoBev) is the standard of care for first-line treatment of unresectable HCC. No evidence exists as to its use in routine clinical practice in patients with impaired liver function. APPROACH AND RESULTS In 216 patients with HCC who were consecutively treated with AtezoBev across 11 tertiary centers, we retrospectively evaluated treatment-related adverse events (trAEs) graded (G) according to Common Terminology Criteria for Adverse Events v5.0, including in the analysis all patients treated according to label (n = 202, 94%). We also assessed overall survival (OS), progression-free survival (PFS), overall response (ORR), and disease control rates (DCR) defined by Response Evaluation Criteria in Solid Tumors v1.1. Disease was mostly secondary to viral hepatitis, namely hepatitis C (n = 72; 36%) and hepatitis B infection (n = 35, 17%). Liver function was graded as Child-Pugh (CP)-A in 154 patients (76%) and CP-B in 48 (24%). Any grade trAEs were reported by 143 patients (71%), of which 53 (26%) were G3 and 3 (2%) G4. Compared with CP-A, patients with CP-B showed comparable rates of trAEs. Presence and grade of varices at pretreatment esophagogastroduodenoscopy did not correlate with bleeding events. After a median follow-up of 9.0 months (95% CI, 7.8-10.1), median OS was 14.9 months (95% CI, 13.6-16.3), whereas median PFS was 6.8 months (95% CI, 5.2-8.5). ORR and DCR were respectively 25% and 73%, with no difference across CP classes. CONCLUSIONS This study confirms reproducible safety and efficacy of AtezoBev in routine practice. Patients with CP-B reported similar tolerability compared with CP-A, warranting prospective evaluation of AtezoBev in this treatment-deprived population.
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Affiliation(s)
- Antonio D’Alessio
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK,Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, MilanItaly
| | - Claudia Angela Maria Fulgenzi
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK,Division of Medical OncologyPoliclinico Universitario Campus Bio‐MedicoRomeItaly
| | - Naoshi Nishida
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Martin Schönlein
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of PneumologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Johann von Felden
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Kornelius Schulze
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Henning Wege
- Department of MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | | | - Anwaar Saeed
- Division of Medical OncologyDepartment of MedicineKansas University Cancer CenterKansas CityKansasUSA
| | - Brooke Wietharn
- Division of Medical OncologyDepartment of MedicineKansas University Cancer CenterKansas CityKansasUSA
| | - Hannah Hildebrand
- Division of Medical OncologyDepartment of MedicineKansas University Cancer CenterKansas CityKansasUSA
| | - Linda Wu
- Division of Hematology/OncologyDepartment of MedicineTisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Celina Ang
- Division of Hematology/OncologyDepartment of MedicineTisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Thomas U. Marron
- Division of Hematology/OncologyDepartment of MedicineTisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | | | | | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases)Faculty of MedicineFreiburg University Medical CenterUniversity of FreiburgFreiburgGermany
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases)Faculty of MedicineFreiburg University Medical CenterUniversity of FreiburgFreiburgGermany,University of FreiburgSignalling Research Centres BIOSS and CIBSSFreiburgGermany,German Cancer Consortium (DKTK), partner siteFreiburgGermany
| | | | - Lorenz Balcar
- Division of Gastroenterology & HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Bernhard Scheiner
- Division of Gastroenterology & HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Pei‐Chang Lee
- Division of Gastroenterology and HepatologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yi‐Hsiang Huang
- Division of Gastroenterology and HepatologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Institute of Clinical MedicineSchool of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Suneetha Amara
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Mahvish Muzaffar
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Abdul Rafeh Naqash
- Division of Hematology/OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA,Medical Oncology/TSET Phase 1 ProgramStephenson Cancer CenterUniversity of OklahomaNormanOklahomaUSA
| | - Antonella Cammarota
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, MilanItaly,Medical Oncology and Hematology UnitHumanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoMilanItaly
| | - Nicola Personeni
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, MilanItaly,Medical Oncology and Hematology UnitHumanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoMilanItaly
| | - Tiziana Pressiani
- Medical Oncology and Hematology UnitHumanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoMilanItaly
| | - Rohini Sharma
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK
| | - Matthias Pinter
- Division of Gastroenterology & HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria
| | - Alessio Cortellini
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK
| | - Masatoshi Kudo
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsakaJapan
| | - Lorenza Rimassa
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, MilanItaly,Medical Oncology and Hematology UnitHumanitas Cancer CenterIRCCS Humanitas Research HospitalRozzanoMilanItaly
| | - David J. Pinato
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK,Division of OncologyDepartment of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
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16
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Abstract
OBJECTIVE To evaluate the antibody-drug conjugate- sacituzumab govitecan, its pharmacological properties, toxicity, data supporting efficacy against a wide variety of solid tumors beyond breast cancer, and potential future uses. DATA SOURCES Articles in MEDLINE/PubMed databases and the National Institutes of Health Clinical Trials Registry (http://www. clinicaltrials.gov) between January 1, 2015, and July 1, 2021 using MeSH terms sacituzumab govitecan(- hziy) and solid tumors were reviewed. DATA SUMMARY Antibody-drug conjugates (ADC's) are a subclass of emerging cancer therapeutics which combines chemotherapy with targeted antibodies. Sacituzumab govitecan (SG) is a novel antibody drug conjugate that has recently been approved by the Food and Drug Administration (FDA) in adult patients for the treatment of unresectable locally advanced or metastatic triple-negative breast cancer (mTNBC) who have received two or more prior systemic therapies, at least one of them for metastatic disease. The approval of sacituzumab govitecan provides a new option for solid tumors that need to be further explored. In this review article, we discussed the pharmacokinetics, pharmacodynamics, safety profile of sacituzumab govitecan and various ongoing clinical trials on sacituzumab govitecan. CONCLUSION Sacituzumab is a significant advancement made in cancer therapy. SG has showed significantly improved Health-related quality of life (HRQoL) in addition to prolonged progression free survival and Over all survival in addition to maintaining a good safety profile. Multiple clinical trials on SG are ongoing to evaluate the potential use of SG as neoadjuvant therapy in triple negative breast cancer, as an Adjuvant therapy, in combination with immunotherapy, and also for various solid tumors.
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Affiliation(s)
- Sindhusha Veeraballi
- Department of Medical Education, 22423Saint Michael's Medical Center, New York Medical College, New Jersey, United States
| | - Zaineb Khawar
- Medical student, 136414Saint Gorge's University school of medicine, St George's, Grenada
| | - Hafiz Muhammad Aslam
- Department of Hematology/Oncology, 3627East carolina university, Greenville, North Carolina, United States
| | - Mahvish Muzaffar
- Department of Hematology/Oncology, 3627East carolina university, Greenville, North Carolina, United States
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17
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Sharma R, Pillai A, Marron TU, Fessas P, Saeed A, Jun T, Dharmapuri S, Szafron D, Naqash AR, Gampa A, Wang Y, Khan U, Muzaffar M, Lee CJ, Lee PC, Bulumulle A, Paul S, Bettinger D, Hildebrand H, Yehia M, Pressiani T, Kaseb A, Huang YH, Ang C, Kudo M, Nishida N, Personeni N, Rimassa L, Pinato DJ. Patterns and outcomes of subsequent therapy after immune checkpoint inhibitor discontinuation in HCC. Hepatol Commun 2022; 6:1776-1785. [PMID: 35481940 PMCID: PMC9234627 DOI: 10.1002/hep4.1927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022] Open
Abstract
The availability of immune checkpoint inhibitors (ICIs) for the management of advanced hepatocellular cancer (HCC) has changed the treatment paradigm. There are emerging questions regarding the efficacy of subsequent anticancer therapies. The primary aim of this retrospective, multicenter study was to examine the types of anticancer treatment received after ICIs and to assess the impact on post-ICI survival. We established an international consortium of 11 tertiary-care referral centers located in the USA (n = 249), Europe (n = 74), and Asia (n = 97), and described patterns of care following ICI therapy. The impact of subsequent therapy on overall survival (OS) was estimated using the Kaplan-Meier method and presented with a 95% confidence interval (CI). A total of 420 patients were treated with ICIs for advanced HCC after one line of systemic therapy (n = 371, 88.8%): 31 (8.8%) had died, 152 (36.2%) received best supportive care (BSC) following ICIs, and 163 patients (38.8%) received subsequent anticancer therapy. Tyrosine kinase inhibitors (TKIs, n = 132, 80.9%), in particular sorafenib (n = 49, 30.0%), were the most common post-ICI therapy followed by external beam radiotherapy (n = 28, 17.2%), further immunotherapy (n = 21, 12.9%), locoregional therapy (n = 23, 14.1%), chemotherapy (n = 9, 5.5%), and surgery (n = 6, 3.6%). Receipt of post-ICI therapy was associated with longer median OS compared with those who had received BSC (12.1 vs. 3.3 months; hazard ratio [HR]: 0.4 (95% CI: 2.7-5.0). No difference in OS was noted in those patients who received TKI before ICIs compared with those who received ICIs followed by TKI. Conclusion: Post-ICI therapy is associated with OS in excess of 12 months, suggesting a role for therapeutic sequencing. OS from TKI therapy was similar to that reported in registration studies, suggesting preserved efficacy following ICIs.
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Affiliation(s)
- Rohini Sharma
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK
| | - Anjana Pillai
- Section of Gastroenterology, Hepatology and NutritionThe University of Chicago MedicineChicagoIllinoisUSA
| | - Thomas Urban Marron
- Department of MedicineDivision of Hematology/OncologyTisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Petros Fessas
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK
| | - Anwaar Saeed
- Division of Medical OncologyGI Oncology ProgramKansas University Cancer CentreKansas CityKansasUSA
| | - Tomi Jun
- Department of MedicineDivision of Hematology/OncologyTisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Sirish Dharmapuri
- Department of MedicineDivision of Hematology/OncologyTisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - David Szafron
- Department of MedicineBaylor College of MedicineHoustonTexasUSA
| | - Abdul Rafeh Naqash
- Division of Cancer Treatment and DiagnosisNational Cancer InstituteBethesdaMarylandUSA
| | - Anuhya Gampa
- Section of Gastroenterology, Hepatology and NutritionThe University of Chicago MedicineChicagoIllinoisUSA
| | - Yinghong Wang
- Department of GastroenterologyHepatology & NutritionThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Uqba Khan
- Department of medicineLincoln Medical CenterWeill Cornell/New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Mahvish Muzaffar
- Division of Hematology/ OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Chieh-Ju Lee
- Division of Gastroenterology and HepatologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Pei-Chang Lee
- Division of Gastroenterology and HepatologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Anushi Bulumulle
- Division of Hematology/ OncologyEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Sonal Paul
- New York Presbyterian Brooklyn Methodist HospitalNew YorkNew YorkUSA
| | - Dominic Bettinger
- Department of Medicine IIFaculty of MedicineMedical Center University of FreiburgUniversity of FreiburgFreiburgGermany.,Berta-Ottenstein ProgrammeFaculty of MedicineMedical Center University of FreiburgUniversity of FreiburgFreiburgGermany
| | - Hannah Hildebrand
- Division of Medical OncologyGI Oncology ProgramKansas University Cancer CentreKansas CityKansasUSA
| | - Mohammed Yehia
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Tiziana Pressiani
- Medical Oncology and Hematology UnitHumanitas Cancer CenterHumanitas Clinical and Research Center - IRCCSRozzano, MilanItaly
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Yi-Hsiang Huang
- Division of Gastroenterology and HepatologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Celina Ang
- Department of MedicineDivision of Hematology/OncologyTisch Cancer InstituteMount Sinai HospitalNew YorkNew YorkUSA
| | - Masatoshi Kudo
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka-sayama, OsakaJapan
| | - Naoshi Nishida
- Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka-sayama, OsakaJapan
| | - Nicola Personeni
- Medical Oncology and Hematology UnitHumanitas Cancer CenterHumanitas Clinical and Research Center - IRCCSRozzano, MilanItaly.,Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, MilanItaly
| | - Lorenza Rimassa
- Medical Oncology and Hematology UnitHumanitas Cancer CenterHumanitas Clinical and Research Center - IRCCSRozzano, MilanItaly.,Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, MilanItaly
| | - David James Pinato
- Department of Surgery & CancerImperial College LondonHammersmith HospitalLondonUK
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18
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Amara S, Yang LV, Tiriveedhi V, Muzaffar M. Complex Role of Microbiome in Pancreatic Tumorigenesis: Potential Therapeutic Implications. Cells 2022; 11:1900. [PMID: 35741028 PMCID: PMC9221309 DOI: 10.3390/cells11121900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 12/12/2022] Open
Abstract
Pancreatic cancer (PC) is the fourth leading cause of cancer-related mortality with limited diagnostic and therapeutic options. Although immunotherapy has shown promise in the treatment of several cancers, its role in pancreatic cancer is rather limited. Several studies have focused on determining the role of the tumor microenvironment with cancer-cell-intrinsic events and tumor-infiltrating immune cellular properties. However, in the past decade, there has been emerging research aimed at delineating the role of the host microbiome, including the metabolites from microbes and host responses, on pancreatic tumorigenesis. Importantly, there is emerging evidence suggesting the beneficial role of a gut microbiome transplant to improve immunotherapeutic outcomes in cancer patients. In this review, we summarize the recent understanding of the role of the microbiome in pancreatic cancer progression, along with its clinical diagnostic and therapeutic implications.
