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Vaz-Luis I, Masiero M, Cavaletti G, Cervantes A, Chlebowski RT, Curigliano G, Felip E, Ferreira AR, Ganz PA, Hegarty J, Jeon J, Johansen C, Joly F, Jordan K, Koczwara B, Lagergren P, Lambertini M, Lenihan D, Linardou H, Loprinzi C, Partridge AH, Rauh S, Steindorf K, van der Graaf W, van de Poll-Franse L, Pentheroudakis G, Peters S, Pravettoni G. ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe. Ann Oncol 2022; 33:1119-1133. [PMID: 35963481 DOI: 10.1016/j.annonc.2022.07.1941] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. DESIGN AND METHODS Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. RESULTS We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. CONCLUSIONS The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.
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Affiliation(s)
- I Vaz-Luis
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif; UMR 981, Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy-Cancer Campus, Villejuif, France.
| | - M Masiero
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - A Cervantes
- Department of Medical Oncology, INCLIVA, Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon; Catolica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - P A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, USA
| | - J Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - J Jeon
- Exercise Medicine Center for Cancer and Diabetes Patients (ICONS), Department of Sport Industry, Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - C Johansen
- Centre for Cancer Late Effect Research (CASTLE), Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Joly
- Department of Medical Oncology, Centre François Baclesse, U1086 Anticipe, Unicaen Normandy Universtity, Caen, France
| | - K Jordan
- Department for Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - B Koczwara
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - P Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Lenihan
- International Cardio-Oncology Society, Tampa, USA
| | - H Linardou
- Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece
| | | | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Rauh
- Department of Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - W van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer institute, Erasmus University Medical Center, Rotterdam
| | - L van de Poll-Franse
- Division of Psychosocial Research & Epidemiology, Department of Psycological Research, The Netherlands Cancer Institute, Amsterdam; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S Peters
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
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Di Maio M, Basch E, Denis F, Fallowfield LJ, Ganz PA, Howell D, Kowalski C, Perrone F, Stover AM, Sundaresan P, Warrington L, Zhang L, Apostolidis K, Freeman-Daily J, Ripamonti CI, Santini D. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol 2022; 33:878-892. [PMID: 35462007 DOI: 10.1016/j.annonc.2022.04.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/05/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- M Di Maio
- Department of Oncology, University of Turin, at A.O. Ordine Mauriziano Hospital, Turin, Italy
| | - E Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - F Denis
- Institut Inter-régional de Cancérologie Jean Bernard (ELSAN), Le Mans, France; Faculté de Santé, Université de Paris, Paris, France
| | - L J Fallowfield
- Sussex Health Outcomes Research & Education in Cancer, Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - P A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles (UCLA), USA
| | - D Howell
- Department of Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - C Kowalski
- Department of Certification - Health Services Research, German Cancer Society, Berlin, Germany
| | - F Perrone
- Clinical Trial Unit, National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy
| | - A M Stover
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - P Sundaresan
- Sydney West Radiation Oncology Network, Westmead Hospital, Westmead, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - L Warrington
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, UK
| | - L Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - K Apostolidis
- European Cancer Patient Coalition, Brussels, Belgium
| | | | - C I Ripamonti
- Oncology - Supportive Care in Cancer Unit, Department Oncology-Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, Milan, Italy
| | - D Santini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
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Frampton MW, Balmes JR, Bromberg PA, Arjomandi M, Hazucha MJ, Thurston SW, Alexis NE, Ganz P, Zareba W, Koutrakis P, Thevenet-Morrison K, Rich DQ. Effects of short-term increases in personal and ambient pollutant concentrations on pulmonary and cardiovascular function: A panel study analysis of the Multicenter Ozone Study in oldEr subjects (MOSES 2). Environ Res 2022; 205:112522. [PMID: 34919956 DOI: 10.1016/j.envres.2021.112522] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The cardiovascular effects of ozone exposure are unclear. Using measurements from the 87 participants in the Multicenter Ozone Study of oldEr Subjects (MOSES), we examined whether personal and ambient pollutant exposures before the controlled exposure sessions would be associated with adverse changes in pulmonary and cardiovascular function. METHODS We used mixed effects linear regression to evaluate associations between increased personal exposures and ambient pollutant concentrations in the 96 h before the pre-exposure visit, and 1) biomarkers measured at pre-exposure, and 2) changes in biomarkers from pre-to post-exposure. RESULTS Decreases in pre-exposure forced expiratory volume in 1 s (FEV1) were associated with interquartile-range increases in concentrations of particulate matter ≤2.5 μm (PM2.5) 1 h before the pre-exposure visit (-0.022 L; 95% CI -0.037 to -0.006; p = 0.007), carbon monoxide (CO) in the prior 3 h (-0.046 L; 95% CI -0.076 to -0.016; p = 0.003), and nitrogen dioxide (NO2) in the prior 72 h (-0.030 L; 95% CI -0.052 to -0.008; p = 0.007). From pre-to post-exposure, increases in FEV1 were marginally significantly associated with increases in personal ozone exposure (0.010 L; 95% CI 0.004 to 0.026; p = 0.010), and ambient PM2.5 and CO at all lag times. Ambient ozone concentrations in the prior 96 h were associated with both decreased pre-exposure high frequency (HF) heart rate variability (HRV) and increases in HF HRV from pre-to post-exposure. CONCLUSIONS We observed associations between increased ambient PM2.5, NO2, and CO levels and reduced pulmonary function, and increased ambient ozone concentrations and reduced HRV. Pulmonary function and HRV increased across the exposure sessions in association with these same pollutant increases, suggesting a "recovery" during the exposure sessions. These findings support an association between short term increases in ambient PM2.5, NO2, and CO and decreased pulmonary function, and increased ambient ozone and decreased HRV.
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Affiliation(s)
- M W Frampton
- University of Rochester Medical Center, Rochester, NY, USA.
| | - J R Balmes
- University of California at San Francisco, San Francisco, CA, USA
| | - P A Bromberg
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Arjomandi
- University of California at San Francisco, San Francisco, CA, USA
| | - M J Hazucha
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S W Thurston
- University of Rochester Medical Center, Rochester, NY, USA
| | - N E Alexis
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P Ganz
- University of California at San Francisco, San Francisco, CA, USA
| | - W Zareba
- University of Rochester Medical Center, Rochester, NY, USA
| | - P Koutrakis
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - D Q Rich
- University of Rochester Medical Center, Rochester, NY, USA
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Ferreira AR, Di Meglio A, Pistilli B, Gbenou AS, El-Mouhebb M, Dauchy S, Charles C, Joly F, Everhard S, Lambertini M, Coutant C, Cottu P, Lerebours F, Petit T, Dalenc F, Rouanet P, Arnaud A, Martin A, Berille J, Ganz PA, Partridge AH, Delaloge S, Michiels S, Andre F, Vaz-Luis I. Differential impact of endocrine therapy and chemotherapy on quality of life of breast cancer survivors: a prospective patient-reported outcomes analysis. Ann Oncol 2020; 30:1784-1795. [PMID: 31591636 DOI: 10.1093/annonc/mdz298] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In early breast cancer (BC), there has been a trend to escalate endocrine therapy (ET) and to de-escalate chemotherapy (CT). However, the impact of ET versus CT on the quality of life (QoL) of early BC patients is unknown. Here, we characterize the independent contribution of ET and CT on patient-reported outcomes (PROs) at 2 years after diagnosis. PATIENTS AND METHODS We prospectively collected PROs in 4262 eligible patients using the European Organization for Research and Treatment of Cancer QLQ-C30/BR23 questionnaires inside CANTO trial (NCT01993498). The primary outcome was the C30 summary score (C30-SumSc) at 2 years after diagnosis. RESULTS From eligible patients, 37.2% were premenopausal and 62.8% postmenopausal; 81.9% received ET and 52.8% CT. In the overall cohort, QoL worsened by 2 years after diagnosis in multiple functions and symptoms; exceptions included emotional function and future perspective, which improved over time. ET (Pint = 0.004), but not CT (Pint = 0.924), had a persistent negative impact on the C30-SumSc. In addition, ET negatively impacted role and social function, pain, insomnia, systemic therapy side-effects, breast symptoms and further limited emotional function and future perspective recovery. Although CT had no impact on the C30-SumSc at 2-years it was associated with deteriorated physical and cognitive function, dyspnea, financial difficulties, body image and breast symptoms. We found a differential effect of treatment by menopausal status; in premenopausal patients, CT, despite only a non-significant trend for deteriorated C30-SumSc (Pint = 0.100), was more frequently associated with QoL domains deterioration than ET, whereas in postmenopausal patients, ET was more frequently associated with QoL deterioration, namely using the C30-SumSc (Pint = 0.004). CONCLUSION(S) QoL deterioration persisted at 2 years after diagnosis with different trajectories by treatment received. ET, but not CT, had a major detrimental impact on C30-SumSc, especially in postmenopausal women. These findings highlight the need to properly select patients for adjuvant ET escalation.
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Affiliation(s)
- A R Ferreira
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - A Di Meglio
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
| | - B Pistilli
- Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
| | - A S Gbenou
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
| | - M El-Mouhebb
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France
| | - S Dauchy
- Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
| | - C Charles
- Department of Supportive Care, Gustave Roussy, Cancer Campus, Villejuif
| | - F Joly
- Medical Oncology, Centre François Baclesse Caen, Caen
| | | | - M Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - C Coutant
- Surgical Oncology, Centre Georges-François Leclerc, Dijon
| | - P Cottu
- Medical Oncology, Institut Curie, Paris
| | - F Lerebours
- Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud
| | - T Petit
- Department of Medicine, Paul Strauss Cancer Center and University of Strasbourg, Strasbourg
| | - F Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer - Oncopole, Toulouse
| | - P Rouanet
- Surgical Oncology, C.R.L.C Val d'Aurelle, Montpellier
| | - A Arnaud
- Radiotherapy Department, Clinique Sainte Catherine Avignon, Avignon
| | | | - J Berille
- Ministry of Higher Education and Research, Ministere de l'Enseignement Superieur et de la Recherche, Paris, France
| | - P A Ganz
- Medical Oncology, Ronald Reagan UCLA Medical Center, Los Angeles
| | - A H Partridge
- Women's Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - S Delaloge
- Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
| | - S Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, University Paris-Sud, University Paris-Saclay, Villejuif; CESP, INSERM, U1018 ONCOSTAT, Université Paris-Saclay, Univ. Paris-Sud, Villejuif, France
| | - F Andre
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France; Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif
| | - I Vaz-Luis
- INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France; Medical Oncology, Gustave Roussy, Cancer Campus, Villejuif.
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Rich DQ, Frampton MW, Balmes JR, Bromberg PA, Arjomandi M, Hazucha MJ, Thurston SW, Alexis NE, Ganz P, Zareba W, Koutrakis P, Thevenet-Morrison K. Multicenter Ozone Study in oldEr Subjects (MOSES): Part 2. Effects of Personal and Ambient Concentrations of Ozone and Other Pollutants on Cardiovascular and Pulmonary Function. Res Rep Health Eff Inst 2020; 2020:1-90. [PMID: 32239870 PMCID: PMC7325421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION The Multicenter Ozone Study of oldEr Subjects (MOSES) was a multi-center study evaluating whether short-term controlled exposure of older, healthy individuals to low levels of ozone (O3) induced acute changes in cardiovascular biomarkers. In MOSES Part 1 (MOSES 1), controlled O3 exposure caused concentration-related reductions in lung function with evidence of airway inflammation and injury, but without convincing evidence of effects on cardiovascular function. However, subjects' prior exposures to indoor and outdoor air pollution in the few hours and days before each MOSES controlled O3 exposure may have independently affected the study biomarkers and/or modified biomarker responses to the MOSES controlled O3 exposures. METHODS MOSES 1 was conducted at three clinical centers (University of California San Francisco, University of North Carolina, and University of Rochester Medical Center) and included healthy volunteers 55 to 70 years of age. Consented participants who successfully completed the screening and training sessions were enrolled in the study. All three clinical centers adhered to common standard operating procedures and used common tracking and data forms. Each subject was scheduled to participate in a total of 11 visits: screening visit, training visit, and three sets of exposure visits consisting of the pre-exposure day, the exposure day, and the post-exposure day. After completing the pre-exposure day, subjects spent the night in a nearby hotel. On exposure days, the subjects were exposed for 3 hours in random order to 0 ppb O3 (clean air), 70 ppb O3, and 120 ppm O3. During the exposure period the subjects alternated between 15 minutes of moderate exercise and 15 minutes of rest. A suite of cardiovascular and pulmonary endpoints was measured on the day before, the day of, and up to 22 hours after each exposure. In MOSES Part 2 (MOSES 2), we used a longitudinal panel study design, cardiopulmonary biomarker data from MOSES 1, passive cumulative personal exposure samples (PES) of O3 and nitrogen dioxide (NO2) in the 72 hours before the pre-exposure visit, and hourly ambient air pollution and weather measurements in the 96 hours before the pre-exposure visit. We used mixed-effects linear regression and evaluated whether PES O3 and NO2 and these ambient pollutant concentrations in the 96 hours before the pre-exposure visit confounded the MOSES 1 controlled O3 exposure effects on the pre- to post-exposure biomarker changes (Aim 1), whether they modified these pre- to post-exposure biomarker responses to the controlled O3 exposures (Aim 2), whether they were associated with changes in biomarkers measured at the pre-exposure visit or morning of the exposure session (Aim 3), and whether they were associated with differences in the pre- to post-exposure biomarker changes independently of the controlled O3 exposures (Aim 4). RESULTS Ambient pollutant concentrations at each site were low and were regularly below the National Ambient Air Quality Standard levels. In Aim 1, the controlled O3 exposure effects on the pre- to post-exposure biomarker differences were little changed when PES or ambient pollutant concentrations in the previous 96 hours were included in the model, suggesting these were not confounders of the controlled O3 exposure/biomarker difference associations. In Aim 2, effects of MOSES controlled O3 exposures on forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were modified by ambient NO2 and carbon monoxide (CO), and PES NO2, with reductions in FEV1 and FVC observed only when these concentrations were "Medium" or "High" in the 72 hours before the pre-exposure visit. There was no such effect modification of the effect of controlled O3 exposure on any other cardiopulmonary biomarker. As hypothesized for Aim 3, increased ambient O3 concentrations were associated with decreased pre-exposure heart rate variability (HRV). For example, high frequency (HF) HRV decreased in association with increased ambient O3 concentrations in the 96 hours before the pre-exposure visit (-0.460 ln[ms2]; 95% CI, -0.743 to -0.177 for each 10.35-ppb increase in O3; P = 0.002). However, in Aim 4 these increases in ambient O3 were also associated with increases in HF and low frequency (LF) HRV from pre- to post-exposure, likely reflecting a "recovery" of HRV during the MOSES O3 exposure sessions. Similar patterns across Aims 3 and 4 were observed for LF (the other primary HRV marker), and standard deviation of normal-to-normal sinus beat intervals (SDNN) and root mean square of successive differences in normal-to-normal sinus beat intervals (RMSSD) (secondary HRV markers). Similar Aim 3 and Aim 4 patterns were observed for FEV1 and FVC in association with increases in ambient PM with an aerodynamic diameter ≤ 2.5 μm (PM2.5), CO, and NO2 in the 96 hours before the pre-exposure visit. For Aim 3, small decreases in pre-exposure FEV1 were significantly associated with interquartile range (IQR) increases in PM2.5 concentrations in the 1 hour before the pre-exposure visit (-0.022 L; 95% CI, -0.037 to -0.006; P = 0.007), CO in the 3 hours before the pre-exposure visit (-0.046 L; 95% CI, -0.076 to -0.016; P = 0.003), and NO2 in the 72 hours before the pre-exposure visit (-0.030 L; 95% CI, -0.052 to -0.008; P = 0.007). However, FEV1 was not associated with ambient O3 or sulfur dioxide (SO2), or PES O3 or NO2 (Aim 3). For Aim 4, increased FEV1 across the exposure session (post-exposure minus pre-exposure) was marginally significantly associated with each 4.1-ppb increase in PES O3 concentration (0.010 L; 95% CI, 0.004 to 0.026; P = 0.010), as well as ambient PM2.5 and CO at all lag times. FVC showed similar associations, with patterns of decreased pre-exposure FVC associated with increased PM2.5, CO, and NO2 at most lag times, and increased FVC across the exposure session also associated with increased concentrations of the same pollutants, reflecting a similar recovery. However, increased pollutant concentrations were not associated with adverse changes in pre-exposure levels or pre- to post-exposure changes in biomarkers of cardiac repolarization, ST segment, vascular function, nitrotyrosine as a measure of oxidative stress, prothrombotic state, systemic inflammation, lung injury, or sputum polymorphonuclear leukocyte (PMN) percentage as a measure of airway inflammation. CONCLUSIONS Our previous MOSES 1 findings of controlled O3 exposure effects on pulmonary function, but not on any cardiovascular biomarker, were not confounded by ambient or personal O3 or other pollutant exposures in the 96 and 72 hours before the pre-exposure visit. Further, these MOSES 1 O3 effects were generally not modified, blunted, or lessened by these same ambient and personal pollutant exposures. However, the reductions in markers of pulmonary function by the MOSES 1 controlled O3 exposure were modified by ambient NO2 and CO, and PES NO2, with reductions observed only when these pollutant concentrations were elevated in the few hours and days before the pre-exposure visit. Increased ambient O3 concentrations were associated with reduced HRV, with "recovery" during exposure visits. Increased ambient PM2.5, NO2, and CO were associated with reduced pulmonary function, independent of the MOSES-controlled O3 exposures. Increased pollutant concentrations were not associated with pre-exposure or pre- to post-exposure changes in other cardiopulmonary biomarkers. Future controlled exposure studies should consider the effect of ambient pollutants on pre-exposure biomarker levels and whether ambient pollutants modify any health response to a controlled pollutant exposure.
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Affiliation(s)
- D Q Rich
- University of Rochester Medical Center, Rochester, New York
| | - M W Frampton
- University of Rochester Medical Center, Rochester, New York
| | - J R Balmes
- University of California at San Francisco
| | | | | | | | - S W Thurston
- University of Rochester Medical Center, Rochester, New York
| | - N E Alexis
- University of North Carolina at Chapel Hill
| | - P Ganz
- University of California at San Francisco
| | - W Zareba
- University of Rochester Medical Center, Rochester, New York
| | - P Koutrakis
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Vicini FA, Cecchini RS, White JR, Julian TB, Arthur DW, Rabinovitch RA, Kuske RR, Parda DS, Ganz PA, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, Costantino JP, Bear HD, Germaine I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran WJ, Wolmark N. Abstract GS4-04: Primary results of NSABP B-39/RTOG 0413 (NRG Oncology): A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs4-04] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Conventional WBI after lumpectomy for early-stage breast cancer decreases ipsilateral breast tumor recurrence (IBTR), yielding comparable results to mastectomy. Accelerated PBI appears effective in reducing IBTR by treating only the tumor bed area. As the majority of IBTR occur at or in the vicinity of the tumor bed, we hypothesized that PBI would be as effective as WBI in controlling IBTR. The primary aim of NSABP B-39/RTOG 0413 was to determine if PBI provides equivalent local tumor control post lumpectomy compared to WBI in pts with early-stage breast cancer. The equivalency test was based on a 50% margin of increase in the hazard ratio (HR=1.5). Secondary endpoints included: overall survival (OS), recurrence-free interval (RFI), distant disease-free interval (DDFI), and toxicity.
Methods: Eligible pts had lumpectomy with histologically-free margins and 0-3 positive axillary nodes. Pts were stratified by stage, menopausal status, hormone receptor status, and intent to receive chemotherapy and then randomized to PBI or WBI. PBI was 10 fractions of 3.4-3.85 Gy, given twice daily with either brachytherapy or 3D external beam radiation. WBI was 50 Gy in 2 Gy fractions given daily with a sequential boost to the surgical cavity. Follow-up was every 6 mos for 5 yrs and then annually. All analyses were by intent-to-treat.
Results: From 3-21-05 to 4-16-13, 4216 pts were randomized: 2107 PBI; 2109 WBI. 61% were postmenopausal; 81% were hormone receptor-positive; 29% intended to receive chemotherapy. Stage distribution was: DCIS, 24%; invasive pN0, 65%; invasive pN1, 10%. As of 7-31-18, median follow-up was 10.2 yrs. There were 161 IBTRs as first events: 90 PBI v 71 WBI (HR 1.22; 90%CI 0.94-1.58). Per protocol-defined margin, to declare PBI and WBI equivalent regarding IBTR risk, the 90% CI for the observed HR had to lie entirely between 0.667 and 1.5. The percent of pts IBTR-free at 10 yrs was 95.2% PBI v 95.9% WBI. A statistically significant difference in the 10-yr RFI rate favored WBI (91.9% PBI v 93.4% WBI; HR 1.32; 95%CI 1.04-1.68; p=0.02). No statistically significant differences existed between PBI and WBI in DDFI (HR 1.31; 95%CI 0.91-1.91; p=0.15), OS (HR 1.10; 95%CI 0.90-1.35; p=0.35), or DFS (HR 1.12; 95%CI 0.98-1.29; p=0.11). Grade 3 toxicity was 9.6% PBI v 7.1% WBI, and grade 4-5 toxicity was 0.5% v 0.3%, respectively.