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Affiliation(s)
- Suneetha Amara
- Division of Hematology/Oncology, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (L.V.Y.); (M.M.)
| | - Li V. Yang
- Division of Hematology/Oncology, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (L.V.Y.); (M.M.)
| | - Venkataswarup Tiriveedhi
- Department of Biological Sciences, Tennessee State University, Nashville, TN 37209, USA;
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37212, USA
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA; (L.V.Y.); (M.M.)
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19
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Marinelli B, Kim E, D'Alessio A, Cedillo M, Sinha I, Debnath N, Kudo M, Nishida N, Saeed A, Hildebrand H, Kaseb AO, Abugabal YI, Pillai A, Huang YH, Khan U, Muzaffar M, Naqash AR, Patel R, Fischman A, Bishay V, Bettinger D, Sung M, Ang C, Schwartz M, Pinato DJ, Marron T. Integrated use of PD-1 inhibition and transarterial chemoembolization for hepatocellular carcinoma: evaluation of safety and efficacy in a retrospective, propensity score-matched study. J Immunother Cancer 2022; 10:jitc-2021-004205. [PMID: 35710293 PMCID: PMC9204420 DOI: 10.1136/jitc-2021-004205] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) have revolutionized treatment of advanced hepatocellular carcinoma. Integrated use of transarterial chemoembolization (TACE), a locoregional inducer of immunogenic cell death, with ICI has not been formally assessed for safety and efficacy outcomes. Methods From a retrospective multicenter dataset of 323 patients treated with ICI, we identified 31 patients who underwent >1 TACE 60 days before or concurrently, with nivolumab at a single center. We derived a propensity score-matched cohort of 104 patients based on Child-Pugh Score, portal vein thrombosis, extrahepatic metastasis and alpha fetoprotein (AFP) who received nivolumab monotherapy. We described overall survival (OS), progression-free survival (PFS), objective responses according to modified RECIST criteria and safety in the multimodal arm in comparison to monotherapy. Results Over a median follow-up of 9.3 (IQR 4.0–16.4) months, patients undergoing multimodal immunotherapy with TACE achieved a significantly longer median (95% CI) PFS of 8.8 (6.2–23.2) vs 3.7 (2.7–5.4) months (log-rank 0.15, p<0.01) in the monotherapy group. Multimodal immunotherapy with TACE demonstrated a numerically longer OS compared with ICI monotherapy with a median 35.1 (16.1–Not Evaluable) vs 16.6 (15.7–32.6) months (log-rank 0.41, p=0.12). In the multimodal treatment group, there were three (10%) grade 3 or higher adverse events (AEs) attributed to immunotherapy compared with seven (6.7%) in the matched ICI monotherapy arm. There were no AEs grade 3 or higher attributed to TACE in the multimodal treatment arm. At 3 months following each TACE in the multimodal arm, there was an overall objective response rate of 84%. There were no significant changes in liver functional reserve 1 month following each TACE. Four patients undergoing multimodal treatment were successfully bridged to transplant. Conclusions TACE can be safely integrated with programmed cell death 1 blockade and may lead to a significant delay in tumor progression and disease downstaging in selected patients.
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Affiliation(s)
- Brett Marinelli
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Edward Kim
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Antonio D'Alessio
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mario Cedillo
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ishan Sinha
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Neha Debnath
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Masatoshi Kudo
- Faculty of Medicine Hospital, Department of Gastroenterology and Hepatology, Kindai University, Osakasayama, Japan
| | - Naoshi Nishida
- Faculty of Medicine Hospital, Department of Gastroenterology and Hepatology, Kindai University, Osakasayama, Japan
| | - Anwaar Saeed
- Department of Medicine, Division of Clinical Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hannah Hildebrand
- Department of Medicine, Division of Clinical Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yehia I Abugabal
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anjana Pillai
- Department of Medicine, Section of Gastroenterology, University of Chicago, Chicago, Illinois, USA
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Uqba Khan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York City, New York, USA
| | - Mahvish Muzaffar
- Department of Medicine, Division of Hematology and Oncology, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Abdul Rafeh Naqash
- Department of Medicine, Division of Hematology and Oncology, Stephenson Cancer Center at the University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Rahul Patel
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Aaron Fischman
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Vivian Bishay
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Dominik Bettinger
- Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany
| | - Max Sung
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Celina Ang
- Hematology and Oncology, Mount Sinai School of Medicine, New York City, New York, USA
| | - Myron Schwartz
- Department of Surgery, Recanti/Miller Transplant Institute at the Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Thomas Marron
- Division of Hematology and Medical Oncology, Mount Sinai School of Medicine, New York City, New York, USA
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20
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Amara S, Muzaffar M, Namireddy P, Yang LV. Peripheral blood t cell responses to immunotherapy related adverse events in metastatic non-small cell lung cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21047] [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
e21047 Background: There has been prospective and retrospective evidence for the onset of immunotherapy (IO) related adverse events (irAE) and efficacy of anti programmed death (PD1) and Programmed death Ligand 1(PD L1) antibodies. The incidence of irAE in these studies ranged anywhere from 30-44%. There have been attempts in the past to cluster irAEs into distinct subtypes by T cell profiling before and after immunotherapy. Identifying the trend of CD4/CD8 changes during irAE may aid in finding ways to mitigate the severe toxicities, so the benefits of immunotherapy can be extended to far more number of patients. Methods: We have collected blood samples from 20 patients of Non Small Cell Lung Cancer patients (NSCLC) before each cycle of immunotherapy with informed consent. We have measured the different inflammatory markers such as IL6, IL10 using ELISA and isolated cellular components such as CD4, CD8 T cells along with others using magnetic bead technique, from these samples in our research laboratory at East Carolina University. We have also collected clinical information including the adverse events with their (Common Terminology Criteria for Adverse events) CTCAE 5.0 grading, different cell counts and C- reactive Protein (CRP). Results: In the cohort of 20 patients, 9 experienced irAE, out of which 6 had grade 2, including thyroiditis, pneumonitis, dermatitis, cytokine release syndrome (CRS), 1 had grade 3 pneumonitis, 1 had grade 4 pneumonitis and 1 had grade 1 CRS. When we looked at the CD4/CD8 ratio before each cycle, the one prior to the incidence of the irAE had at least 30-40% drop in the ratio consistently although there were minor fluctuations in the ratio at other times in both directions. Conclusions: Although most irAEs can be treated and reversed with steroids and other immunosuppressive agents, prolonged immunosuppression can lead to reduced efficacy of IO and development of undue opportunistic infections. Experience with IO has shown that earlier initiation of immunosuppression shortens the required treatment. However, given the challenge in the subtility of the earlier presentation, therapies are frequently delayed. Hence, biomarker to identify the early manifestations is of critical importance for early intervention. Studies suggest there is clonal expansion of CD8 T cells preceding grade 2-3 irAEs. Studies also indicate that increased T cells in the tumor is indicative of response to immunotherapy. Our observation suggests that increased CD8 in proportion to CD4 in the peripheral blood precedes the onset of irAE. It is unclear as to how this leads to increased toxicity when the immunotherapy treatment works by affecting T cell function. One possible explanation is that the T cell response in the tumor tissue is beneficial, however, T cell response in the peripheral blood may indicate response against self antigens leading to toxicities in the form of irAE.
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Affiliation(s)
| | | | | | - Li V. Yang
- East Carolina University, Greenville, NC
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21
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You B, Purdy C, Swisher EM, Bookman MA, Fleming GF, Coleman RL, Randall LM, Tewari KS, Monk BJ, Mannel RS, Walker JL, Cappuccini F, Copeland LJ, Muzaffar M, Mutch DG, Wahner Hendrickson AE, Martin LP, Colomban O, Burger RA. Identification of patients with ovarian cancer who are experiencing the highest benefit from bevacizumab in first-line setting based on their tumor intrinsic chemosensitivity (KELIM): GOG-0218 validation study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.5553] [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
5553 Background: In patients with high-grade ovarian cancer in first-line setting, predictive factors of bevacizumab efficacy are needed, for selecting patients. In ICON-7 trial, a poor tumor intrisic chemosensitivity (defined by unfavorable modeled CA-125 kinetic ELIMination rate constant KELIM) was a predictive biomarker. Among patients with high-risk diseases, only those with unfavorable KELIM had survival benefit from bevacizumab (mOS: 29.7 vs 20.6 months, HR = 0.78)(Colomban. JNCI CS 2020). The objective was to perform an external validation in GOG-0218 trial (NCT00262847). Methods: In GOG-0218, 1,873 patients were treated with carboplatin-paclitaxel +/- concurrent bevacizumab/placebo followed by a 15 month maintenance. Patient KELIM values were estimated with longitudinal CA-125 kinetics during the first 100 chemotherapy days. The association between KELIM score (categorized as favorable ≥ 1, or unfavorable < 1) and efficacy of bevacizumab (bevacizumab-concurrent + maintenance, vs placebo) for PFS and OS was assessed using univariate/multivariate analyses, in a Training set with 2/3 patients managed the investigators, and then a Validation set with all patients, managed by NGR-GOG. Results: KELIM was assessable in 1,662 patients with ≥ 3 CA-125 available values. In both sets, the patients with unfavorable KELIM derived benefit from bevacizumab compared to placebo (Training: PFS, HR = 0.65 [0.54-0.80]; OS, HR = 0.80 [0.65-0.99]; Validation: PFS, HR = 0.69 [0.59-0.82]; OS, HR = 0.87 [0.73-1.03]), whilst those with favorable KELIM had no benefit from bevacizumab (Training: PFS, HR = 0.96 [0.75-1.23]; OS, HR = 1.05 [0.80-1.37]; Validation, PFS, HR = 0.96 [0.79-1.17]; OS HR = 1.11 [0.89-1.84]). The highest benefit was observed in patients with high-risk diseases (stage IV or sub-optimally resected stage III) characterized by unfavorable KELIM, for PFS (Learning (n = 276): mPFS: 9.0 vs 5.2 months, HR = 0.61 [0.48-0.78]; Validation (n = 433): mPFS: 9.1 vs 5.6 months, HR = 0.64 [0.53-0.78]), and for OS (Learning (n = 278): mOS: 38.9 vs 27.9 months, HR = 0.72 [0.56-0.93], Validation set (n = 438): mOS: 35.1 vs 29.1 months, HR = 0.79 [0.65-0.97]). Conclusions: This validation analysis of GOG-0218 trial confirms the outcomes of ICON-7 trial about the association between poor tumor chemosensitivity and benefit from concurrent + maintenance bevacizumab, suggesting that bevacizumab is mainly effective in patients with poorly chemosensitive diseases. No benefit was found in patients with favorable KELIM. The patients who derived the highest benefit from bevacizumab in PFS and OS (OS absolute benefit ̃ 6 to 9 months) were those with high-risk diseases (stage IV, or incompletely resected stage III) associated with an unfavorable KELIM score (calculator on https://www.biomarker-kinetics.org/CA-125).
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Affiliation(s)
- Benoit You
- Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Lyon, France
| | | | | | | | | | | | | | - Krishnansu Sujata Tewari
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California, Irvine, CA
| | - Bradley J. Monk
- GOG Foundation, Creighton University, University of Arizona, Phoenix, AZ
| | | | - Joan L. Walker
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Fabio Cappuccini
- University of California-Irvine Medical Center, Orange County, CA
| | - Larry J. Copeland
- The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH
| | | | | | | | - Lainie P. Martin
- University of Pennsylvania, Abramson Cancer Center, Philadelphia, PA
| | | | - Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
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22
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Jayananda S, Muzaffar M, Namireddy P, Sharma N, Meyer D, Walker PR. Correlation of clinical outcomes with programmed death ligand-1 expression on liquid biopsy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21050] [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
e21050 Background: Programmed death ligand-1 (PD-L1) expression is predictive of immunotherapy benefit. However, tissue PD-L1 protein immunohistochemical testing can be fraught with tissue acquisition and heterogeneity limitations. PD-L1 expression by RNA sequencing can be performed by both tissue and plasma with tissue PD-L1 protein correlations. What has not been well characterized is the correlation of plasma cell free circulating tumor RNA (cfRNA) PD-L1 and clinical outcomes with immunotherapy. Plasma cfRNA PD-L1 expression was evaluated and correlated with immunotherapy benefit in advanced non-small cell lung cancers (NSCLC). Methods: Patients with advanced NSCLC undergoing plasma next-generation sequencing including plasma cfRNA.PD-L1 testing in a Clinical Laboratory Improvement Amendments (CLIA) and College of American pathologists (CAP) accredited laboratory were retrospectively identified and evaluated at a single institution. Plasma PD-L1 positive patients underwent a de-identified chart abstraction to identify those patients with advanced NSCLC treated with front line immunotherapy regimens and those who received cytotoxic chemotherapy alone. Results: Sixteen patients with plasma PD-L1 expression treated with front-line immunotherapy regimens including single-agent immune checkpoint inhibitors, and combinatorial chemo-immune or chemo-immune-bevacizumab regimens were assessed for overall survival (OS). Eleven patients with plasma PD-L1 expression who received chemotherapy were used as a non-immunotherapy OS comparison. Median OS for the immunotherapy treated patients was thirteen months with a thirty percent three year landmark OS versus four months median OS and a ten percent three-year landmark OS for those treated with chemotherapy alone. Comparative log-rank test p-value 0.0091 and a hazard ratio of 0.36 (95%-CI 0.13-0.99). Conclusions: Plasma cfRNA PD-L1 expression is predictive of a statistically significant survival benefit from immunotherapy treatment compared to chemotherapy in the first line treatment of advanced NSCLC. The three year landmark OS of thirty percent parallels tissue PD-L1 directed immunotherapy-based treatment outcomes. The clinical utility of plasma cfRNA PD-L1 to overcome tissue acquisition and PD-L1 protein heterogeneity limitations and to study the dynamic nature of PD-L1 expression with non-immune cancer treatments and potential immunotherapy response monitoring are undergoing ongoing research.
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Affiliation(s)
| | | | | | - Nitika Sharma
- East Carolina University/Vidant Cancer Care, Greenville, NC
| | - David Meyer
- East Carolina University Brody School of Medicine, Greenville, NC
| | - Paul R. Walker
- Brody School of Medicine/East Carolina University, Greenville, NC
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23
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Dharmapuri S, Ozbek U, Saeed A, Muzaffar M, Amara S, Personeni N, Pressiani T, Nishida N, Paul S, Bettinger D, Khan U, Fessas P, Huang YH, Kaseb AO, Pillai A, Rimassa L, Pinato DJJ, Ang C. Relationship between systemic inflammatory response markers and immune treatment related toxicity (IrAEs) in hepatocellular carcinoma (HCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e16204] [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
e16204 Background: A well-recognized class effect of immune check point inhibitors (ICI) is IrAEs ranging from low grade toxicities to life-threatening end organ damage requiring permanent discontinuation of ICI. Treatment related deaths are reported in ̃5% of patients (pts) treated with ICI. There are, however, no reliable markers to predict the onset & severity of IrAEs. We tested the association between neutrophil-lymphocyte ratio (NLR) & platelet-lymphocyte ratio (PLR) at baseline with development of clinically significant IrAE (graded ≥2) in HCC pts treated with ICI. Methods: Data was extracted from a large international database from a consortium of 11 tertiary-care referral centers located in the USA, Europe & Asia. NLR=Absolute neutrophil count/ Absolute lymphocyte count (ALC) & PLR=Platelet count/ALC. A cutoff of 5 for was used NLR & 300 for PLR based on literature. We also tested the association between antibiotic & steroid exposure to IrAEs. Results: Clinical data was collected from 361 pts treated between 2016–2020 across the USA (66%), Asia (12%) & Europe (22%) in this multinational database. Most pts received Nivolumab monotherapy (n=318, 74%). 167 (46%) pts developed at least one IrAE, highest grade 1 in 80 (48%), grade ≥2 in 87(52%) pts. Baseline characteristics did not differ significantly between the groups (Table). In a univariable regression model to predict grade ≥2 IrAEs, a PLR >300 was associated with a lower incidence of clinically significant IrAEs (OR = 0.40; p=0.044). NLR >5 was associated with a trend toward lower incidence of clinically significant IrAEs (OR = 0.58; p=0.097). Multivariate analyses confirmed PLR as independent predictive marker of grade ≥2 IrAEs (OR = 0.24; p=0.007). Antibiotics use was not associated with IrAE incidence (OR = 1.02; p=0.954). Steroid use was associated with a >2-fold higher incidence of grade ≥2 IrAEs (OR = 2.74; p<0.001), though it may be noted that 37% of pts received steroids for treatment of IrAEs. Conclusions: Lower NLR & PLR may predict the appearance of IrAEs in HCC treated with ICI, although this conclusion warrants prospective validation. This finding is in keeping with several studies that showed improved survival in pts who develop of IrAEs & have a lower NLR & PLR.[Table: see text]
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Affiliation(s)
- Sirish Dharmapuri
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Umut Ozbek
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anwaar Saeed
- University of Kansas Cancer Center, Westwood, KS
| | | | | | | | | | | | - Sonal Paul
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Dominik Bettinger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Uqba Khan
- Weill Cornell Medical College, New York, NY
| | - Petros Fessas
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ahmed Omar Kaseb
- GI Medical Oncology Department, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anjana Pillai
- Section of Gastroenterology, Hepatology & Nutrition, The University of Chicago Medicine, Chicago, IL
| | | | | | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
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24
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Geradts J, Kousar A, Wong J, Vohra N, Muzaffar M, Mohamed A. Abstract P4-06-09: Prediction of oncotype DX recurrence score by patho-biologic variables and three surrogate models. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-06-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The Oncotype DX Recurrence Score (RS) predicts recurrence and chemotherapy benefit in early stage estrogen receptor positive breast cancer patients. Cost and unavailability are two major disadvantages of the assay. Multiple models have been developed to predict the RS using different pathobiologic parameters. The goal of our study was to predict RS based on histopathologic and biomarker features, and to determine concordance and correlation with RS of three surrogate models that are independent of Ki67 index: Breast Cancer Prognostic Score (BCPS), Magee0, and Magee2. Methods: Early stage, ER-positive breast cancer cases with available RS were reviewed (n = 442). ER, PR and HER2 subscores were abstracted from the Oncotype DX reports. RS categories were stratified by pathologic and biomarker variables. Histopathologic and biomarker data were abstracted from pathology reports, and the surrogate RS was calculated by each model. Correlation and concordance between models and actual RS were calculated. Analyses were performed using both conventional (18, 30) and TAILORx (11, 25) thresholds. Results: Less than 5% of breast cancers with pure or mixed lobular features, low grade tumors, carcinomas with high PR content, or Luminal A tumors had a RS >25 (Table 1). Recurrence scores in node-positive tumors were not significantly higher compared to node-negative cases. Both actual and calculated RS were higher in Luminal B versus Luminal A breast cancers. Subscore analysis revealed 99.5% concordance for ER status, 90% concordance for PR status, and 96% concordance for HER2 status (Table 2). BCPS, Magee0, and Magee2 algorithms demonstrated correlation coefficients with RS of 0.63, 0.61, and 0.62, respectively. BCPS showed the best agreement with RS using conventional cutoffs (73%), whereas the two Magee algorithms showed better concordance with the TAILORx thresholds. Two-step discordances were uncommon, especially with the TAILORx cutoffs and Magee2. When a RS of 25 was used to separate high risk from non-high risk cases, concordance rates of 86-88% were achieved for all three models. Using different tumor blocks for Oncotype and biomarker testing did not adversely affect correlation or concordance with RS. Discussion: High RS was observed only in a small percentage of pure or mixed lobular carcinomas, low grade or Luminal A tumors, and tumors with high PR expression, suggesting that these breast cancers may not require Oncotype testing. All three surrogate models demonstrated comparable correlation and high concordance with the RS when a cutoff of 25 was used, suggesting their utility in cases where the actual RS in unavailable. Our data also indicate that models using different hormone receptor quantitation methods (Allred versus H-score) have similar performance characteristics. Possible sources of discordance between actual and computed RS include methodological differences, variable tumor cellularity, intratumoral heterogeneity, and inflammatory infiltrates.
Table 1.Stratification of RS Risk Categories by Pathologic and Biomarker VariablesConventional Risk CategoryLow RiskIntermediate RiskHigh RiskTAILORx Risk CategoryLow RiskIntermediate RiskHigh RiskOncotype DX Recurrence Score<1111-1718-2526-30>30n (%)n (%)n (%)n (%)n (%)Histologic Type (n)Invasive ductal carcinoma (340)94 (28)121 (36)73 (21)20 (6)32 (9)Invasive lobular carcinoma (47)10 (21)27 (57)8 (17)1 (2)1 (2)Mixed ductal/lobular carcinoma (22)3 (14)15 (68)4 (18)0 (0)0 (0)Invasive mucinous carcinoma (10)4 (40)4 (40)0 (0)1 (10)1 (10)Molecular Subtype (n)Luminal A (317)112 (35)143 (45)46 (15)11 (3)5 (1)Luminal B (125)9 (7)33 (26)41 (33)10 (8)32 (26)Combined Tumor Grade (n)Low (143)45 (31)59 (41)32 (22)4 (3)3 (2)Intermediate (239)69 (29)101 (42)41 (17)13 (5)15 (6)High (60)5 (8)17 (28)13 (22)5 (8)20 (33)ER (n)High (Allred Score 7-8) (408)120 (29)164 (40)74 (18)21 (5)29 (7)High (Modified H Score ≥ 200) (320)101 (32)133 (42)54 (17)15 (5)17 (5)Low (Allred Score 3-6) (34)1 (3)12 (35)12 (35)1 (3)8 (24)Low (Modified H Score < 200) (122)18 (15)45 (37)33 (27)7 (6)19 (16)PR (n)High (Allred Score 7-8) (306)106 (35)146 (48)41 (13)9 (3)4 (2)High (Modified H Score ≥ 200) (248)96 (39)111 (45)31 (13)8 (3)2 (1)Low (Allred Score 3-6) (97)12 (12)27 (28)32 (33)7 (7)19 (20)Low (Modified H Score 1-199) (155)23 (15)61 (39)41 (26)9 (6)21 (14)Negative (Allred Score 0-2) (39)1 (3)5 (13)14 (36)5 (13)14 (36)Negative (Modified H Score <1) (39)1 (3)5 (13)14 (36)5 (13)14 (36)HER2 (n)Negative (428)120 (28)170 (40)84 (20)20 (5)34 (8)Positive/Equivocal (14)0 (0)6 (34)3 (21)2 (14)3 (21)
Table 2.Concordance Between Clinical ER, PR, and HER2 Status and Oncotype DX SubscoreOncotype DX SubscoresClinical LabNegativeBorderlinePositiveERNegative0N/A0Positive2N/A379PRNegative29N/A4Positive34N/A314HER2Negative36540Equivocal800Positive220
Citation Format: Joseph Geradts, Aisha Kousar, Jan Wong, Nasreen Vohra, Mahvish Muzaffar, Anas Mohamed. Prediction of oncotype DX recurrence score by patho-biologic variables and three surrogate models [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-06-09.
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Affiliation(s)
- Joseph Geradts
- East Carolina University Brody School of Medicine, Greenville, NC
| | - Aisha Kousar
- East Carolina University Brody School of Medicine, Greenville, NC
| | - Jan Wong
- East Carolina University Brody School of Medicine, Greenville, NC
| | - Nasreen Vohra
- East Carolina University Brody School of Medicine, Greenville, NC
| | - Mahvish Muzaffar
- East Carolina University Brody School of Medicine, Greenville, NC
| | - Anas Mohamed
- East Carolina University Brody School of Medicine, Greenville, NC
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Mohamed A, Kousar A, Wong J, Vohra N, Muzaffar M, Geradts J. Pathobiologic Stratification of Oncotype DX Recurrence Scores and Comparative Validation of 3 Surrogate Models. Arch Pathol Lab Med 2022; 146:1258-1267. [PMID: 35119458 DOI: 10.5858/arpa.2021-0367-oa] [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] [Accepted: 09/23/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The Oncotype DX Recurrence Score (RS) predicts recurrence and chemotherapy benefit in early-stage estrogen receptor positive breast cancer patients. Cost and unavailability are 2 major disadvantages of the assay. Multiple models have been developed to predict the RS. OBJECTIVE.— To predict RS based on histopathologic and biomarker features, and to measure concordance and correlation with RS of the following 3 algorithms: breast cancer prognostic score, Magee0, and Magee2. DESIGN.— Breast cancer cases with available RS were reviewed (n = 442). RS categories were stratified by pathologic and biomarker variables. Histopathologic and biomarker data were abstracted from pathology reports, and RS was calculated by each model. Correlation and concordance between models and RS were calculated. RESULTS.— Less than 5% of breast cancers with lobular features, low-grade tumors, carcinomas with high progesterone receptor content, or luminal A tumors had an RS greater than 25. Breast cancer prognostic score, Magee0, and Magee2 demonstrated correlation coefficients with RS of 0.63, 0.61, and 0.62, respectively. Two-step discordances were uncommon. When an RS of 25 was used to separate high-risk from non-high-risk cases, concordance rates of 86% to 88% were achieved. CONCLUSIONS.— High RS was observed only in a small percentage of pure or mixed lobular carcinomas, low-grade or luminal A tumors, and tumors with high progesterone receptor expression, suggesting that these cancers may not require Oncotype testing. All 3 surrogate models demonstrated comparable correlation and high concordance with the RS when a cutoff of 25 was used, suggesting their utility in cases where the actual RS is unavailable.