Discussion: PBI did not meet the criteria for equivalence to WBI in controlling IBTR based on the upper limit of the hazard ratio confidence interval. However, the absolute difference in 10-yr rate of IBTR was <1% (4.8% PBI v 4.1% WBI). The risk of an RFI event was statistically significantly higher for PBI compared to WBI, but the absolute difference in 10-yr RFI rate was also small (8.1% PBI v 6.6% WBI). DDFI, OS, and DFS were not statistically different for PBI v WBI. Grade 3-5 toxicities, although low, were more common for PBI than WBI. The trial population was heterogeneous, ranging from Stage 0-2 breast cancer, and outcome by risk categories are being analyzed.
Support: U10CA180868, -180822, UG1CA189867.
Citation Format: Vicini FA, Cecchini RS, White JR, Julian TB, Arthur DW, Rabinovitch RA, Kuske RR, Parda DS, Ganz PA, Scheier MF, Winter KA, Paik S, Kuerer HM, Vallow LA, Pierce LJ, Mamounas EP, Costantino JP, Bear HD, Germaine I, Gustafson G, Grossheim L, Petersen IA, Hudes RS, Curran, Jr. WJ, Wolmark N. Primary results of NSABP B-39/RTOG 0413 (NRG Oncology): A randomized phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I, or II 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 GS4-04.
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Affiliation(s)
- FA Vicini
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RS Cecchini
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - JR White
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - TB Julian
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - DW Arthur
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RA Rabinovitch
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RR Kuske
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - DS Parda
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - PA Ganz
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - MF Scheier
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - KA Winter
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - S Paik
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - HM Kuerer
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - LA Vallow
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - LJ Pierce
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - EP Mamounas
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - JP Costantino
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - HD Bear
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - I Germaine
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - G Gustafson
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - L Grossheim
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - IA Petersen
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - RS Hudes
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - WJ Curran
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
| | - N Wolmark
- NRG Oncology, Pittsburgh; MHP Radiation Oncology Institute St. Jospeh's Mercy Hopsital, Pontiac; NRG Oncology/NSABP, Pittsburgh; University of Pittsburgh, Pittsburgh; Ohio State University Comprehensive Cancer Center, Columbus; Allegheny Health Network Cancer Institute, Pittsburgh; Virginia Commonwealth University, Richmond; University of Colorado Cancer Center, Aurora; Arizona Breast Cancer Specialists /Arizona Oncology Services, Scottsdale; University of California at Los Angeles, Los Angeles; Carnegie Mellon University, Pittsburgh; American College of Radiology, Reston; Severance Biomedical Science Institute and Yonsei University College of Medicine, Seoul, Korea; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic Florida, Jacksonville; University of Michigan Health System, Ann Arbor; Orlando Health UF Health Cancer Center, Orlando; CHU de Québec – Université Laval, Pavillon Hôtel-Dieu de Québec, Quebec City; CCOP William Beaumont Hospital, Royal Oak; West Michigan Cancer Center (WMCC), K
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Sehl ME, Henry JE, Storniolo AM, Horvath S, Ganz PA. Abstract P1-09-08: Hormonal factors associated with elevation of DNA methylation age in breast tissue of healthy women. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-09-08] [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: Healthy breast tissue appears older than matched peripheral blood, when using a biologic aging measurement based on DNA methylation markers. The underlying cause of this acceleration is not known. We hypothesize that cumulative estrogen exposure is associated with accelerated breast epigenetic aging. In this study, we examined factors associated with breast epigenetic age in a healthy population of women.
Methods: We used breast tissue samples from 232 healthy women donors (119 pre-menopausal, 113 post-menopausal) to the Komen Tissue Bank, with data available on variables related to cumulative estrogen exposure, including age at menarche, gravidity, parity, and menopausal status. DNA methylation experiments were performed using the Illumina EPIC 850K array platform. DNA methylation age (DNAm age) was calculated using the epigenetic clock methods developed by Horvath (2013). Total years of estrogen exposure was calculated as the difference between age at menopause (or current age) - number of live births x 9 months – number of miscarriages x 3 months. Nonparametric group testing was used to compare mean levels of the difference between DNAm age and chronologic age for pre- and post-menopausal groups. We examined the outcome “age acceleration”, calculated using the residuals of the regression of DNAm age versus chronologic age, because it is age-adjusted and independent of cell distribution. Multivariate linear regression models were used to examine for associations between age acceleration and each of our covariates.
Results: Our sample included women aged 19-90 years (mean age 50.7, SD 11.8), with 114 nulliparous women. We confirmed that DNAm age in breast tissue is strongly correlated with chronologic age (ρ=0.89, p<0.0001). The difference between DNAm age and chronologic age is greater at earlier ages, and is significantly greater in premenopausal women (mean 8.9 years, SE 0.04), compared with postmenopausal women (mean 2.7 years, SE 0.05) (p<0.0001). Age acceleration was significantly associated with earlier age at menarche (β=-0.395 for each year, p=0.036). For women with limited total years of exposure to estrogen (<19 years), there was a significant association between age acceleration and total estrogen exposure and β=0.673 for each year, p=0.028).
Conclusion: Acceleration of epigenetic age in breast tissues occurs in healthy women and is most pronounced in the pre-menopausal period. Earlier age at menarche and total years of estrogen exposure are associated with higher degree of acceleration, suggesting that cumulative estrogen exposure drives this process.
Citation Format: Sehl ME, Henry JE, Storniolo AM, Horvath S, Ganz PA. Hormonal factors associated with elevation of DNA methylation age in breast tissue of healthy women [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 P1-09-08.
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Affiliation(s)
- ME Sehl
- Univeristy of California, Los Angeles, Los Angeles, CA; Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN
| | - JE Henry
- Univeristy of California, Los Angeles, Los Angeles, CA; Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN
| | - AM Storniolo
- Univeristy of California, Los Angeles, Los Angeles, CA; Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN
| | - S Horvath
- Univeristy of California, Los Angeles, Los Angeles, CA; Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN
| | - PA Ganz
- Univeristy of California, Los Angeles, Los Angeles, CA; Susan G. Komen Tissue Bank at the Indiana University Simon Cancer Center, Indianapolis, IN
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Mamounas EP, Bandos H, White JR, Julian TB, Khan AJ, Shaitelman SF, Torres MA, Vicini FA, Ganz PA, McCloskey SA, Paik S, Gupta N, Li XA, DiCostanzo DJ, Curran WJ, Wolmark N. Abstract OT2-04-01: Phase III trial to determine if chest wall and regional nodal radiotherapy (CWRNRT) post mastectomy (Mx) or the addition of RNRT to whole breast RT post breast-conserving surgery (BCS) reduces invasive breast cancer recurrence-free interval (IBCR-FI) in patients (pts) with pathologically positive axillary (PPAx) nodes who are ypN0 after neoadjuvant chemotherapy (NC): NRG Oncology/NSABP B-51/RTOG 1304. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-04-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This phase III post-NC trial evaluates if CWRNRT post-Mx or whole breast irradiation (WBI) with RNRT after BCS significantly reduces the IBCR-FI rate in pts with PPAx nodes that are pathologically negative after NC. Secondary aims are OS, LRR-FI, DR-FI, DFS-DCIS, second primary cancer, and comparison of RT effect on cosmesis in reconstructed Mx pts. Correlative science examines RT effect by tumor subtype, molecular outcome predictors for residual disease, and predictors for the degree of reduction in loco-regional recurrence.
Methods: Clinical T1-3, N1 IBC PPAx nodes (FNA or core needle biopsy) pts complete ≥8 weeks of NC (anthracycline and/or taxane). HER2+ pts receive anti-HER2 therapy. Following NC, BCS or Mx, sentinel node biopsy (≥2 nodes) and/or Ax dissection with histologically negative nodes is performed. ER/PR and HER-2neu status before NC is required. Pts may receive appropriate adjuvant systemic therapy. Radiation credentialing with a facility questionnaire/case benchmark is required. Random assignment for Mx pts is to no CWRNRT or CWRNRT and for BCS pts to WBI or WBI+RNRT.
Statistics: 1,636 pts are to be enrolled over 5 yrs (definitive analysis at 7.5 yrs). Study is powered at 80% to test that RT reduces the annual hazard rate of events for IBCR-FI by 35% for an absolute risk reduction of 4.6% (5-yr cumulative rate). Intent-to-treat analysis with 3 interim analyses (43, 86, and 129 events) and a 4th/final analysis at 172 events. Pt-reported outcomes focusing on RT effect will be provided by 736 pts before random assignment and at 3, 6, 12, and 24 mos. Accrual as of 6-21-18 is 967 (59.11%).
Contacts: Protocol: CTSU member website https://www.ctsu.org. Questions: NRG Oncology Pgh Clin Coord Dpt: 1-800-477-7227 or ccd@nsabp.org. Pt entry: OPEN at https://open.ctsu.org or the OPEN tab on CTSU member website.
NCT01872975
Support: U10 CA-2166; -180868, -180822; 189867; Elekta
Citation Format: Mamounas EP, Bandos H, White JR, Julian TB, Khan AJ, Shaitelman SF, Torres MA, Vicini FA, Ganz PA, McCloskey SA, Paik S, Gupta N, Li XA, DiCostanzo DJ, Curran WJ, Wolmark N. Phase III trial to determine if chest wall and regional nodal radiotherapy (CWRNRT) post mastectomy (Mx) or the addition of RNRT to whole breast RT post breast-conserving surgery (BCS) reduces invasive breast cancer recurrence-free interval (IBCR-FI) in patients (pts) with pathologically positive axillary (PPAx) nodes who are ypN0 after neoadjuvant chemotherapy (NC): NRG Oncology/NSABP B-51/RTOG 1304 [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 OT2-04-01.