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Affiliation(s)
- Anas Mohamed
- From the Department of Pathology and Laboratory Medicine (Mohamed, Kousar, Geradts), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Aisha Kousar
- From the Department of Pathology and Laboratory Medicine (Mohamed, Kousar, Geradts), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Jan Wong
- Department of Surgery (Wong, Vohra), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Nasreen Vohra
- Department of Surgery (Wong, Vohra), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Mahvish Muzaffar
- The Department of Medical Oncology (Muzaffar), East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Joseph Geradts
- From the Department of Pathology and Laboratory Medicine (Mohamed, Kousar, Geradts), East Carolina University Brody School of Medicine, Greenville, North Carolina
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Wu L, Ozbek U, van Hyfte G, Reincke M, Gampa A, Abugabal YI, Nishida N, Wietharn B, Amara S, Balcar L, Pinter M, Vogel A, Weinmann A, Saeed A, Rimassa L, Naqash AR, Muzaffar M, Huang YH, Pinato DJ, Ang C. Outcomes of beta blockers (BB) in hepatocellular carcinoma (HCC) treated with immune checkpoint inhibitors (ICIs). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
399 Background: Portal hypertension increases intestinal permeability, dysbiosis, and bacterial translocation, leading to a pro-inflammatory state, which can in turn promote progression of liver disease. However, multiple studies have shown that BB use in patients with cirrhosis can reduce the risk of developing HCC, and in patients with HCC, BB can improve overall survival (OS). In recent years, ICIs have become first-line therapy for patients with unresectable HCC, and we aimed to evaluate whether BB use conferred survival benefits in patients treated with ICIs using real-world data. Methods: We conducted a retrospective chart review of HCC patients treated with ICI from 2017 to 2019 at 13 institutions across North America, Europe, and Asia in order to evaluate the association between BB use and OS, as well as BB use and overall response rate (ORR). Univariable and multivariable logistic regression models were used to evaluate associations, and survival analyses were performed using the Kaplan-Meier method. Results: A total of 578 patients were evaluated. The median age of the cohort was 65 years, and 80% of patients were male. The majority of patients (70%) were cirrhotic. The causes of underlying liver disease were as follows: HBV (22%), HCV (36%), alcohol (20.8%), and NASH (13%). Most patients (73.5%) had Child Pugh (CP) class A liver disease, and good performance status with ECOG score either 0 (52%) or 1 (45%). The majority of patients (75%) treated with ICIs received a PD-1 inhibitor alone. There were 360 deaths (62% of patients) with a median follow-up of 30.8 months (Quartiles: 17.2-40.3 months). Two hundred and three (35%) patients had BB use at any point during ICI therapy. Fifty-one percent of these patients were on a nonselective BB whereas 49% were taking a cardio-selective BB. BB use was not significantly correlated with OS (hazard ratio, 1.12; 95% CI, 0.9-1.39; P = 0.298) or ORR (odds ratio, 0.84; 95% CI, 0.54-1.31; P = 0.451) in univariate or multivariate analyses. Conclusions: Patients who used BB while on immunotherapy for unresectable HCC did not have statistically significant differences in OS or ORR compared to patients who did not use BB. More studies are required to elucidate the effect of beta blockade on the microbiome, immune activation, and HCC.
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Affiliation(s)
- Linda Wu
- Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
| | - Umut Ozbek
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Marlene Reincke
- Medical Center University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Anuhya Gampa
- The University of Chicago Medical Center, Chicago, IL
| | | | | | | | | | - Lorenz Balcar
- Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | | | | | - Arndt Weinmann
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anwaar Saeed
- Kansas University Cancer Center, Kansas City, KS
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele & Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Abdul Rafeh Naqash
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - David James Pinato
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY
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Fessas P, Naeem M, Pinter M, Marron TU, Szafron D, Balcar L, Saeed A, Jun T, Dharmapuri S, Gampa A, Wang Y, Khan U, Muzaffar M, Navaid M, Lee PC, Bulumulle A, Yu B, Paul S, Nimkar N, Bettinger D, Hildebrand H, Abugabal YI, Pressiani T, Personeni N, Nishida N, Kudo M, Kaseb A, Huang YH, Ang C, Pillai A, Rimassa L, Naqash AR, Sharon E, Cortellini A, Pinato DJ. Early Antibiotic Exposure Is Not Detrimental to Therapeutic Effect from Immunotherapy in Hepatocellular Carcinoma. Liver Cancer 2021; 10:583-592. [PMID: 34950181 PMCID: PMC8647090 DOI: 10.1159/000519108] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND RATIONALE Immune checkpoint inhibitor (ICI) therapy is an expanding therapeutic option for hepatocellular carcinoma (HCC). Antibiotics (ATB) taken prior to or early during ICI therapy can impact immunotherapy efficacy across indications; however, the effect of ATB is undefined in HCC. METHODS In a large international cohort of 450 ICI recipients from Europe, North America, and Asia, we categorized patients according to timing of ATB focusing on exposure within -30 to +30 days from ICI (early immunotherapy period [EIOP]). EIOP was evaluated in association with overall survival (OS), progression-free survival (PFS), and best radiologic response using RECIST 1.1 criteria. RESULTS Our study comprised mostly cirrhotic (329, 73.3%) males (355, 79.1%) with a Child-Turcotte Pugh class of A (332, 73.9%), receiving ICI after 1 therapy line (251, 55.9%) for HCC of Barcelona clinic liver cancer stage C (325, 72.4%). EIOP (n = 170, 37.9%) was independent of baseline clinicopathologic features of HCC and correlated with longer PFS (6.1 vs. 3.7 months, log-rank p = 0.0135). EIOP+ patients had similar OS, overall response, and disease control rates (DCRs) compared to EIOP. The effect of EIOP persisted in landmark time analyses and in multivariable models, confirming the independent predictive role of EIOP in influencing PFS following adjustment for covariates reflective of tumor burden, liver function, and ICI regimen administered. In patients receiving programmed cell death-1 receptor/ligand inhibitors monotherapy, EIOP was also associated with higher DCRs (61.4% vs. 50.9%, p = 0.0494). CONCLUSIONS Unlike other oncological indications, ATB in the 30 days before or after ICI initiation is associated with improved benefit from immunotherapy, independent of disease and treatment-related features. Evaluation of the immune microbiologic determinants of response to ICI in HCC warrants further investigation.
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Affiliation(s)
- Petros Fessas
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Muntaha Naeem
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna Liver Cancer Study Group, AKH and Medical University of Vienna, Vienna, Austria
| | - Thomas U. Marron
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, New York, USA
| | - David Szafron
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Lorenz Balcar
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna Liver Cancer Study Group, AKH and Medical University of Vienna, Vienna, Austria
| | - Anwaar Saeed
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Westwood, Kansas, USA
| | - Tomi Jun
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, New York, USA
| | - Sirish Dharmapuri
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, New York, USA
| | - Anuhya Gampa
- Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Uqba Khan
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, USA
| | - Musharraf Navaid
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, USA
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Anushi Bulumulle
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, USA
| | - Bo Yu
- Lincoln Medical Center, New York, New York, USA
| | - Sonal Paul
- New York Presbyterian Brooklyn Methodist Hospital, New York, New York, USA
| | - Neil Nimkar
- New York Presbyterian Brooklyn Methodist Hospital, New York, New York, USA
| | - Dominik Bettinger
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Hannah Hildebrand
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Westwood, Kansas, USA
| | - Yehia I. Abugabal
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center IRCCS, Milan, Italy
| | - Nicola Personeni
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center IRCCS, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Celina Ang
- Division of Hematology/Oncology, Department of Medicine, Tisch Cancer Institute, Mount Sinai Hospital, New York, New York, USA
| | - Anjana Pillai
- Section of Gastroenterology, Hepatology and Nutrition, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center IRCCS, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Abdul Rafeh Naqash
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA
| | - Elad Sharon
- National Cancer Institute, Cancer Therapy Evaluation Program, Bethesda, Maryland, USA
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom,*David J. Pinato,
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Fessas P, Kaseb A, Wang Y, Saeed A, Szafron D, Jun T, Dharmapuri S, Rafeh Naqash A, Muzaffar M, Navaid M, Khan U, Lee C, Bulumulle A, Yu B, Paul S, Nimkar N, Bettinger D, Benevento F, Hildebrand H, Pressiani T, Abugabal YI, Personeni N, Huang YH, Rimassa L, Ang C, Marron T, Pinato DJ. Post-registration experience of nivolumab in advanced hepatocellular carcinoma: an international study. J Immunother Cancer 2021; 8:jitc-2020-001033. [PMID: 32868393 PMCID: PMC7462152 DOI: 10.1136/jitc-2020-001033] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 12/11/2022] Open
Abstract
Background Nivolumab is Food and Drug Administration approved in sorafenib-experienced, advanced hepatocellular carcinoma (HCC). Post-registration data of treatment in a real-world setting is lacking. Patients and methods We performed an international, multicenter observational study to confirm safety and efficacy of nivolumab in 233 patients treated outside clinical trials from eight centers in North America, Europe and Asia. Results Patients received nivolumab for Barcelona Clinic Liver Cancer stage C (n=191, 92.0%) and Child-Pugh (CP) A (n=158, 67.8%) or B (n=75, 32.2%) HCC as first (n=85, 36.5%) or second to fourth systemic therapy line (n=148, 63.5%). Objective response rate (ORR) was 22.4% and disease control rate was 52.1%. Median overall survival (OS) was 12.2 months (95% CI 8.4 to 16.0) and median progression-free survival was 10.1 months (95% CI 6.1 to 14.2). Treatment-related adverse events of grade >2 occurred in 26 patients (11.2%). Efficacy and safety were similar across CP classes and therapy line. OS was shorter in CP-B than A (7.3 months vs 16.3 months, p<0.001) and in post-first line use (10.4 months vs 16.3 months, p=0.05). Achievement of an objective response predicted for improved OS (25.4 months vs 13.2 months, p<0.001). Conclusions This study confirms safety and efficacy of nivolumab in advanced HCC across various lines of therapy and degrees of liver dysfunction. Despite equal ORR and toxicity to nivolumab, patients with CP-B functional class have shorter survival than the patients with CP-A.
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Affiliation(s)
- Petros Fessas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Anwaar Saeed
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Westwood, Kansas, United States
| | - David Szafron
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Tomi Jun
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York City, New York, United States
| | - Sirish Dharmapuri
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York City, New York, United States
| | - Abdul Rafeh Naqash
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, United States
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, United States
| | - Musharraf Navaid
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, United States
| | - Uqba Khan
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, New York City, New York, United States
| | - ChiehJu Lee
- Division of Gastroenterology and Hepatology, Department of Medicine at Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Anushi Bulumulle
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, United States
| | - Bo Yu
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States
| | - Sonal Paul
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States
| | - Neil Nimkar
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States
| | - Dominik Bettinger
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Francesca Benevento
- Department of Medical and Surgical Sciences, University of Bologna, S Orsola-Malpighi Hospital, Bologna, Italy
| | - Hannah Hildebrand
- Division of Medical Oncology, Department of Medicine, Kansas University Cancer Center, Westwood, Kansas, United States
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Yehia I Abugabal
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Nicola Personeni
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine at Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York City, New York, United States
| | - Thomas Marron
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York City, New York, United States
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
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Fessas P, Naeem M, Marron TU, Szafron D, Sharon E, Saeed A, Jun T, Dharmapuri S, Naqash AR, Peeraphatdit T, Gampa A, Wang Y, Khan U, Muzaffar M, Navaid M, Lee C, Lee PC, Bulumulle A, Yu B, Paul S, Nimkar N, Bettinger D, Hildebrand H, Abugabal YI, Pressiani T, Personeni N, Nishida N, Kudo M, Kaseb A, Huang YH, Ang C, Pillai A, Rimassa L, Pinato DJ. Abstract 485: Early antibiotic exposure delays disease progression following immune checkpoint inhibitor therapy for hepatocellular carcinoma: Evidence from an observational study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-485] [Citation(s) in RCA: 2] [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
Background: Immune checkpoint inhibition (ICI) is an expanding option in hepatocellular carcinoma (HCC). Antibiotics (ATB) have been shown to reduce response and survival after ICI in other cancers.
Methods: Efficacy of ICI is described in patients (pt) from 11 centres (246 USA, 100 Asia, 68 Europe), with median overall (OS), progression-free survival (PFS) and best response (RECIST 1.1) compared between pt with and without ATB exposure in the early immunotherapy period (EIOP) of 30 days before and after ICI initiation.