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Affiliation(s)
- EP Mamounas
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - H Bandos
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - JR White
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - TB Julian
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - AJ Khan
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - SF Shaitelman
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - MA Torres
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - FA Vicini
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - PA Ganz
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - SA McCloskey
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - S Paik
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - N Gupta
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - XA Li
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - DJ DiCostanzo
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - WJ Curran
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
| | - N Wolmark
- NRG Oncology, Pittsburgh, PA; NRG Oncology/NSABP, Pittsburgh, PA; Orlando Health UF Health Cancer Center, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; Ohio State University, Columbus, OH; Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA; Memorial Sloan Kettering Cancer Center, New York, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute at Emory University School of Medicine, Atlanta, GA; MPH Radiation Oncology Institute St. Joseph Mercy Hospital Campus, Pontiac, MI; University of California, Santa Monica, CA; Yonsei University College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI
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Di Meglio A, El-Mouhebb M, Michiels S, Carene D, Everhard S, Martin A, Cottu P, Lerebours F, Coutant C, Lesur A, Tredan O, Soulie P, Vanlemmens L, Arveux P, Delaloge S, Ganz P, André F, Partridge A, Jones L, Vaz-Luis I. Physical activity (PA) and patterns of quality of life (QOL) after adjuvant chemotherapy (CT) for breast cancer (BC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vaz Luis I, Di Meglio A, El-Mouhebb M, Dumas A, Charles C, Menvielle G, Mesleard C, Martin A, Cottu P, Lerebours F, Coutant C, Lesur A, Dauchy S, Arveux P, Delaloge S, Lin N, Ganz P, Partridge A, Michiels S, André F. Breast cancer (BC) related fatigue: A longitudinal investigation of its prevalence, domains and correlates. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schreiber T, Bäckert W, Ganz P, Christ A, Soltermann M, Ettlin T. Standardized evaluation of vocational reintegration abilities – The Rheinfelden modular assessment tool. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Pusztai L, Barlow WE, Ganz PA, Henry NL, White J, Jagsi R, Mammen JMV, Lew D, Mejia J, Karantza V, Aktan G, Sharon E, Korde L, Hortobagyi GN, Mamounas E. Abstract OT1-02-04: SWOG S1418/NRG -BR006: A randomized, phase III trial to evaluate the efficacy and safety of MK-3475 as adjuvant therapy for triple receptor-negative breast cancer with > 1 cm residual invasive cancer or positive lymph nodes (>pN1mic) after neoadjuvant chemotherapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with residual cancer after neoadjuvant chemotherapy, particularly triple negative cancers (TNBC), have poor prognosis.The SWOG S1418 / NRG BR-006 (NCT02954874) randomized, phase III trial tests the hypothesis that administration of pembrolizumab after surgery for 12 months will reduce invasive disease-free survival (IDFS) by 33% compared to observation in patients with TNBC and > 1 cm residual invasive cancer or positive lymph nodes (>pN1mic) after neoadjuvant chemotherapy.
Methods: Eligible patients ≥18 years old with triple negative breast cancer defined by ASCO/CAP guidelines and >1 cm residual invasive cancer in the breast, or any macrometastases in the lymph nodes after completion of 16-24 weeks of neoadjuvant chemotherapy. Patients may receive post-operative chemotherapy for up to 24 weeks but must be registered for screening within 35 days of completion of adjuvant chemo. Completion of radiation therapy prior to registration is allowed, but it is preferred that patients receive radiation after randomization; patients randomized to pembrolizumab will receive their XRT concomitant with pembrolizumab. Adequate organ functions: ANC > 1.5, PLT > 100, Hgb > 9, normal creatinine, Tbili < 1.5 IUNL, AST/ALT/AlkPhos < 2.5 IULN. HIV with good CD4 count is allowed. Active autoimmune disease, Hep B,C, prior immunotherapy, active immunosuppressive therapy, or live vaccines within 30 days of registration are not allowed. Five unstained slides for PDL1 staining are required for stratification. The study has a dual primary endpoint; comparison of IDFS between arms in (i) all randomized patients (1-sided a=0.01) and in PDL-1 positive patients (1-sided a=0.015). Secondary endpoints include toxicity, overall survival, distant recurrence free survival (DRFS) and quality of life measures. Patients will be randomized 1:1 with stratification for PDL1 status, T size, nodal status and adjuvant chemo (yes or no) to observation or 1 year of pembrolizumab 200mg IV q 3 weeks. The accrual goal is N=1000 patients with estimated trial duration of 8 years. Two interim analyses are planned for all randomized patients when 50% and 75% of IDFS events have occurred for early stopping for either futility or efficacy. The study was activated on 11/15/16 and 34 patients were registered as of June 9, 2017. Cancer Trials Support Unit (CTSU) sites can use “OPEN” (https://open.ctsu.org) to enroll patients to this trial.
Funding: NIH/NCI U10CA180888, U10CA180819, CA180868; and in part by Merck, Sharpe & Dohme, Corporation.
Citation Format: Pusztai L, Barlow WE, Ganz PA, Henry NL, White J, Jagsi R, Mammen JMV, Lew D, Mejia J, Karantza V, Aktan G, Sharon E, Korde L, Hortobagyi GN, Mamounas E. SWOG S1418/NRG -BR006: A randomized, phase III trial to evaluate the efficacy and safety of MK-3475 as adjuvant therapy for triple receptor-negative breast cancer with > 1 cm residual invasive cancer or positive lymph nodes (>pN1mic) after neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-04.
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Affiliation(s)
- L Pusztai
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - WE Barlow
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - PA Ganz
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - NL Henry
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - J White
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - R Jagsi
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - JMV Mammen
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - D Lew
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - J Mejia
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - V Karantza
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - G Aktan
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - E Sharon
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - L Korde
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - GN Hortobagyi
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
| | - E Mamounas
- Yale Cancer Center; SWOG Statistical Center; University of California Los Angeles; Huntsman Cancer Institute; Ohio State University Medical Center; University of Michigan; Cansas University Medical Center; Merck and Company; National Cancer Institute; University of Texas MD Andrson Cancer Center; Orlando Health Cancer Center
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Frampton MW, Balmes JR, Bromberg PA, Stark P, Arjomandi M, Hazucha MJ, Rich DQ, Hollenbeck-Pringle D, Dagincourt N, Alexis N, Ganz P, Zareba W, Costantini MG. Multicenter Ozone Study in oldEr Subjects (MOSES): Part 1. Effects of Exposure to Low Concentrations of Ozone on Respiratory and Cardiovascular Outcomes. Res Rep Health Eff Inst 2017; 2017:1-107. [PMID: 31898880 PMCID: PMC7266375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Exposure to air pollution is a well-established risk factor for cardiovascular morbidity and mortality. Most of the evidence supporting an association between air pollution and adverse cardiovascular effects involves exposure to particulate matter (PM). To date, little attention has been paid to acute cardiovascular responses to ozone, in part due to the notion that ozone causes primarily local effects on lung function, which are the basis for the current ozone National Ambient Air Quality Standards (NAAQS). There is evidence from a few epidemiological studies of adverse health effects of chronic exposure to ambient ozone, including increased risk of mortality from cardiovascular disease. However, in contrast to the well-established association between ambient ozone and various nonfatal adverse respiratory effects, the observational evidence for impacts of acute (previous few days) increases in ambient ozone levels on total cardiovascular mortality and morbidity is mixed. Ozone is a prototypic oxidant gas that reacts with constituents of the respiratory tract lining fluid to generate reactive oxygen species (ROS) that can overwhelm antioxidant defenses and cause local oxidative stress. Pathways by which ozone could cause cardiovascular dysfunction include alterations in autonomic balance, systemic inflammation, and oxidative stress. These initial responses could lead ultimately to arrhythmias, endothelial dysfunction, acute arterial vasoconstriction, and procoagulant activity. Individuals with impaired antioxidant defenses, such as those with the null variant of glutathione S-transferase mu 1 (GSTM1), may be at increased risk for acute health effects. The Multicenter Ozone Study in oldEr Subjects (MOSES) was a controlled human exposure study designed to evaluate whether short-term exposure of older, healthy individuals to ambient levels of ozone induces acute cardiovascular responses. The study was designed to test the a priori hypothesis that short-term exposure to ambient levels of ozone would induce acute cardiovascular responses through the following mechanisms: autonomic imbalance, systemic inflammation, and development of a prothrombotic vascular state. We also postulated a priori the confirmatory hypothesis that exposure to ozone would induce airway inflammation, lung injury, and lung function decrements. Finally, we postulated the secondary hypotheses that ozone-induced acute cardiovascular responses would be associated with: (a) increased systemic oxidative stress and lung effects, and (b) the GSTM1-null genotype. METHODS The study was conducted at three clinical centers with a separate Data Coordinating and Analysis Center (DCAC) using a common protocol. All procedures were approved by the institutional review boards (IRBs) of the participating centers. Healthy volunteers 55 to 70 years of age were recruited. Consented participants who successfully completed the screening and training sessions were enrolled in the study. All three clinical centers adhered to common standard operating procedures (SOPs) and used common tracking and data forms. Each subject was scheduled to participate in a total of 11 visits: screening visit, training visit, and three sets of exposure visits, each consisting of the pre-exposure day, the exposure day, and the post-exposure day. The subjects spent the night in a nearby hotel the night of the pre-exposure day. On exposure days, the subjects were exposed for three hours in random order to 0 ppb ozone (clean air), 70 ppb ozone, and 120 ppm ozone, alternating 15 minutes of moderate exercise with 15 minutes of rest. A suite of cardiovascular and pulmonary endpoints was measured on the day before, the day of, and up to 22 hours after, each exposure. The endpoints included: (1) electrocardiographic changes (continuous Holter monitoring: heart rate variability [HRV], repolarization, and arrhythmia); (2) markers of inflammation and oxidative stress (C-reactive protein [CRP], interleukin-6 [IL-6], 8-isoprostane, nitrotyrosine, and P-selectin); (3) vascular function measures (blood pressure [BP], flow-mediated dilatation [FMD] of the brachial artery, and endothelin-1 [ET-1]; (4) venous blood markers of platelet activation, thrombosis, and microparticle-associated tissue factor activity (MP-TFA); (5) pulmonary function (spirometry); (6) markers of airway epithelial cell injury (increases in plasma club cell protein 16 [CC16] and sputum total protein); and (7) markers of lung inflammation in sputum (polymorphonuclear leukocytes [PMN], IL-6, interleukin-8 [IL-8], and tumor necrosis factor-alpha [TNF-α]). Sputum was collected only at 22 hours after