Results: Most of our 414 pt were cirrhotic (297, 71.7%) due to hepatitis C (162, 391.1%) with Barcelona Clinic Stage C (294, 71.0%), Child-Pugh class (CP) A (313, 76.3%) and AFP>400 IU/mL (158, 39.3%). OS was 15.4 mo (95%CI 13.1-17.7) and PFS was 5.3 months (95% CI 4.5-6.0). Most ICI was anti-PD-1 monotherapy (358, 86.5%) and given as 1st (173, 41.8%) or 2nd line (208, 50.2%). Best response to ICI was complete response in 27 pt (6.5%), partial response in 45 (10.9%), stable disease (SD) in 160 (38.6%) and progressive disease (PD) in 161 (38.9%). ATB was given to 167 pt (40.3%), prior to or early after (30 d) ICI initiation (EIOP, 157, 38.0%) or beyond 30 days (21, 5.1%), mostly as beta-lactams (27, 10.9%) or quinolones (26, 10.5%). ATB use was independent of CP class (p=0.76), ECOG performance status (p=0.58) and BCLC stage (p=0.60). mOS in the EIOP+ group was similar to the EIOP- group (13.1 vs 15.5 mo, p=0.92). mPFS in the EIOP+ group was significantly longer than the EIOP- group (7.9 vs 4.2 mo, p=0.004). Observations persisted when stratified by CP class (p=0.42) and ICI type (p=0.92). Partial response rate was higher in the EIOP+ group (17.3% vs 8.6%, p=0.01), although overall objective response and disease control rates were similar between EIOP groups (ORR: 22.7% vs 15.9%, p=0.10; DCR: 64.0% vs 56.6%, p=0.15). Pt in the EIOP+ group were not more likely to experience gastrointestinal AE (EIOP +/- 9.2%/5.4%, p=0.12) or hepatic AE (EIOP +/-, 17.9%/16.5%, p=0.92) of any grade, while severe liver AE (grade 2 or above) were less common in the EIOP+ group (EIOP+/- 2.8%/9.5%, p=0.01).
Conclusions: ATB in the 30 d before or after ICI initiation in HCC is associated with prolonged PFS. This is contrary to findings in other solid tumors. Evaluation of the immune-microbiologic determinants of response to ICI in HCC a key research question.
Citation Format: Petros Fessas, Muntaha Naeem, Thomas U. Marron, David Szafron, Elad Sharon, Anwar Saeed, Tomi Jun, Sirish Dharmapuri, Abdul R. Naqash, Thoetchai Peeraphatdit, Anuhya Gampa, Yinghong Wang, Uqba Khan, Mahvish Muzaffar, Musharraf Navaid, ChiehJu Lee, Pei-Chang Lee, Anushi Bulumulle, Bo Yu, Sonal Paul, Neil Nimkar, Dominik Bettinger, Hannah Hildebrand, Yehia I. Abugabal, Tiziana Pressiani, Nicola Personeni, Naoshi Nishida, Masatoshi Kudo, Ahmed Kaseb, Yi-Hsiang Huang, Celina Ang, Anjana Pillai, Lorenza Rimassa, David J. Pinato. Early antibiotic exposure delays disease progression following immune checkpoint inhibitor therapy for hepatocellular carcinoma: Evidence from an observational study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 485.
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Affiliation(s)
| | | | - Thomas U. Marron
- 2Tisch Cancer Institute, Mount Sinai Hospital, New York City, NY
| | | | | | - Anwar Saeed
- 5Kansas University Cancer Center, Westwood, KS
| | - Tomi Jun
- 2Tisch Cancer Institute, Mount Sinai Hospital, New York City, NY
| | | | | | | | | | - Yinghong Wang
- 8The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Uqba Khan
- 9Weill Cornell Medicine/New York Presbyterian Hospital, New York City, NY
| | | | | | - ChiehJu Lee
- 10Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | - Bo Yu
- 11Lincoln Medical Center, New York City, NY
| | - Sonal Paul
- 12New York Presbyterian Brooklyn Methodist Hospital, New York City, NY
| | - Neil Nimkar
- 12New York Presbyterian Brooklyn Methodist Hospital, New York City, NY
| | | | | | | | | | | | | | | | - Ahmed Kaseb
- 8The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Celina Ang
- 2Tisch Cancer Institute, Mount Sinai Hospital, New York City, NY
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McCallen JD, Naqash AR, Marie MA, Sharma N, Muzaffar M, Walker PR, Yang L. Abstract 1667: A pilot study correlating baseline plasma levels of adenosine 2A receptor (A2aR) with acute phase reactants in advanced non-small cell lung cancer (NSCLC) patients treated with immune-checkpoint inhibitors. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1667] [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: Acute-phase reactants, such as C-reactive protein (CRP) and IL-6, can modulate immune suppression within the tumor microenvironment (TME) and thus potentially result in inferior outcomes to immune checkpoint inhibitors (ICIs). Immunosuppression within the TME is also be mediated by tumoral adenosine production, via hypoxia-induced exonuclease activity of CD39 and CD73 and adenosine 2a receptor (A2aR) signaling. We sought to evaluate whether plasma levels of A2aR correlate with the acute phase reactants (CRP and IL-6) in advanced NSCLC patients treated with ICIs.
Methods: Between December 2016 and April 2019, we enrolled 18 patients with advanced NSCLC treated with single-agent ICIs or in combination with chemotherapy. We isolated plasma samples from patients before ICI initiation and again after each treatment. Plasma concentrations of A2aR and IL-6 were measured using ELISA. The baseline level of CRP was obtained from peripheral blood at ICI initiation (± 3 days). Previous studies correlating CRP and cancer outcomes defined a C-reactive protein (CRP) cutoff of 10 mg/L to define normal (CRP-N) and high CRP (CRP-H) levels. We assessed the relationship between CRP, IL-6, and A2aR plasma levels. Statistical analyses were performed using the Mann-Whitney test and linear regression analysis.
Results: At the initiation of ICI, the median age of the cohort was 63. Two patients had stage III disease and 16 patients had stage IV disease. Four had squamous cell carcinoma, and 14 had non-squamous cell carcinoma. Six patients were treated with concomitant chemotherapy (pembrolizumab with carboplatin and pemetrexed). Patients received a median of 4 ICI cycles (range: 1-8 cycles) in our study. In the cohort, the median baseline levels of CRP, IL-6, and A2aR were 16.9 mg/L, 5.1 pg/mL, and 3.6 ng/mL, respectively. A positive correlation was present between baseline CRP levels and IL-6 plasma levels (R=0.76; p=0.003). Seven patients were CRP-N, and 11 patients were CRP-H. CRP-H patients had a greater median baseline level of A2aR (6.0 ng/mL vs. 1.3 ng/mL; p=0.01). Likewise, patients with baseline IL-6 levels greater than 5 pg/mL had a higher median baseline level of A2aR (6.0 ng/mL vs. 1.3 ng/mL; p=0.02).
Conclusions: In a small, heterogeneous cohort of advanced NSCLC patients treated with ICIs, we demonstrate that elevated baseline levels of acute-phase reactants (CRP and IL-6) potentially act as an indirect surrogate for high plasma A2aR levels. Validation from larger studies is required to understand the biomarker implications of these findings in determining outcomes to ICIs.
J.D.M. and A.R.N contributed equally to this work.
Citation Format: Justin D. McCallen, Abdul R. Naqash, Mona A. Marie, Nitika Sharma, Mahvish Muzaffar, Paul R. Walker, Li Yang. A pilot study correlating baseline plasma levels of adenosine 2A receptor (A2aR) with acute phase reactants in advanced non-small cell lung cancer (NSCLC) patients treated with immune-checkpoint inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1667.
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Affiliation(s)
| | | | - Mona A. Marie
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Nitika Sharma
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Mahvish Muzaffar
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Paul R. Walker
- 1Brody School of Medicine at East Carolina University, Greenville, NC
| | - Li Yang
- 1Brody School of Medicine at East Carolina University, Greenville, NC
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McCallen JD, Naqash AR, Marie MA, Atwell DC, Muzaffar M, Sharma N, Amara S, Liles D, Walker PR, Yang LV. Peripheral blood interleukin 6, interleukin 10, and T lymphocyte levels are associated with checkpoint inhibitor induced pneumonitis: a case report. Acta Oncol 2021; 60:813-817. [PMID: 33939588 DOI: 10.1080/0284186x.2021.1917001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Justin D. McCallen
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Gastrointestinal Malignancy Section, Thoracic and GI Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Abdul Rafeh Naqash
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Mona A. Marie
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Druid C. Atwell
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Mahvish Muzaffar
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Nitika Sharma
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Suneetha Amara
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Darla Liles
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Paul R. Walker
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
- Circulogene, Birmingham, AL, USA
| | - Li V. Yang
- Department of Internal Medicine, Hematology/Oncology Division, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Murtaza F, Muzaffar M, Mustafa T, Anwer J. Water and sanitation risk exposure in children under-five in Pakistan. J Family Community Med 2021; 28:103-109. [PMID: 34194274 PMCID: PMC8213103 DOI: 10.4103/jfcm.jfcm_149_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Children under-five constitute 11.9% (n = 20,447,628) of the total population of Pakistan. Poor water and sanitation in Pakistan cause 97,900 deaths annually, 54,000 of whom are children under-five. MATERIALS AND METHODS: This study calculates an index for water and sanitation risk for children under-5 in Pakistan to give a detailed understanding and insight into the prevalent risks. Data from Pakistan Integrated Household Survey 2011–12 are used. Stata 15.0 was used for data analysis. A risk index was created by integrating hazard and vulnerability factors including toilet facilities, water source, mother's education, and the number of children in the household. Children were ranked according to their risk score in three categories: low risk, medium risk, and high risk. For each level of risk, profiles of children are created at the national, regional (urban, rural), and provincial levels. RESULTS: Out of 20.5 million children under-five in Pakistan, 71.6% live in rural areas. About 24.9% of children benefit from pipe-borne drinking water; 15.5% of children have toilets connected to the public sewerage system; 62.6% of the children have mothers who had no education; and 50.5% of children live in households with three or more children. It appeared that 57.5% of children are at high risk of poor water and sanitation as compared to merely 1.3% of children at low risk. Around 69.9% of children living in rural areas are at high risk compared to 24.6% of children in urban areas. In Balochistan, 77.9% of children are at high risk, the highest of all provinces. CONCLUSION: The majority of children under-five in Pakistan are at high risk owing to poor water and sanitation. A comprehensive public health program is needed to address the key indicators related to child health risk identified in this research such as safe drinking water, improved sanitation, education and mothers' awareness, and population growth.
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Affiliation(s)
- Fowad Murtaza
- Department of Pathways/Economics, University of Essex, Colchester, UK
| | | | - Tajammal Mustafa
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University (IAU), Dammam, Saudi Arabia
| | - Javaria Anwer
- Department of Community Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
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Ved R, Sharouf F, Harari B, Muzaffar M, Manivannan S, Ormonde C, Gray WP, Zaben M. Disulfide HMGB1 acts via TLR2/4 receptors to reduce the numbers of oligodendrocyte progenitor cells after traumatic injury in vitro. Sci Rep 2021; 11:6181. [PMID: 33731757 PMCID: PMC7971069 DOI: 10.1038/s41598-021-84932-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/31/2020] [Accepted: 02/05/2021] [Indexed: 01/31/2023] Open
Abstract
Traumatic brain injury (TBI) is associated with poor clinical outcomes; autopsy studies of TBI victims demonstrate significant oligodendrocyte progenitor cell (OPC) death post TBI; an observation, which may explain the lack of meaningful repair of injured axons. Whilst high-mobility group box-1 (HMGB1) and its key receptors TLR2/4 are identified as key initiators of neuroinflammation post-TBI, they have been identified as attractive targets for development of novel therapeutic approaches to improve post-TBI clinical outcomes. In this report we establish unequivocal evidence that HMGB1 released in vitro impairs OPC response to mechanical injury; an effect that is pharmacologically reversible. We show that needle scratch injury hyper-acutely induced microglial HMGB1 nucleus-to-cytoplasm translocation and subsequent release into culture medium. Application of injury-conditioned media resulted in significant decreases in OPC number through anti-proliferative effects. This effect was reversed by co-treatment with the TLR2/4 receptor antagonist BoxA. Furthermore, whilst injury conditioned medium drove OPCs towards an activated reactive morphology, this was also abolished after BoxA co-treatment. We conclude that HMGB1, through TLR2/4 dependant mechanisms, may be detrimental to OPC proliferation following injury in vitro, negatively affecting the potential for restoring a mature oligodendrocyte population, and subsequent axonal remyelination. Further study is required to assess how HMGB1-TLR signalling influences OPC maturation and myelination capacity.
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Affiliation(s)
- R Ved
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
| | - F Sharouf
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
| | - B Harari
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
| | - M Muzaffar
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
| | - S Manivannan
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
| | - C Ormonde
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
| | - W P Gray
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK
| | - M Zaben
- Neuroscience and Mental Health Research Institute, Haydn Ellis Building, Cathays, Cardiff, CF24 4HQ, UK.
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, CF24 4HQ, UK.
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Pinato DJ, Kaseb A, Wang Y, Saeed A, Szafron D, Jun T, Dharmapuri S, Naqash AR, Muzaffar M, Navaid M, Khan U, Lee C, Bulumulle A, Yu B, Paul S, Fessas P, Nimkar N, Bettinger D, Hildebrand H, Pressiani T, Abugabal YI, Personeni N, Huang YH, Lozano-Kuehne J, Rimassa L, Ang C, Marron TU. Impact of corticosteroid therapy on the outcomes of hepatocellular carcinoma treated with immune checkpoint inhibitor therapy. J Immunother Cancer 2020; 8:jitc-2020-000726. [PMID: 33028690 PMCID: PMC7542664 DOI: 10.1136/jitc-2020-000726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 01/15/2023] Open
Abstract
The impact of corticosteroid therapy (CT) on efficacy of immune checkpoint inhibitors (ICI) is undefined in hepatocellular carcinoma (HCC). We evaluated whether CT administered at baseline (bCT) or concurrently with ICI (cCT) influences overall (OS), progression-free survival (PFS) and overall response rates (ORR) in 341 patients collected across 3 continents. Of 304 eligible patients, 78 (26%) received >10 mg prednisone equivalent daily either as bCT (n=14, 5%) or cCT (n=64, 21%). Indications for CT included procedure/prophylaxis (n=37, 47%), management of immune-related adverse event (n=27, 35%), cancer-related symptoms (n=8, 10%) or comorbidities (n=6, 8%). Neither overall CT, bCT nor cCT predicted for worse OS, PFS nor ORR in univariable and multivariable analyses (p>0.05). CT for cancer-related indications predicted for shorter PFS (p<0.001) and was associated with refractoriness to ICI (75% vs 33%, p=0.05) compared with cancer-unrelated indications. This is the first study to demonstrate that neither bCT nor cCT influence response and OS following ICI in HCC. Worse outcomes in CT recipients for cancer-related indications appear driven by the poor prognosis associated with symptomatic HCC.
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Affiliation(s)
- David J Pinato
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology & Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Anwaar Saeed
- Division of Medical Oncology, Kansas University Cancer Center, Kansas City, Kansas, USA
| | - David Szafron
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tomi Jun
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital School of Medicine, New York, New York, USA
| | - Sirish Dharmapuri
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital School of Medicine, New York, New York, USA
| | | | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, USA
| | - Musharraf Navaid
- Division of Hematology/Oncology, East Carolina University, Greenville, North Carolina, USA
| | - Uqba Khan
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, Ithaca, New York, USA
| | - ChiehJu Lee
- Division of Gastroenterology and Hepatology, Department of Medicine at Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Anushi Bulumulle
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Bo Yu
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, Ithaca, New York, USA
| | - Sonal Paul
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, Ithaca, New York, USA
| | - Petros Fessas
- Surgery and Cancer, Imperial College London, London, UK
| | - Neil Nimkar
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, Ithaca, New York, USA
| | - Dominik Bettinger
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Hannah Hildebrand
- Division of Medical Oncology, Kansas University Cancer Center, Kansas City, Kansas, USA
| | - Tiziana Pressiani
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy, Rozzano, Lombardia, Italy
| | - Yehia I Abugabal
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicola Personeni
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy, Rozzano, Lombardia, Italy.,Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine at Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy, Rozzano, Lombardia, Italy.,Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital School of Medicine, New York, New York, USA
| | - Thomas U Marron
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital School of Medicine, New York, New York, USA
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Pinato DJ, Kaneko T, Saeed A, Pressiani T, Kaseb A, Wang Y, Szafron D, Jun T, Dharmapuri S, Naqash AR, Muzaffar M, Navaid M, Lee CJ, Bulumulle A, Yu B, Paul S, Nimkar N, Bettinger D, Hildebrand H, Abugabal YI, Ang C, Marron TU, Khan U, Personeni N, Rimassa L, Huang YH. Immunotherapy in Hepatocellular Cancer Patients with Mild to Severe Liver Dysfunction: Adjunctive Role of the ALBI Grade. Cancers (Basel) 2020; 12:cancers12071862. [PMID: 32664319 PMCID: PMC7408648 DOI: 10.3390/cancers12071862] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) have shown positive results in patients with hepatocellular carcinoma (HCC). As liver function contributes to prognosis, its precise assessment is necessary for the safe prescribing and clinical development of ICI in HCC. We tested the accuracy of the albumin-bilirubin (ALBI) grade as an alternative prognostic biomarker to the Child-Turcotte-Pugh (CTP). In a prospectively maintained multi-centre dataset of HCC patients, we assessed safety and efficacy of ICI across varying levels of liver dysfunction described by CTP (A to C) and ALBI grade and evaluated uni- and multi-variable predictors of overall (OS) and post-immunotherapy survival (PIOS). We studied 341 patients treated with programmed-death pathway inhibitors (n = 290, 85%). Pre-treatment ALBI independently predicted for OS, with median OS of 22.5, 9.6, and 4.6 months across grades (p < 0.001). ALBI was superior to CTP in predicting 90-days mortality with area under the curve values of 0.65 (95% CI 0.57-0.74) versus 0.63 (95% CI 0.54-0.72). ALBI grade at ICI cessation independently predicted for PIOS (p < 0.001). Following adjustment for ICI regimen, neither ALBI nor CTP predicted for overall response rates or treatment-emerging adverse events (p > 0.05). ALBI grade identifies a subset of patients with prolonged survival prior to and after ICI therapy, lending itself as an optimal stratifying biomarker to optimise sequencing of systemic therapies in advanced HCC.
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Affiliation(s)
- David J. Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W120HS, UK;
- Correspondence: ; Tel.: +44-020-83833720
| | - Takahiro Kaneko
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W120HS, UK;
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Anwaar Saeed
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Westwood, KS 66160, USA; (A.S.); (H.H.)
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Milan, Italy; (T.P.); (N.P.); (L.R.)
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.K.); (Y.I.A.)
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - David Szafron
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Tomi Jun
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY 10029, USA; (T.J.); (S.D.); (C.A.); (T.U.M.)
| | - Sirish Dharmapuri
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY 10029, USA; (T.J.); (S.D.); (C.A.); (T.U.M.)
| | - Abdul Rafeh Naqash
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA; (A.R.N.); (M.M.); (M.N.); (A.B.)
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA; (A.R.N.); (M.M.); (M.N.); (A.B.)
| | - Musharraf Navaid
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA; (A.R.N.); (M.M.); (M.N.); (A.B.)
| | - Chieh-Ju Lee
- Department of Medicine, Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei 11217, Taiwan; (C.-J.L.); (Y.-H.H.)
| | - Anushi Bulumulle
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA; (A.R.N.); (M.M.); (M.N.); (A.B.)
| | - Bo Yu
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, 1305 York Avenue, Room Y1247, New York, NY 10021, USA; (B.Y.); (U.K.)
| | - Sonal Paul
- New York-Presbyterian Brooklyn Methodist Hospital-Weill Cornell Medicine, Brooklyn, NY 11215, USA; (S.P.); (N.N.)
| | - Neil Nimkar
- New York-Presbyterian Brooklyn Methodist Hospital-Weill Cornell Medicine, Brooklyn, NY 11215, USA; (S.P.); (N.N.)
| | - Dominik Bettinger
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg, 79106 Freiburg, Germany;
| | - Hannah Hildebrand
- Department of Medicine, Division of Medical Oncology, Kansas University Cancer Center, Westwood, KS 66160, USA; (A.S.); (H.H.)
| | - Yehia I. Abugabal
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.K.); (Y.I.A.)
| | - Celina Ang
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY 10029, USA; (T.J.); (S.D.); (C.A.); (T.U.M.)
| | - Thomas U. Marron
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY 10029, USA; (T.J.); (S.D.); (C.A.); (T.U.M.)
| | - Uqba Khan
- Division of Hematology and Oncology, Weill Cornell Medicine/New York Presbyterian Hospital, 1305 York Avenue, Room Y1247, New York, NY 10021, USA; (B.Y.); (U.K.)
| | - Nicola Personeni
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Milan, Italy; (T.P.); (N.P.); (L.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Milan, Italy; (T.P.); (N.P.); (L.R.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Yi-Hsiang Huang
- Department of Medicine, Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital and Institute of Clinical Medicine, National Yang-Ming University, Taipei 11217, Taiwan; (C.-J.L.); (Y.-H.H.)
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Muzaffar M, Naqash AR. Impact of race and socioeconomic factors on outcome in hepatocellular carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16657] [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
e16657 Background: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer related deaths and sixth leading cause of cancer globally. In USA the incidence of HCC has gradually increased over years.We sought to investigate impact of race and socioeconomic factors on the outcome of HCC in USA. Methods: The SEER database (version 8.3.6) was reviewed for patients with Hepatocellular carcinoma diagnosed between 1990-2016. Cases identified on autopsy or reported only on a death certificate were excluded. Variables included were, age, race, gender, stage, insurance, Pacific Coast Purchased/Referred Care Delivery Areas (PRCDA). Cox proportional hazard regression model was employed to test the association between survival and variables. Results: We identified a total of 87,047 cases of HCC that met the inclusion criteria from SEER database. Mean age was 63.15 yrs.( 63.22-63.07),67% were white,13% black, and others 20%.The Male: Female ratio was 3:1 and 59% of patients belonged to Pacific Coast PRCDA compared to 29% to East PRCDA.43% had localized stage,25% regional, 14% distant and 18% unknown.58% patient had some insurance and 42% were uninsured or unknown status. Patients diagnosed between 1990-2003 had median survival for white (4mos), blacks(3mos), others (7 mos.) (p < .0001) and for the time period 2004-2016, median survival was better,white(13 mos), blacks(10 mons), others(20mos) (p < .001). Conclusions: Outcome for HCC have improved over last two decades, but race and socioeconomic factors continue to impact outcome. Interventions addressing the racial and socioeconomic disparity can result in meaningful improvement in survival. [Table: see text]
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Affiliation(s)
| | - Abdul Rafeh Naqash
- Developmental Therapeutics Clinic/Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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Johnson HM, Shivalingappa H, Irish W, Wong JH, Muzaffar M, Verbanac K, Vohra NA. Race May Not Impact Endocrine Therapy-Related Changes in Breast Density. Cancer Epidemiol Biomarkers Prev 2020; 29:1049-1057. [PMID: 32098892 DOI: 10.1158/1055-9965.epi-19-1066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/03/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Reduction in breast density may be a biomarker of endocrine therapy (ET) efficacy. Our objective was to assess the impact of race on ET-related changes in volumetric breast density (VBD). METHODS This retrospective cohort study assessed longitudinal changes in VBD measures in women with estrogen receptor-positive invasive breast cancer treated with ET. VBD, the ratio of fibroglandular volume (FGV) to breast volume (BV), was measured using Volpara software. Changes in measurements were evaluated using a multivariable linear mixed effects model. RESULTS Compared with white women (n = 191), black women (n = 107) had higher rates of obesity [mean ± SD body mass index (BMI) 34.5 ± 9.1 kg/m2 vs. 30.6 ± 7.0 kg/m2, P < 0.001] and premenopausal status (32.7% vs. 16.7%, P = 0.002). Age- and BMI-adjusted baseline FGV, BV, and VBD were similar between groups. Modeled longitudinal changes were also similar: During a follow-up of 30.7 ± 15.0 months (mean ± SD), FGV decreased over time in premenopausal women (slope = -0.323 cm3; SE = 0.093; P = 0.001), BV increased overall (slope = 2.475 cm3; SE = 0.483; P < 0.0001), and VBD decreased (premenopausal slope = -0.063%, SE = 0.011; postmenopausal slope = -0.016%, SE = 0.004; P < 0.0001). Race was not significantly associated with these longitudinal changes, nor did race modify the effect of time on these changes. Higher BMI was associated with lower baseline VBD (P < 0.0001). Among premenopausal women, VBD declined more steeply for women with lower BMI (time × BMI, P = 0.0098). CONCLUSIONS Race does not appear to impact ET-related longitudinal changes in VBD. IMPACT Racial disparities in estrogen receptor-positive breast cancer recurrence and mortality may not be explained by differential declines in breast density due to ET.
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Affiliation(s)
- Helen M Johnson
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Hitesh Shivalingappa
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina.,Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - William Irish
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Jan H Wong
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Mahvish Muzaffar
- Division of Hematology Oncology, Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Kathryn Verbanac
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Nasreen A Vohra
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina.