exposure. The analyses of the continuous electrocardiographic monitoring, the brachial artery ultrasound (BAU) images, and the blood and sputum samples were carried out by core laboratories. The results of all analyses were submitted directly to the DCAC. The variables analyzed in the statistical models were represented as changes from pre-exposure to post-exposure (post-exposure minus pre-exposure). Mixed-effect linear models were used to evaluate the impact of exposure to ozone on the prespecified primary and secondary continuous outcomes. Site and time (when multiple measurements were taken) were controlled for in the models. Three separate interaction models were constructed for each outcome: ozone concentration by subject sex; ozone concentration by subject age; and ozone concentration by subject GSTM1 status (null or sufficient). Because of the issue of multiple comparisons, the statistical significance threshold was set a priori at P < 0.01. RESULTS Subject recruitment started in June 2012, and the first subject was randomized on July 25, 2012. Subject recruitment ended on December 31, 2014, and testing of all subjects was completed by April 30, 2015. A total of 87 subjects completed all three exposures. The mean age was 59.9 ± 4.5 years, 60% of the subjects were female, 88% were white, and 57% were GSTM1 null. Mean baseline body mass index (BMI), BP, cholesterol (total and low-density lipoprotein), and lung function were all within the normal range. We found no significant effects of ozone exposure on any of the primary or secondary endpoints for autonomic function, repolarization, ST segment change, or arrhythmia. Ozone exposure also did not cause significant changes in the primary endpoints for systemic inflammation (CRP) and vascular function (systolic blood pressure [SBP] and FMD) or secondary endpoints for systemic inflammation and oxidative stress (IL-6, P-selectin, and 8-isoprostane). Ozone did cause changes in two secondary endpoints: a significant increase in plasma ET-1 (P = 0.008) and a marginally significant decrease in nitrotyrosine (P = 0.017). Lastly, ozone exposure did not affect the primary prothrombotic endpoints (MP-TFA and monocyte-platelet conjugate count) or any secondary markers of prothrombotic vascular status (platelet activation, circulating microparticles [MPs], von Willebrand factor [vWF], or fibrinogen.). Although our hypothesis focused on possible acute cardiovascular effects of exposure to low levels of ozone, we recognized that the initial effects of inhaled ozone involve the lower airways. Therefore, we looked for: (a) changes in lung function, which are known to occur during exposure to ozone and are maximal at the end of exposure; and (b) markers of airway injury and inflammation. We found an increase in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) after exposure to 0 ppb ozone, likely due to the effects of exercise. The FEV₁ increased significantly 15 minutes after 0 ppb exposure (85 mL; 95% confidence interval [CI], 64 to 106; P < 0.001), and remained significantly increased from pre-exposure at 22 hours (45 mL; 95% CI, 26 to 64; P < 0.001). The increase in FVC followed a similar pattern. The increase in FEV₁ and FVC were attenuated in a dose-response manner by exposure to 70 and 120 ppb ozone. We also observed a significant ozone-induced increase in the percentage of sputum PMN 22 hours after exposure at 120 ppb compared to 0 ppb exposure (P = 0.003). Plasma CC16 also increased significantly after exposure to 120 ppb (P < 0.001). Sputum IL-6, IL-8, and TNF-α concentrations were not significantly different after ozone exposure. We found no significant interactions with sex, age, or GSTM1 status regarding the effect of ozone on lung function, percentage of sputum PMN, or plasma CC16. CONCLUSIONS In this multicenter clinical study of older healthy subjects, ozone exposure caused concentration-related reductions in lung function and presented evidence for airway inflammation and injury. However, there was no convincing evidence for effects on cardiovascular function. Blood levels of the potent vasoconstrictor, ET-1, increased with ozone exposure (with marginal statistical significance), but there were no effects on BP, FMD, or other markers of vascular function. Blood levels of nitrotyrosine decreased with ozone exposure, the opposite of our hypothesis. Our study does not support acute cardiovascular effects of low-level ozone exposure in healthy older subjects. Inclusion of only healthy older individuals is a major limitation, which may affect the generalizability of our findings. We cannot exclude the possibility of effects with higher ozone exposure concentrations or more prolonged exposure, or the possibility that subjects with underlying vascular disease, such as hypertension or diabetes, would show effects under these conditions.
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Affiliation(s)
- M W Frampton
- University of Rochester Medical Center, Rochester, New York
| | | | | | - P Stark
- New England Research Institute, Watertown, Massachusetts
| | | | | | - D Q Rich
- University of Rochester Medical Center, Rochester, New York
| | | | - N Dagincourt
- New England Research Institute, Watertown, Massachusetts
| | - N Alexis
- University of North Carolina, Chapel Hill
| | - P Ganz
- University of California, San Francisco
| | - W Zareba
- University of Rochester Medical Center, Rochester, New York
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Thind A, Olagunju T, Liu Y, Griggs J, Ganz P, Maly R. Disparities in the survivorship experience among Latina breast cancer survivors. Breast 2017. [DOI: 10.1016/s0960-9776(17)30213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Mamounas EP, Bandos H, White JR, Julian TB, Khan AJ, Shaitelman SF, Torres MA, Vicini FA, Ganz PA, McCloskey SA, Paik S, Gupta N, Li XA, DiCostanzo DJ, Curran WJ, Wolmark N. Abstract OT2-03-01: NRG oncology/NSABP B-51/RTOG 1304: A phase III superiority clinical trial designed to determine if chest wall and regional nodal radiotherapy (CWRNRT) post mastectomy (Mx) or the addition of RNRT to breast RT post breast-conserving surgery (BCS) will reduce invasive cancer events in patients (pts) with positive axillary (Ax) nodes and convert to ypN0 after neoadjuvant chemotherapy (NC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-03-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
This phase III post-NC trial evaluates if CWRNRT post Mx or whole breast irradiation (WBI) with RNRT after BCS significantly reduces the invasive breast cancer recurrence-free interval (IBC-RFI) rate in pts presenting with positive Ax nodes that are pathologically negative after NC. Secondary aims are OS, LRRFI, DRFI, DFS-DCIS, and second primary cancer, as well as comparing RT effect on cosmesis in reconstructed Mx pts.
Correlative science studies examine RT effect by tumor subtype, molecular outcome predictors for residual disease pts, and predictors for the degree of reduction in loco-regional recurrence.
Methods:
Clinical T1-3, N1 IBC pts with positive Ax nodes (FNA or core needle biopsy) complete ≥8 wks of NC (anthracycline and/or taxane). HER2-positive pts receive anti-HER2 therapy (tx). After NC, BCS or Mx is performed with a sentinel node biopsy (≥2 nodes) and/or Ax dissection with histologically negative nodes. ER/PR and HER2 neu status before NC is required. Pts receive required systemic tx. Radiation credentialing with a facility questionnaire and a case benchmark is required. Randomization for Mx pts is to no CWRNRT or CWRNRT and for BCS pts to WBI or WBI+RNRT.
Statistics:
1636 pts to be enrolled over 5 yrs with definitive analysis at 7.5 yrs. Study is powered at 80% to test that RT reduces the annual hazard rate of events for IBCR-FI by 35% for an absolute risk reduction in the 5-yr cumulative rate of 4.6%. Intent-to-treat analysis with 3 interim analyses at 43, 86, and 129 events, with a 4th/final analysis at 172 events will occur. Accrual as of 6/13/16 is 356. Pt-reported outcomes focusing on RT effect will be obtained from 736 pts before randomization and at 3, 6, 12, and 24 months.
Contacts:
Protocol: CTSU member website https://www.ctsu.org. Questions: NRG Oncology Pgh Clin Coord Dpt: 1-800-477-7227 or ccd@nsabp.org. Pt entry: OPEN at https://open.ctsu.org or the OPEN tab on CTSU member website.
Support: U10 CA-2166; -180868, -180822; -189867; Elekta.
Citation Format: Mamounas EP, Bandos H, White JR, Julian TB, Khan AJ, Shaitelman SF, Torres MA, Vicini FA, Ganz PA, McCloskey SA, Paik S, Gupta N, Li XA, DiCostanzo DJ, Curran, Jr WJ, Wolmark N. NRG oncology/NSABP B-51/RTOG 1304: A phase III superiority clinical trial designed to determine if chest wall and regional nodal radiotherapy (CWRNRT) post mastectomy (Mx) or the addition of RNRT to breast RT post breast-conserving surgery (BCS) will reduce invasive cancer events in patients (pts) with positive axillary (Ax) nodes and convert to ypN0 after neoadjuvant chemotherapy (NC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT2-03-01.
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Affiliation(s)
- EP Mamounas
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - H Bandos
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - JR White
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - TB Julian
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - AJ Khan
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - SF Shaitelman
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - MA Torres
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - FA Vicini
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - PA Ganz
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - SA McCloskey
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - S Paik
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - N Gupta
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - XA Li
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - DJ DiCostanzo
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - WJ Curran
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
| | - N Wolmark
- NRG Oncology/NSABP (NSABP Legacy Trials Are Now Part of the NRG Oncology Portfolio), Pittsburgh, PA; UF Health Cancer Center at Orlando Health, Orlando, FL; University of Pittsburgh, Pittsburgh, PA; NRG Oncology/RTOG, Philadelphia, PA; Ohio State University, Columbus, OH; Allegheny Health Network Cancer Institute, Pittsburgh, PA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ; University of Texas MD Anderson Cancer Center, Houston, TX; Winship Cancer Institute Emory University, Atlanta, GA; St. Joseph Mercy Oakland, Pontiac, MI; University of California at Los Angeles, Los Angeles, CA; Severance Biomedical Sci Inst and Yonsei Univ College of Medicine, Seoul, Korea; Medical College of Wisconsin, Milwaukee, WI; The Ohio State University Wexner Medical Center, Columbus, OH
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Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Abstract S6-04: Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The clinical results of NSABP B-35, phase III trial comparing 1 mg/day A to 20 mg/day tam, each given for 5 years, were reported at ASCO 2015. B-35 demonstrated a statistically significant benefit in breast cancer free interval for women assigned to A, primarily in women <60 years. A secondary endpoint of B-35 was quality of life (QOL) and symptom (SX) outcomes in the two treatment groups. The primary hypotheses of the PRO study were that there would be no differences in QOL between the two treatments, and that patients receiving A would report higher rates of hot flashes compared to patients receiving tam. Other SX comparisons were secondary endpoints.
Methods
QOL and SX were assessed at baseline (prior to randomization), and every 6 months thereafter for 5 years of treatment and in the following 12 months. QOL was measured with the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS). SX were measured with selected scales from the BCPT symptom-checklist, and other standardized instruments. Stratification was by age (<60 v ≥60) as in the main trial. Study hypotheses and endpoints were examined by comparing PROs in the two treatment arms using a mixed model for repeated measures analysis with adjustment for the baseline scores, time point and age category, using an intention-to-treat principle and including only patients who completed the baseline and at least one follow-up questionnaire. Patients with protocol events were censored. Only data through 60 months are reported here. The accrual goal for the sub-study was 1,150 consecutive patients.
Results
Between January 6, 2003 and June 15, 2006, a total of 3,104 patients were entered and randomly assigned to NSABP Protocol B-35. Accrual to the PRO study of B-35 closed on December 28, 2004, at which time 1,275 patients were entered, with 1,193 patients included in this analysis. There were no medical or demographic differences between patients assigned to A or tam in the PRO sub-study, and they reflected the characteristics of the parent trial. Adherence to data collection across the 60 months was 87%. There were no significant differences in QOL outcomes by treatment for the PCS (p=0.16) or the MCS (p=0.38). SX subscales: hot flash scale was greater in tam group and this difference varied over time (p=0.001); musculoskeletal pain was significantly greater in A group for time points 6-24 months (all p<.001); vaginal problems were greater in A group (p=0.03). Hot flash and vaginal problems were significantly worse in women <60 years. Additional SX outcomes (depression, fatigue, sexual function) will be reported at presentation.
Conclusion
In this large, double-blind, placebo-controlled trial comparing A to tam in patients with DCIS, there was no significant difference in QOL between the two treatments. However, there were important treatment differences in SX outcomes, which should be considered as part of treatment decision-making discussions, along with the clinical breast cancer outcome results.
Support: CA-180868, 180822, 189867, 196067, 114732; AstraZeneca Pharmaceuticals LP.
Citation Format: Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S6-04.
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Affiliation(s)
- PA Ganz
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - RS Cecchini
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TB Julian
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - RG Margolese
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - JP Costantino
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - LA Vallow
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - KS Albain
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - PW Whitworth
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - ME Cianfrocca
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - A Brufsky
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - HM Gross
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - GS Soori
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - JO Hopkins
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - L Fehrenbacher
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - K Sturtz
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TF Wozniak
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TE Seay
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - EP Mamounas
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - N Wolmark
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
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Selwyn AP, Vita JA, Vekshtein VI, Yeung A, Ryan T, Ganz P. Myocardial ischemia: pathogenic role of disturbed vasomotion and endothelial dysfunction in coronary atherosclerosis. Adv Cardiol 2015; 37:42-52. [PMID: 2220464 DOI: 10.1159/000418816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- A P Selwyn
- Department of Medicine, Brigham and Women's Hospital, Boston, Mass
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McCloskey S, Bandos H, Julian T, Kopec J, Wolmark N, Anderson S, Krag D, Mamounas E, Ganz P. The Impact of Radiation Therapy on Lymphedema Risk and the Agreement Between Subjective and Objective Lymphedema Measures: NSABP B-32 Secondary Data Analysis. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pomykala KL, Ganz PA, Bower JE, Kwan L, Castellon SA, Mallam S, Cheng I, Ahn R, Breen EC, Irwin MR, Silverman DHS. The association between pro-inflammatory cytokines, regional cerebral metabolism, and cognitive complaints following adjuvant chemotherapy for breast cancer. Brain Imaging Behav 2014; 7:511-23. [PMID: 23835929 DOI: 10.1007/s11682-013-9243-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To examine relationships following adjuvant chemotherapy between circulating pro-inflammatory cytokines, regional cerebral metabolism, and cognitive complaints in early stage breast cancer patients. 33 breast cancer patients who had completed initial treatment (surgery, ± radiation, 23 chemotherapy, 10 no chemotherapy) obtained resting (18)F-FDG PET/CT brain imaging at baseline and 1 year later. Pro-inflammatory cytokine markers (IL-1ra, sTNF-RII, CRP, and IL-6) and cognitive complaints were also assessed at both time points. At baseline, consistent correlations were seen between the left medial frontal and right inferior lateral anterior temporal cortices and inflammatory markers within the chemotherapy group, and not in the no chemotherapy group. After 1 year, correlations persisted in the medial frontal cortex and the temporal cortex, the latter shifting superiorly. Both of these regional correlations demonstrated the highest levels of significance when looking across the 1 year time frame (IL-1ra: peak voxel p < 0.0005; cluster size p < 0.0005, p = 0.001 after correction (medial prefrontal), p < 0.0005; cluster size p = 0.001, p = 0.029 corr. (anterior temporal), sTNF-RII: p < 0.0005; cluster size p = 0.001, p = 0.040 corr. (medial prefrontal)). Positive correlations were also seen within the chemotherapy group between baseline memory complaints and the medial frontal (p < 0.0005; cluster size p < 0.0005, p < 0.0005 corr.) and anterior temporal (p < 0.0005; cluster size p < 0.0005, p = 0.002 corr.) cortices at baseline and 1 year later. Metabolism in the medial prefrontal cortex and anterior temporal cortex was found to correlate with both memory complaints and cytokine marker levels in chemotherapy patients.
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Affiliation(s)
- K L Pomykala
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite B114, Mail Code: 737024, Los Angeles, CA, 90095-7370, USA
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20
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Ganz PA. Abstract ES4-2: Cognitive Changes and Breast Cancer Treatments. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-es4-2] [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
Cognitive difficulties after cancer treatment are among the most feared outcomes voiced by patients who are approaching the start of chemotherapy. This phenomenon, sometimes referred to as “chemo brain” or “chemo fog,” is quite common during the acute course of chemotherapy treatment. This may result from direct antieneoplastic drug toxicity, use of premedications and anxiolytics to prevent nausea and vomiting, as well as the expected anxiety, depression, and sleep deprivation that accompanies a new diagnosis of cancer and initiation of treatment. For most patients, this fog clears after the completion of acute treatments, and as with many physical symptoms, resolves in the following months. However, 15–25% of post-treatment patients, cognitive complaints persist long after treatment ends. Reports of difficulty concentrating, remembering recent events, multi-tasking, and paying attention are frequent in such patients. For those used to carrying on demanding executive function activities prior to cancer treatment, this can lead to substantial disruption in work and home life. Most of the studies conducted to date with early stage breast cancer have not accounted for the impact of adjuvant endocrine therapy alone or added to adjuvant chemotherapy. This presentation will review emerging data regarding self-reported cognitive complaints, neuropsychological testing, and brain imaging as they related to adjuvant therapies for breast cancer. In addition, some of the developing information about potential mechanisms associated with this late effect will be discussed.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr ES4-2.
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Affiliation(s)
- PA Ganz
- University of California, Los Angeles
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21
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Cardoso F, Costa A, Norton L, Cameron D, Cufer T, Fallowfield L, Francis P, Gligorov J, Kyriakides S, Lin N, Pagani O, Senkus E, Thomssen C, Aapro M, Bergh J, Di Leo A, El Saghir N, Ganz PA, Gelmon K, Goldhirsch A, Harbeck N, Houssami N, Hudis C, Kaufman B, Leadbeater M, Mayer M, Rodger A, Rugo H, Sacchini V, Sledge G, van't Veer L, Viale G, Krop I, Winer E. 1st International consensus guidelines for advanced breast cancer (ABC 1). Breast 2012; 21:242-52. [PMID: 22425534 DOI: 10.1016/j.breast.2012.03.003] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The 1st international Consensus Conference for Advanced Breast Cancer (ABC 1) took place on November 2011, in Lisbon. Consensus guidelines for the management of this disease were developed. This manuscript summarizes these international consensus guidelines.
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Affiliation(s)
- F Cardoso
- European School of Oncology & Breast Unit, Champalimaud Cancer Center, Lisbon, Portugal.
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22
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Fehrenbacher L, Jeong JH, Rastogi P, Geyer CE, Paik S, Ganz PA, Land SR, Costantino JP, Swain SM, Mamounas EP, Wolmark N. OT1-02-07: NSABP B-47: A Randomized Phase III Trial of Adjuvant Therapy Comparing Chemotherapy Alone (Six Cycles of Docetaxel Plus Cyclophosphamide or Four Cycles of Doxorubicin Plus Cyclophosphamide Followed by Weekly Paclitaxel) to Chemotherapy Plus Trastuzumab in Women with Node-Positive or High-Risk Node-Negative HER2−Low Invasive Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot1-02-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Adjuvant studies utilizing trastuzumab in early HER2+ breast cancer demonstrated a large reduction in recurrence and death. Post-enrollment central testing showed HER2 non-amplified participants derived similar benefit. Among HER2−amplified patients, multiple studies showed no effect on benefit by degree of amplification. Extensive testing including blinded external review confirmed the non-amplified nature of the HER2 normal group. Detailed relevant background and confirmatory studies will be provided. As a result of these findings, NSABP study B-47, sponsored by the NCI, was activated January 2011. The study is NCI central IRB approved, open in the CTSU, and endorsed by SWOG as of April 2011.
Study: Selection of one of the two chemotherapy regimens is by physician choice: The non-anthracycline regimen is TC (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2) administered IV every 3 weeks for 6 cycles; the anthracycline regimen is AC followed by WP (doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 administered IV either every 3 weeks or every 2 weeks [per investigator discretion] for 4 cycles followed by paclitaxel 80 mg/m2 IV weekly for 12 doses). Patients will be randomly assigned to receive chemotherapy with or without trastuzumab therapy. For patients receiving the TC chemotherapy regimen, trastuzumab will be given every 3 weeks during and following chemotherapy until 1 year after the first trastuzumab dose (8 mg/kg loading dose; 6 mg/kg for the remaining doses). For patients receiving the AC followed by WP chemotherapy regimen, trastuzumab will begin with the first dose of weekly paclitaxel and will be given weekly for 12 doses (4 mg/kg loading dose; 2 mg/kg for the remaining weekly doses). Following completion of WP, trastuzumab therapy will continue with 6 mg/kg doses given every 3 weeks for a total of 1 year. Patients will also receive adjuvant radiation therapy and endocrine therapy, as clinically indicated.
Detailed menstrual history, concurrent medications, weight changes, and biomarkers (estrogen, stress, inflammation status) will be collected throughout the study. Collection of circulating tumor cells as an ancillary study is planned.
Eligibility: Eligibility includes: node positive or high risk node negative female breast cancer patients; HER2 IHC 1+ or 2+ scores, but non amplified by FISH; normal cardiac, renal, and liver function. Detailed eligibility will be provided.
Statistical: The primary aim is to determine whether the addition of trastuzumab to chemotherapy improves invasive disease-free survival (IDFS). 3260 patients will be enrolled to provide statistical power of 0.9 to detect a 33% reduction in the hazard rate of IDFS using a one-sided alpha level of 0.025. Projected accrual time is approximately 3 years.
Progress: Protocol was activated in January 2011. First patient was entered in February 2011. As of June 16, 2011, 115 of 3260 patients have been enrolled. Supported by NCI U10-12027, -37377, 69651, 69974, and Genentech, Inc.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-02-07.