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Macherla S, Nandimandalam S, Jayananda S, Appah EO, Bulumulle A, Baig S, Patel A, Polsani S, Muzaffar M. Racial variation in molecular profile of advanced gastrointestinal cancers. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.236] [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
236 Background: Heterogeneity in the tumor molecular profile based on race is poorly understood. We sought to review the utilization of next generation sequencing (NGS) in patients with advanced gastrointestinal (GI) malignancies treated at a rural academic center and analyze inter racial variations in the molecular tumor profile. Methods: We conducted a retrospective review of patients with advanced GI malignancies that underwent NGS between 2015 to 2018 at East Carolina University.104 patients met eligibility criteria but 8 patients were excluded due to insufficient tissue sampling. Patients with colorectal, gastric, pancreatic, biliary, small intestinal and esophageal cancers were included. Targeted NGS using Caris Life Sciences¨ platform was performed to obtain molecular analysis. We conducted descriptive univariate analysis, cox regression and Kaplan-Meier survival curve analysis. Results: Median age at diagnosis was 64yrs and 64% of patients were black. The study cohort had 41% (n=39) with colon cancer, 18%(17) gastric cancer, 30% (29) pancreatic cancer, 6%(6) biliary cancer, 4%(4) small intestinal cancer and 1%(1) esophageal cancer. 60% (55) had de novo Stage IV disease. Median overall survival (OS) was 25 months (mo), 30 mo in blacks and 32 mo in whites (p value =0.46). Microsatellite stability was seen in 94% (87) and instability in 3% (3). Overall cohort had mutations (mut) in KRAS (50%), TP53 (64%), BRAF (4%), and ERBB amplification (3%). On the cox regression model APC mutation was associated with worse outcome. Black patients had more alterations in KRAS, TP53 (both not significant), and APC (p=0.02). Conclusions: In our analysis we observed inter racial variations in molecular profile of advanced GI malignancies. Black patients had increased rates of APC, KRAS and TP 53 mut. Further studies are required to analyze the impact of these molecular variations on outcomes. Results. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Anokhi Patel
- East Carolina University/Vidant Cancer Center, Greenville, NC
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Naqash A, Jonnalagadda S, Macherla S, Polsani S, Muzaffar M, Cherry C, Karim NA, Walker P. P1.04-60 Impact of Metastatic Location on Survival in Stage-IV Non-Small Cell Lung Cancer (NSCLC) Treated with Immunotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.963] [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: 11/29/2022]
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Geisel LE, Johnson HM, Weil A, Muzaffar M, Vohra NA, DeAntonio P, Mulligan KH, Morey CL, Wong JH. Enhancing the electronic health record to promote and measure adherence to breast cancer clinical pathways. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.322] [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
322 Background: Clinical pathways are widely accepted tools for improving the quality of cancer care. We developed and implemented, within the electronic health record (EHR), a standardized multidisciplinary breast cancer conference template comprised of NCCN clinical pathway elements, with triggers to promote adherence and measure compliance. Methods: The records of breast cancer patients diagnosed from January 2016 to December 2017 were reviewed. Baseline data on (1) the documentation of clinical stage prior to prospective presentation at multidisciplinary conference, (2) documentation of family history, and (3) functional breast imaging utilization were recorded. EHR enhancements developed throughout 2018 were implemented in January 2019. Post-implementation data were obtained via an EHR query of records from January 2019 to the present. Results: At baseline, 56.5% of new patients (n = 435) had a clinical stage documented appropriately (goal 100%). After the EHR enhancements went live, this rate increased to 76.9% (n = 78 new diagnoses), ranging from 40% for patients with metastatic disease to 85.7% for non-metastatic. Compared with baseline data, EHR-derived data from 149 multidisciplinary conference notes demonstrated relatively stable rates of compliance with the family history and imaging metrics: 94.3% to 93.9% (goal 100%), and 12.8% to 13.4% (goal ≤20%), respectively. In 2019, there were 128 instances of an EHR trigger prompting physicians to review the multidisciplinary conference recommendations. While 89.1% of users responded that they reviewed the note, only 42.1% of these clicked on the link to view it. Conclusions: The EHR is a powerful tool for incorporating clinical pathways into oncology providers’ daily workflow. Quality improvement data can be extracted rapidly and efficiently, which facilitates continuous QI. We observed a notable improvement in documentation of clinical staging prior to multidisciplinary conference after the implementation of the clinical pathways in the EHR. Our first report identified several areas for improvement, which will be the focus of subsequent PDSA cycles.
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Affiliation(s)
- Lauren E. Geisel
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Helen M. Johnson
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Andrew Weil
- Brody School of Medicine at East Carolina University, Greenville, NC
| | | | | | - Phyllis DeAntonio
- Brody School of Medicine at East Carolina University, Greenville, NC
| | | | - Chantel L. Morey
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Jan H. Wong
- East Carolina University Brody School of Medicine, Greenville, NC
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Naqash AR, Appah E, Yang LV, Muzaffar M, Marie MA, Mccallen JD, Macherla S, Liles D, Walker PR. Isolated neutropenia as a rare but serious adverse event secondary to immune checkpoint inhibition. J Immunother Cancer 2019; 7:169. [PMID: 31277704 PMCID: PMC6612131 DOI: 10.1186/s40425-019-0648-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/21/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Compared to conventional chemotherapy, Immune checkpoint inhibitors (ICI) are known to have a distinct toxicity profile commonly identified as immune-related adverse events (irAEs). These irAEs that are believed to be related to immune dysregulations triggered by ICI can be serious and lead to treatment interruptions and in severe cases, precipitate permanent discontinuation. Isolated neutropenia secondary to ICI has been rarely documented in the literature and needs further description. We report a case of pembrolizumab related severe isolated neutropenia in a patient with metastatic non-small cell lung cancer. We were also able to obtain serial blood and plasma-based biomarkers for this patient during treatment and during neutropenia to understand trends that may correlate with the irAE. In addition we summarize important findings from other studies reporting on ICI related neutropenia. CASE PRESENTATION A 74 years old Caucasian male treated with single-agent pembrolizumab for metastatic non-small cell lung cancer presented with fevers, chills, and an isolated neutrophil count (ANC) of 0 2 weeks after the fourth dose. In addition to antibiotics, due to the strong suspicion of this neutropenia being immune-mediated, he was started on 1 mg/kg of steroids and also received filgrastim to accelerate neutrophil recovery. Serial trends in C-reactive protein and certain other inflammatory cytokines demonstrated a corresponding rise at the time of neutropenia. Post recovery, his pembrolizumab was kept on hold. Eight weeks later he had a second episode of neutropenia which was again managed similar to the first episode. Despite permanent discontinuation of ICI after the first neutropenia, his disease showed an ongoing complete metabolic response on imaging. Our literature review reveals that hematological toxicities constitute < 1% irAEs with isolated neutropenia roughly accounting for one-fourth of the hematological irAEs. Based on the handful of ICI related neutropenia cases reported to date, we identified nivolumab to be the most common offender. The median number of ICI cycles administered before presenting with neutropenia was three, and the median time to recovery was approximately two weeks. All of these neutropenic episodes were ≥ grade 3 and led to permanent ICI discontinuation. Using immunosuppressive therapies in conjunction with granulocyte-colony stimulating factor was the most common strategy described to have favorable results. CONCLUSION Neutropenia as an isolated irAE secondary to ICI is rare but represents a severe toxicity that needs early recognition and can often result in treatment discontinuations. Careful monitoring of these patients with the prompt initiation of immunosuppressive and supportive measures to promote rapid recovery as well as prevent and treat infectious complications should be part of the management algorithms. Serial monitoring of blood and plasma-based biomarkers from more extensive studies may help in identifying patients at risk for irAEs and thus guide patient selection for ICI.
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Affiliation(s)
- Abdul Rafeh Naqash
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - Ebenezer Appah
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Li V Yang
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mahvish Muzaffar
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mona A Marie
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Justin D Mccallen
- Brody School of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Shravanti Macherla
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Darla Liles
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Paul R Walker
- Division of Hematology/Oncology, East Carolina University, 600 Moye Boulevard, Greenville, NC, 27834, USA
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Naqash AR, Walker PR, Muzaffar M, Feldman R, Hafiz M, Liu SV, Mamdani H, Patel A, Borghaei H, Sharma N, Nieva JJ, Boumber Y, Vanderwalde AM, Ma PC, Eldessouki I, Portnoy DC, Spira AI, Yang LV, Abdel Karim NF. Tumor mutational burden (TMB) profile of K-RAS/TP-53 co-mutation in metastatic non-small cell lung cancer (m-NSCLC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2626] [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
2626 Background: Early data suggests that co-occurring genetic events define biological heterogeneity in K-RAS mutant NSCLC, with K-RAS/ TP-53 (KP) co-mutated subset having potential therapeutic vulnerabilities to immune checkpoint blockade (ICB). To explore the immunological basis for these findings, we evaluated the immune biomarker profile (TMB/PD-L1) in KP mutant m-NSCLC using a large next-generation sequencing (NGS) dataset. Methods: Caris life sciences NGS dataset consisting of 1317 m-NSCLC tissue samples from 2016-18 was queried. PD-L1pos was defined as ≥ 1% staining using 22c3 Dako assay. TMB was measured by counting all somatic non-synonymous missense mutations using targeted NGS (592 genes). TMB-high (H) was defined as ≥ 10 mutations/Megabase (mut/Mb). P-values were calculated using Chi-square and Mann-Whitney test. Results: K-RAS mutations were identified in 28.7% (378/1317). Within this K-RAS mutant group, KP subset constituted 49.4% (187/378), remaining were K-RAS mutated/ TP-53 wild type (K-Pwt). 72.2 % (135/187) of KP had PD-L1pos with 51.9% (97/187) having PD-L1 ≥ 50%. KP had higher median TMB vs. K-Pwt (14.5 vs. 9.0 mut/Mb, p<0.001) and higher % of TMB-H vs. K-Pwt (79.9 vs. 45.1%, p<0.001; Table). Even in the PD-L1neg group, KP had higher % of TMB-H vs. K-Pwt (86.5 vs. 41.5%, p<0.001). K-RAS or TP-53 exon-subtypes had no difference in median TMB or % of TMB-H. Across metastatic sites, brain tissue had the highest % of KP subset (38.3%, 68/187) followed by bone (28.9%, 54/187). Within KP subset, brain tissue had higher median TMB vs. bone (16 vs. 11 mut/Mb, p<0.01) as well as greater % of TMB-H vs. bone (86.5 vs. 68.5%, p=0.01). Conclusions: This is the largest dataset to date highlighting the unique immune profile of KP mutant m-NSCLC. Our results show that KP subset has a significantly higher TMB than K-Pwt, especially in the PD-L1neg subgroup. Metastatic site-specific variations in TMB were also observed for the KP subset. These findings could have therapeutic implications in guiding patient selection for ICB and merit prospective investigation.[Table: see text]
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Affiliation(s)
| | - Paul R. Walker
- East Carolina University/ Vidant Cancer Center, Greenville, NC
| | | | | | | | | | | | - Anokhi Patel
- East Carolina University/ Vidant Cancer Center, Greenville, NC
| | | | - Nitika Sharma
- East Carolina University/ Vidant Cancer Center, Greenville, NC
| | | | | | | | - Patrick C. Ma
- WVU Cancer Institute, West Virginia University, Morgantown, WV
| | | | | | | | - Li V. Yang
- East Carolina University, Greenville, NC
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Muzaffar M, Naqash AR, Liles DK, Kachru S. Metastatic pattern and tumor sidedness in colorectal cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15147] [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
e15147 Background: Tumor side has emerged as an important prognostic and predictive factor in metastatic colon cancer. We sought to study its impact on the metastatic pattern of colorectal cancer. Methods: The SEER database (version 8.3.5) was reviewed for patients with Stage IV colorectal cancer diagnosed between 2004-2015. We only included patients with labeled primary site, and excluded appendiceal, unlabeled and autopsy alone cases. Variables included in the analysis were: age, race, gender, grade, primary tumor side and sites of metastasis at diagnosis. Primary outcome analyzed was overall survival and disease specific survival.Cox proportional hazard regression model was employed to test the association between survival and side of cancer/ site of metastasis. Results: A total of 74,768 cases were identified who met the eligibility criteria. The mean age was 68.5 yrs. for right colon cancer (RCC),64.0 yrs. for left colon cancer (LCC). and 62.9 yrs. for rectal cancer. White race was predominant group for RCC, LCC and rectum. More females were vs men in RCC (52% vs 48%), LCC (44% vs 56%) and rectum (60% vs 40%). (The cox regression model suggested inferior outcome for black race HR 1.05(1.03-1.07) (<0.001), high grade HR 1.32(1.30-1.35) p<.0001, right side tumors HR 1.23(1.21-1.250, p <.0001 (table). Conclusions: Over last few years tumor sidedness has emerged as an important prognostic and predictive factor in colon cancer. Our study also highlights the impact of sidedness on survival irrespective of distant metastatic pattern. This analysis contributes to the ongoing discussion that right and left colon cancer are two distinct disease entities. Impact of primary tumor side and metastatic site on survival in colorectal cancer. [Table: see text]
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Affiliation(s)
| | | | - Darla K. Liles
- Leo Jenkins Cancer Center, Brody School of Medicine at East Carolina University, Greenville, NC
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Muzaffar M, Vohra N, Wong J. Abstract P1-17-06: Breast cancer in elderly women: Ageism or primum non nocere? Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-06] [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: The risk of breast cancer increases with advancing age. Routine use of screening mammogram in women after 75yrs and its impact on overall survival is controversial. Studies have also found that elderly breast cancer patients are underrepresented among clinical trials and a tendency for undertreatment may result in inferior outcome.
Method and Material:Female patients with breast cancer who were 75 years or older and diagnosed from 2000-2015 were identified from Surveillance, Epidemiology, and End Results (SEER) 18 database. We excluded patients with unknown stage and race. We performed multivariate and survival analysis using JMP pro 13.
Results: 186,682 women with breast cancer of ≥ 75 yrs. were identified from the SEER. 167,802 patients met the inclusion criteria. Mean age was 81.27 years (CI 95% 81.25-81.30). Most of the patients were white (88%), and had Stage I/II (83%) breast cancer.78% of patients had estrogen receptor positive cancer, while 66% had grade 1/2 disease. The 5-year overall survival was 74% for Stage I,60% for Stage II,38% for stage III and 11% for Stage IV cancer(p<0.0001). The disease specific survival (DSS)for stage I (96%), Stage II (88%), Stage III (64%), and Stage IV (23%).Out of the patients who were deceased at the time of analysis only 24% of deaths were attributed to this cancer. Cox proportional hazards regression model of overall survival [Table:1]
Cox proportional hazards regression model of overall survivalVariableHazard ratio( 95% CI)p value75—79 80-84 85+1 1.22 1.7<0.0001Race White Black Others1 1.14 0.95<0.001ER Positive Negative unknown1 1.19 1.2<0.001Stage I Stage II Stage III Stage IV1 1.17 1.66 3.7<0.001
Conclusion: Early breast cancer continues to be the most common presentation for patients ≥75 yrs. of age. Historical prognostic factors of breast cancer like race, hormone receptor status, stage and grade continue to impact cancer outcome among elderly patients. Only 24% of deaths among the deceased were attributed to this breast cancer highlighting the concern for over diagnosis. Nonetheless once diagnoses is established a multidisciplinary comprehensive geriatric assessment should be the cornerstone of the management.
Citation Format: Muzaffar M, Vohra N, Wong J. Breast cancer in elderly women: Ageism or primum non nocere? [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 P1-17-06.
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Affiliation(s)
- M Muzaffar
- East Carolina University/Brody School of Medicine, Greenville, NC
| | - N Vohra
- East Carolina University/Brody School of Medicine, Greenville, NC
| | - J Wong
- East Carolina University/Brody School of Medicine, Greenville, NC
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Johnson HM, Shivalingappa H, Wong JH, Muzaffar M, Verbanac K, Vohra NA. Abstract P5-11-12: Longitudinal changes in volumetric breast density and fibroglandular volume with endocrine therapy in African American women with estrogen receptor positive breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-11-12] [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 and Aim:
Reduction in breast density has been proposed as a biomarker of response to endocrine therapy (ET). The vast majority of current data are derived from white or Asian women. Because baseline breast density is associated with race, it is possible that changes in breast density with treatment may also be affected by race. Our objective was to assess the impact of ET on volumetric breast density (VBD) and fibroglandular volume (FGV) in African American (AA) women with invasive breast cancer.
Methods:
We conducted a retrospective study of AA women diagnosed with estrogen receptor positive invasive breast cancer at our institution from 2009-2013. Mammograms within two years prior to diagnosis and at least 6 months post-diagnosis were utilized for comparing density measurements. Using Volpara automated software, VBD and FGV were measured for the contralateral normal breast by averaging the respective values measured on the craniocaudal and mediolateral oblique views.
Results:
51 women met the inclusion criteria and were confirmed to have received ET. Sixteen women received tamoxifen, 34 received an aromatase inhibitor, and medication data was unavailable in one case. The mean age at diagnosis was 56 years (range 29-72, median 55). 53% of women had stage I disease, 29% had stage II disease, and 18% had stage III disease. The majority of women had ER+ PR+ HER2 - disease (82.4%). 53.0% of women received systemic chemotherapy and all but one woman were treated surgically. Average body mass index (BMI) at diagnosis was 36.5, with data not available for 22 women. The mean time between diagnosis and baseline mammogram was 32 days, and the mean time between follow-up mammogram and baseline mammogram was 401 days. Average BMI at one year follow up was 33.7, with data not available for 19 women. The mean baseline VBD was 7.5% (range 1.9-21.5%, median 6.3%) and the mean follow-up VBD was 6.9% (range 2.0-23.6%, median 5.6%). Fifteen women had a longitudinal increase in VBD. The mean absolute change in VBD was -0.6% (range -3.4% to +9.8%, median 0.7%), with a mean 8.0 percent decrease from baseline to follow-up (range -0.7 to +0.5, median 0.1). The mean baseline FGV was 72.3 cm3 (range 18.5-208.4, median 65.3) and the mean follow-up FGV was 69.7 cm3 (range 22.7-197.5, median 60.5). Nineteen women had a longitudinal increase in FGV. The mean absolute reduction in FGV was 2.6 cm3 (range -53.3 to 49.3, median 4.8), with a mean 0.9 percent decrease from baseline to follow-up (range -111.6 to +53.0, median 5.2).
Conclusions:
We observed an overall decrease in Volpara-calculated VBD and FGV in our cohort of AA women treated with ET. It remains to be determined whether changes in VBD and FGV across serial mammograms may be a biomarker for response to ET in women of all races. Large prospective studies are needed to evaluate the effects of ET on longitudinal changes in VBD and FGV while controlling for confounders such as menopausal status, BMI, and chemotherapy.
Citation Format: Johnson HM, Shivalingappa H, Wong JH, Muzaffar M, Verbanac K, Vohra NA. Longitudinal changes in volumetric breast density and fibroglandular volume with endocrine therapy in African American women with estrogen receptor positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-11-12.
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Affiliation(s)
- HM Johnson
- East Carolina University Brody School of Medicine, Greenville, NC
| | - H Shivalingappa
- East Carolina University Brody School of Medicine, Greenville, NC
| | - JH Wong
- East Carolina University Brody School of Medicine, Greenville, NC
| | - M Muzaffar
- East Carolina University Brody School of Medicine, Greenville, NC
| | - K Verbanac
- East Carolina University Brody School of Medicine, Greenville, NC
| | - NA Vohra
- East Carolina University Brody School of Medicine, Greenville, NC
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Vohra NA, Brinkley J, Kachare S, Muzaffar M. Reply to "Letter to the Editor" intent of surgery of the primary tumor in metastatic breast cancer remains palliative. Breast J 2019; 25:354-355. [PMID: 30761703 DOI: 10.1111/tbj.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nasreen A Vohra
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Jason Brinkley
- American Institutes of Research, Chapel Hill, North Carolina
| | - Swapnil Kachare
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Mahvish Muzaffar
- Division of Hematology Oncology, Department of Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
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Abstract
712 Background: 25% of patients with colorectal cancer(CRC) present with synchronous metastatic disease. The incidence of brain metastasis (BM) in CRC is very low (1.2–3.2%) and tend to occur later in the disease course. Synchronous BM(SBM) in CRC is very rare. We sought to explore the impact of primary tumor characteristics on SBM. Methods: Surveillance Epidemiology End Results Program (SEER) 18 registries research data on primary colorectal cancer cases diagnosed during 2010-2015 with brain metastasis at diagnosis were identified. Patients with unlabeled primary site and autopsy alone cases were excluded. Demographic and colorectal cancer characteristics including age, gender, race, tumor grade and primary tumor side were analyzed. Logistic regression model was used to test the association between survival and side of cancer. Results: A total of 475 cases met the inclusion criteria. The mean age was 64.04 yrs. (range 28-95). Majority of the patients (80%) were white, 12% black and others (8%), Male: Female ratio was 1:1.58% patients had primary tumor on left side (splenic flexure, sigmoid, rectosigmoid and rectal) and 42% had right sided (ascending colon, hepatic flexure, cecum, transverse colon) primary tumor. The median overall survival was 5 months with 1-year survival of 26% in the whole cohort. The 1-year overall survival was 21% for patients with right sided primary tumor versus 30% for patients with SBM and left sided primary tumor(p = 0.03). The median disease specific survival was 5 months for right side and 7 months for Left sided tumor with SBM. The regression model showed that higher grade (RR 14, p = 0.003)) and right sided primary tumor (RR 4.2, p = 0.04) were associated with worse outcome among patients with SBM in colorectal cancer. Conclusions: Synchronous brain metastasis is very rare in colorectal cancer. Tumor side seems to be prognostic even in this aggressive disease subset. This differential outcome further indicates that sidedness should be considered in goals of care and treatment discussion.
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Affiliation(s)
| | - Abdul Rafeh Naqash
- Division of Hematology/Oncology, Department of Internal Medicine, East Carolina University, Greenville, NC
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Schreier AM, Johnson LA, Vohra NA, Muzaffar M, Kyle B. Post-Treatment Symptoms of Pain, Anxiety, Sleep Disturbance, and Fatigue in Breast Cancer Survivors. Pain Manag Nurs 2018; 20:146-151. [PMID: 30527856 DOI: 10.1016/j.pmn.2018.09.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND In part because of improvements in early detection and treatment, the number of breast cancer survivors is increasing. After treatment, however, breast cancer survivors often experience distressing symptoms, including pain, sleep disturbance, anxiety, and fatigue; at the same time, they have less frequent contact with health care providers. Pain commonly co-occurs with other symptoms and the combination of symptoms contribute to the amount of distress experienced by survivors. Previous studies of post-treatment symptoms include primarily urban and white women. AIMS The purpose of this study was to describe the post-treatment cluster of symptoms, to examine the correlations among these symptoms, and to examine the role pain intensity may play in understanding the variation in sleep disturbance, fatigue, and anxiety in a racially diverse sample of rural breast cancer survivors. DESIGN The theoretical framework for this descriptive correlational study was the theory of unpleasant symptoms. SETTINGS Outpatient university-affiliated cancer clinic. PARTICIPANTS/SUBJECTS Forty women who were between 6 months and 5 years post breast cancer diagnosis. METHODS Participants completed the following self-report instruments: Patient Reported Outcomes Measurement Information System of pain intensity, pain interference, anxiety, and sleep disturbance and the Piper Fatigue Short Form 12. RESULTS The average age of participants was 58 years, and 57.5% were black. Most women reported sleep disturbance (78%), pain interference (68%), and pain intensity (63%) above the national average for an American adult. Black women reported higher pain intensity than whites. There were moderate to strong correlations among the symptoms (range r = 0.35-0.89). CONCLUSIONS Nurses and health care providers in primary care settings need to screen for symptoms, and nursing interventions are needed to assist breast cancer survivors to manage distressing symptoms.
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Affiliation(s)
- Ann M Schreier
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina.
| | - Lee Ann Johnson
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, North Carolina
| | - Nasreen A Vohra
- Division of Surgical Oncology, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Mahvish Muzaffar
- Division of Hematology Oncology, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Brandon Kyle
- Department of Psychiatry & Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Macherla S, Laks S, Naqash AR, Bulumulle A, Zervos E, Muzaffar M. Emerging Role of Immune Checkpoint Blockade in Pancreatic Cancer. Int J Mol Sci 2018; 19:E3505. [PMID: 30405053 PMCID: PMC6274962 DOI: 10.3390/ijms19113505] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/25/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023] Open
Abstract
Immune checkpoint blockade (ICB) with programmed cell death protein-1(PD-1)/programmed death ligand -1(PD-L1) antibodies has revolutionized the management of several cancers, especially non-small cell lung cancer, melanoma, urothelial, and renal cancer. Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers associated with high morbidity and mortality. Based on available data, it's obvious that ICB has limited success in PDACs, which can be explained by the low immunogenicity and immunosuppressive tumor microenvironment of these tumors. In this review article, we focus on PD-L1 expression and microsatellite instability (MSI) in PDAC, and their roles as prognostic and predictive markers. We also discuss data supporting combination therapies to augment cancer immunity cycle. Combining anti-PD-1/PD-L1 agents with other modalities such as vaccines, chemotherapy, and radiation could potentially overcome resistance patterns and increase immune responsiveness in PDAC.
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Affiliation(s)
- Shravanti Macherla
- Department of Medicine, Division of Hematology/Oncology, East Carolina University Brody School of Medicine, Greenville, NC 27834, USA.
| | - Shachar Laks
- Department of Surgery, Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC 27834, USA.
| | - Abdul Rafeh Naqash
- Department of Medicine, Division of Hematology/Oncology, East Carolina University Brody School of Medicine, Greenville, NC 27834, USA.
| | - Anushi Bulumulle
- Department of Medicine, Division of Hematology/Oncology, East Carolina University Brody School of Medicine, Greenville, NC 27834, USA.
| | - Emmanuel Zervos
- Department of Surgery, Division of Surgical Oncology, East Carolina University Brody School of Medicine, Greenville, NC 27834, USA.
| | - Mahvish Muzaffar
- Department of Medicine, Division of Hematology/Oncology, East Carolina University Brody School of Medicine, Greenville, NC 27834, USA.
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Muzaffar M, Brinkley J, Vohra NA. Reply to the letter to editor by Zeki Gokhan Surmeli, M.D. Breast J 2018; 24:1146-1147. [PMID: 30288857 DOI: 10.1111/tbj.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Mahvish Muzaffar
- Division of Hematology Oncology, Department of Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Jason Brinkley
- American Institutes of Research, Chapel Hill, North Carolina
| | - Nasreen A Vohra
- Division of Surgical Oncology, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina
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