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Affiliation(s)
- L Fehrenbacher
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - J-H Jeong
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - P Rastogi
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - CE Geyer
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - S Paik
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - PA Ganz
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - SR Land
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - JP Costantino
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - SM Swain
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - EP Mamounas
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
| | - N Wolmark
- 1National Surgical Adjuvant Breast and Bowel Project (NSABP) Operations and Biostatistical Centers; Kaiser Permanente, Northern California; University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine; Allegheny General Hospital; Jonsson Comprehensive Cancer Center at UCLA; Washington Cancer Institute, Washington Hospital Center; Aultman Health Foundation
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Cescon DW, Ganz PA, Hallak S, Ennis M, Mills BK, Goodwin PJ. Abstract P5-13-09: Feasibility of a Randomized Controlled Trial of Vitamin D vs. Placebo in Recently Diagnosed Breast Cancer Patients. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-13-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Vitamin D (Vit D) supplementation is an area of interest in the primary and secondary prevention of many cancers. We previously reported a high prevalence of Vit D insufficiency and deficiency in newly diagnosed breast cancer (BC) patients. Low Vit D levels were associated with poor BC outcomes. Here we evaluate the state of Vit D adequacy and supplementation in a more recently diagnosed cohort of BC patients from 2 large urban centres, and we examine the feasibility of a placebo-controlled randomized trial (RCT) of supplementation in this population. Patients and Methods: Women diagnosed with T1-3, N0-3, M0 invasive BC within the previous 2 years were prospectively identified from institutional registries and recruited from Mount Sinai Hospital, Toronto and UCLA, Los Angeles (LA), between March 2009 and January 2010. Anthropometric measurements were performed, and dietary, lifestyle and medication histories were obtained using structured questionnaires and interviews. Tumor and treatment characteristics were obtained from clinical records; blood samples were collected for analysis of Vit D levels. The pre-specified feasibility criteria for a Vit D (vs placebo) RCT were: ≥30% of patients with (i) deficient or insufficient Vit D levels, (ii) taking ≥1000 IU Vit D/day and (iii) willing to participate in such a trial.
Results: 173 eligible patients were enrolled (80 Toronto, 93 LA). Median age at enrollment was 57 years; 73.4% were post-menopausal. Median tumor size (1.8 cm), lymph node involvement (39%), ER (80%), PR (65%) and Her2 (15%) positivity were similar between centres. Treatment characteristics including rates of mastectomy (44%), adjuvant chemotherapy (56%), radiation (68%), hormonal therapy (69%) and trastuzumab (14%) did not differ between centres. 84.4% of women reported use of Vit D containing supplements, with median daily doses of 1200 IU (Toronto) and 1400 IU (LA) (p=0.3) among users. Respective median 25-OH Vit D levels were 85.5 nmol/L (34.3 ng/mL) and 98.5 nmol/L (39.5 ng/mL) (p=0.04), and rates of deficiency, insufficiency and adequacy were 3.8%, 23.8%, 72.5% (Toronto) and 4.3%, 20.7%, 75.0% (LA) (p=0.88). No Vit D levels were in the toxic range. 25-OH Vit D levels correlated with Vit D supplement use (r=0.41, P<0.0001). 68% of women expressed willingness to participate in a Vit D RCT; however, only 12.7% of the study population met the pre-specified feasibility criteria.
Conclusions: Vit D levels and supplementation rates are substantially higher in these BC patients than in previous cohorts, though more than 25% of women do not have adequate levels. Rates of adequacy did not
differ between patients recruited in Toronto and LA. While the maj ority of women would be willing to participate in an RCT of Vit D supplementation, low levels of deficiency/insufficiency and high rates of supplement use may limit the feasibility of such a study. Funded by the Breast Cancer Research Foundation.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-13-09.
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Affiliation(s)
- DW Cescon
- Mount Sinai and Princess Margaret Hospitals, University of Toronto, ON, Canada; Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine & Public Health, Los Angeles, CA
| | - PA Ganz
- Mount Sinai and Princess Margaret Hospitals, University of Toronto, ON, Canada; Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine & Public Health, Los Angeles, CA
| | - S Hallak
- Mount Sinai and Princess Margaret Hospitals, University of Toronto, ON, Canada; Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine & Public Health, Los Angeles, CA
| | - M Ennis
- Mount Sinai and Princess Margaret Hospitals, University of Toronto, ON, Canada; Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine & Public Health, Los Angeles, CA
| | - BK Mills
- Mount Sinai and Princess Margaret Hospitals, University of Toronto, ON, Canada; Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine & Public Health, Los Angeles, CA
| | - PJ. Goodwin
- Mount Sinai and Princess Margaret Hospitals, University of Toronto, ON, Canada; Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine & Public Health, Los Angeles, CA
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Phillips M, Haines M, Peck E, Lee H, Phillips B, Wein B, Bekenstein J, O'Grady J, Schoenberg M, Ogrocki P, Maddux B, Whitney C, Gould D, Riley D, Maciunas R, Espe-Pfeifer P, Arguello J, Taber S, Duff K, Fields A, Newby R, Weissgerber K, Epping A, Panepinto J, Scott P, Reesman J, Zabel A, Wodka E, Ferenc L, Comi A, Cohen N, Bigelow S, McCrea Jones L, Sandoval R, Vilar-Lopez R, Puente N, Hidalgo-Ruzante N, Bure A, Ojeda C, Puente A, Zolten A, Mallory L, Heyanka D, Golden C, McCue R, Heyanka D, Mackelprang J, Reuther B, Golden C, Odland A, Scarisbrick D, Heyanka D, Martin P, Golden C, Mazur-Mosiewicz A, Holcomb M, Dean R, Schneider J, Morgan D, Scott J, Leber W, Adams R, Marceaux J, Triebel K, Griffith H, Gifford K, Potter E, Webbe F, Barker W, Loewenstein D, Duara R, Gifford K, Mahaney T, Srinivasan V, Cummings T, Frankl M, Bayan R, Webbe F, Mulligan K, Duncan N, Greenaway M, Sakamoto M, Spiers M, Libon D, Pimontel M, Gavett B, Jefferson A, Nair A, Green R, Stern R, Mahaney T, Frankl M, Cummings T, Mulligan K, Webbe F, Lou K, Gavett B, Jefferson A, Nair A, Green R, Morere D, Gifford K, Ferro J, Ezrine G, Kiefel J, Hinton V, Greco S, Corradino G, Pantone J, MacLeod R, Stern R, Hart J, Lavach J, Pick L, Szymanski C, Ilardi D, Marcus D, Burns T, Mahle W, Jenkins P, Davis A, McDermott A, Pierson E, Freeman Floyd E, McIntosh D, Dixon F, Davis A, Boseck J, Berry K, Whited A, Gelder B, Davis A, Dodd J, Berry K, Boseck J, Koehn E, Gelder B, Riccio C, Kahn D, Perez E, Reynolds C, Scott M, Nguyen-Driver M, Ruchinskas R, Lennen D, Steiner R, Sikora D, Freeman K, Carboni J, Fong G, Fong G, Carboni J, Whigham K, O'Toole K, Schneider B, Burns T, Olivier T, Nemeth D, Whittington L, Moreau A, Webb N, Weimer M, Gontier J, Labrana J, Rioseco F, Lichtenberg P, Puente A, Puente A, Bure A, Buddin H, Teichner G, Golden C, Pacheco E, Chong J, Gold S, Mittenberg W, Miller A, Bruce J, Hancock L, Peterson S, Jacobson J, Guse E, Tyrer J, Lasater J, Fritz J, Lynch S, Yarger L, Bryant K, Zychowski L, Nippoldt-Baca L, Lehman C, Arffa S, Marceaux J, Dilks L, Arthur A, Myers B, Levy J, Blancett S, Martincin K, Thrasher A, Koushik N, McArthur S, Baird A, Foster P, Drago V, Yung R, Crucian G, Heilman K, Castellon S, Livers E, Oppenheim A, Carter C, Ganz P, San Miguel-Montes L, Escabi-Quiles Y, Allen D, Gavett B, Stern R, Nowinski C, Cantu R, Martukovich R, McKee A, Davis A, Roberds E, Lutz J, Williams R, Gupta A, Schoenberg M, Werz M, Maciunas R, Koubeissi M, Poreh A, Luders H, Barwick F, Arnett P, Morse C, Gonzalez-Heydrich J, Luna L, Rao S, McClendon J, Rotelle P, Waber D, Holland A, Boyer K, Faraone S, Whitney J, Guild D, Biederman J, Baerwald J, Ryan G, Baerwald J, Ryan G, Guerrero J, Carmona J, Parsons T, Rizzo A, Lance B, Courtney C, Baerwald J, Ryan G, Perna R, Jackson A, Luton L, O'Toole K, Harrison D, Alosco M, Emerson K, Hill B, Bauer L, Tremont G, Zychowski L, Yarger L, Kegel N, Arffa S, Crockett D, Hunt S, Parks R, Vernon-Wilkinsion R, Hietpas-Wilson T, Zartman A, Gordon S, Krueger K, VanBuren K, Yates A, Hilsabeck R, Campbell J, Riner B, Crowe S, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Latham K, Thompson J, Barisa M, Maulucci A, Sumowski J, Chiaravalloti N, Lengenfelder J, DeLuca J, Iturriaga L, Henry G, Heilbronner R, Carmona J, Mittenberg W, Enders C, Stevens A, Dux M, Henry G, Heilbronner R, Mittenberg W, Enders C, Myers A, Arffa S, Holland A, Nippoldt-Baca L, Yarger L, Acocella-Stollerman J, Lee E, Peck E, Lee H, Khawaja S, Phillips B, Crockett A, Greve K, Comer C, Ord J, Etherton J, Bianchini K, Curtis K, Harrison A, Edwards M, Harrison A, Edwards M, Cottingham M, Goldberg H, Harrison D, Victor T, Perry L, Pazienza S, Boone K, Bowers T, Triebel K, Denney R, Halfaker D, Tussey C, Barber A, Martin P, Denney R, Deal W, Bailey C, Denney R, Marcopulos B, Schaefer L, Rabin L, Kakkanatt T, Popalzai A, Chantasi K, Heyanka D, Magyar Y, Cruz R, Weiss L, Schatz P, Gibney B, Lietner D, Koushik N, Brooks B, Iverson G, Horton A, Odland A, Reynolds C, Horton A, Reynolds C, Davis A, Finch W, Skierkiewicz A, Rothlisberg B, McIntosh D, Davis A, Finch W, Golden C, Chang M, McIntosh D, Rothlisberg B, Paulson S, Davis A, Starling J, Whited A, Chang M, Roberds E, Dodd J, Martin P, Goldstein G, DeFilippis N, Carlozzi N, Tulsky D, Kurkowski R, Browne K, Wortman K, Gershon R, Heyanka D, Odland A, Golden C, Rodriguez M, Myers A, West S, Golden C, Holster J, Bolanos J, Corsun-Ascher C, Golden C, Robbins J, Restrepo L, Prinzi L, Garcia J, Golden C, Holster J, Bolanos J, Garcia J, Golden C, Osgood J, Trice A, Ernst W, Mahaney T, Gifford K, Oelschlager J, Gurrea J, Tourgeman I, Odland A, Golden C, Tourgeman I, Gurrea J, Stack M, Boddy R, Demsky Y, Golden C, Judd T, Jurecska D, Holmes J, Aguerrevere L, Greve K, Capps D, Izquierdo R, Feldman C, Boddy R, Scarisbrick D, Rice J, Tourgeman I, Golden C, Scarisbrick D, Boddy R, Corsun-Ascher C, Heyanka D, Golden C, Woon F, Hedges D, Odland A, Heyanka D, Martin P, Golden C, Yamout K, Heinrichs R, Baade L, Soetaert D, Perle J, Odland A, Martin P, Golden C, Armstrong C, Bello D, Randall C, Allen D, McLaren T, Konopacki K, Peery S, Miranda F, Saleh M, Moise F, Mendoza J, Mak E, Gomez R, Mihaila E, Parrella M, White L, Harvey P, Marshall D, Gomez R, Keller J, Rogers E, Misa J, Che A, Tennakoon L, Schatzberg A, Sutton G, Allen D, Strauss G, Bello D, Armstrong C, Randall C, Duke L, Ross S, Randall C, Bello D, Armstrong C, Sutton G, Ringdahl E, Thaler N, McMurray J, Sanders L, Isaac H, Allen D, Rumble S, Klonoff P, Wilken J, Sullivan C, Fratto T, Sullivan A, McKenzie T, Ensley M, Saunders C, Quig M, Kane R, Simsarian J, Restrepo L, Rodriguez M, Robbins J, Morrow J, Golden C, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Lanting S, Brooks B, Iverson G, Horton A, Reynolds C, Scarisbrick D, Odland A, Perle J, Golden C, West S, Collins K, Frisch D, Golden C, Guerrero J, Baerwald J, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Mackelprang J, Heyanka D, Lennertz L, Morin I, Marker C, Collins M, Dodd J, Goldstein G, DeFilippis N, Holcomb M, Kimball T, Luther E, Belsher B, Botelho V, Reed R, Hernandez B, Noda A, Yesavage J, Kinoshita L, Kakos L, Gunstad J, Hughes J, Spitznagel M, Potter V, Stanek K, Szabo A, Waechter D, Josephson R, Rosneck J, Schofield H, Getz G, Magnuson S, Bryant K, Miller A, Martincin K, Pastel D, Poreh A, Davis J, Ramos C, Sherer C, Bertram D, Wall J, Bryant K, Poreh A, Magnuson S, Miller A, Martincin K, Pastel D, Gow C, Francis J, Olson L, Sautter S, Ord J, Capps D, Greve K, Bianchini K, Stettler T, Daniel M, Kleman V, Etchells M, Rabinowitz A, Barwick F, Arnett P, Proto D, Barker A, Gouvier W, Jones K, Williams J, Lockwood C, Mansoor Y, Homer-Smith E, Moses J, Stolberg P, Jones W, Krach S, Loe S, Mortimer J, Avirett E, Maricle D, Miller D, Avirett E, Mortimer J, Maricle D, Miller D, Avirett E, Mortimer J, Miller D, Maricle D, McGill C, Moneta L, Gioia G, Isquith P, Lazarus G, Puente A, Ahern D, Faust D, Bridges A, Ahern D, Faust D, Bridges A, Hobson V, Hall J, Harvey M, Spering C, Cullum M, Lacritz L, Massman P, Waring S, O'Bryant S, Frisch D, Morrow J, West S, Golden C, West S, Dougherty M, Rice J, Golden C, Morrow J, Frisch D, Pearlson J, Golden C, Thorgusen S, Watson J, Miller A, Kesner R, Levy J, Lambert A, Fazeli P, Marceaux J, Vance D, Marceaux J, Fazeli P, Vance D, Frankl M, Cummings T, Mahaney T, Webbe F, Spering C, Cooper J, Hobson V, O'Bryant S, Bolanos J, Holster J, Metoyer K, Garcia J, Golden C, Brown C, O'Toole K, Brown C, O'Toole K, Granader Y, Keller S, Bender H, Rathi S, Nass R, MacAllister W, Maehr A, Kiefel J, Bigras C, Slick D, Dewey L, Tao R, Motes M, Emslie G, Rypma B, Kahn D, Riccio C, Reynolds C, Eberle N, Mucci G, Chase A, Boyle M, Gallaway M, Bowyer S, Lajiness-O'Neill R, Gifford K, Mahaney T, Cohen R, Gorman P, Levin Allen S, O'Hara E, LeGoff D, Chute D, Barakat L, Laboy G, San Miguel-Montes L, Rios-Motta M, Pita-Garcia I, Van Horn H, Cuevas M, Ross P, Kinjo C, Basanez T, Patel S, Dinishak D, Zhou W, Ortega M, Zareie R, Lane B, Rosen A, Myers A, Domboski K, Ireland S, Mittenberg W, Mazur-Mosiewicz A, Holcomb M, Dean R, Myerson C, Katzen H, Mittel A, McClendon M, Guevara A, Nahab F, Gallo B, Levin B, Fay T, Brooks B, Sherman E, Szabo A, Gunstad J, Spitznagel M, McCaffery J, McGeary J, Paul R, Sweet L, Cohen R, Hancock L, Bruce J, Peterson S, Jacobson J, Tyrer J, Guse E, Lasater J, Fritz J, Lynch S, O'Rourke J, Queller S, Whitlock K, Beglinger L, Stout J, Duff K, Paulsen J, Kim M, Jang J, Chung J, Zukerman J, Miller S, Waterman G, Sadek J, Singer E, Heaton R, van Gorp W, Castellon S, Hinkin C, Yamout K, Baade L, Panos S, Becker B, Kim M, Foley J, Jang J, Chung J, Castellon S, Hinkin C, Kim M, Jang J, Foley J, Chung J, Miller S, Castellon S, Marcotte T, Hinkin C, Merrick E, Kazakov D, Duke L, Field R, Allen D, Mayfield J, Barney S, Thaler N, Allen D, Donohue B, Mayfield J, Mauro C, Shope C, Riber L, Dhami S, Citrome L, Tremeau F, Heyanka D, Corsun-Ascher C, Englebert N, Golden C, Block C, Sautter S, Stolberg P, Terranova J, Jones W, Allen D, Mayfield J, Ramanathan D, Medaglia J, Chiou K, Wardecker B, Slocomb J, Vesek J, Wang J, Hills E, Good D, Hillary F, Kimpton T, Kirshenbaum A, Madathil R, Trontel H, Hall S, Chiou K, Slocomb J, Ramanathan D, Medaglia J, Wardecker B, Vesek J, Wang J, Hills E, Good D, Hillary F, Salinas C, Tiedemann S, Webbe F, Williams C, Wood R, Ringdahl E, Thaler N, Hodges T, Mayfield J, Allen D, Kazakov D, Haderlie M, Terranova J, Martinez A, Allen D, Mayfield J, Medaglia J, Ramanathan D, Chiou K, Wardecker B, Franklin R, Genova H, Deluca J, Hillary F, Pastrana F, Wurst L, Zeiner H, Garcia A, Bender H, Rice J, West S, Dougherty M, Boddy R, Golden C, Tyrer J, Bruce J, Hancock L, Guse E, Jacobson J, Lynch S, Yung R, Sullivan W, Stringer K, Ferguson B, Drago V, Foster P, Scarisbrick D, Heyanka D, Frisch D, Golden C, Prinzi L, Morrow J, Robbins J, Golden C, Fallows R, Amin K, Virden T, Borgaro S, Hubel K, Miles G, Gomez R, Nazarian S, Mucci G, Moreno-Torres M, San Miguel-Montes L, Otero-Zeno T, Rios M, Douglas K, McGhee R, Sakamoto M, Spiers M, Vanderslice-Barr J, Elbin R, Covassin T, Kontos A, Larson E, Stiller-Ostrowski J, McLain M, Serina N, John S, Rautiola M, Waldstein S, Che A, Gomez R, Keller J, Tennakoon L, Marshall D, Rogers E, Misa J, Schatzberg A, Stiles M, Ericson R, Earleywine M, Ericson R, Earleywine M, Tourgeman I, Boddy R, Gurrea J, Buddin H, Golden C, Holcomb M, Mazur-Mosiewicz A, Dean R, Miele A, Lynch J, McCaffrey R, Miele A, Vanderslice-Barr J, Lynch J, McCaffrey R, Wershba R, Stevenson M, Thomas M, Sturgeon J, Youngjohn J, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Morgan D, Bello D, Hollimon M, Schneider J, Edgington C, Scott J, Adams R, Heinrichs R, Baade L, Soetaert D, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Barisa M, Noggle C, Thompson J, Pimental P, Riedl K, Kimsey M, Sartori A, Griffith H, Okonkwo O, Marson D, Bertisch H, Schaefer L, McKenzie S, Mittelman M, Hibbard M, Sherr R, Diller L, McTaggart A, Williams R, Troster A, Clark J, Owens T, O'Jile J, Schmitt A, Livingston R, Smernoff E, Galusha J, Piazza J, Gutierrez M, Yeager C, Hyer L, Vaughn E, LaPorte D, Schoenberg M, Werz M, Pedigo T, Lavach J, Hart J, Vyas S, Dorta N, Granader Y, Roberts E, Hill B, Musso M, Pella R, Barker A, Proto D, Gouvier W, Gibson K, Bowers T, Bowers T, Gibson K, Hinkle S, Barisa M, Noggle C, Thompson J, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Thompson J, Noggle C, Barisa M, Maulucci A, Benitez A, Gunstad J, Spitznagel M, Szabo A, Rogers E, Gomez R, Keller J, Marshall D, Tennakoon L, Che A, Misa J, Schatzber A, Strauss G, Ringdahl E, Barney S, Jetha S, Duke L, Ross S, Watrous B, Allen D, Maucieri L, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Barisa M, Thompson J, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Noggle C, Thompson J, Barisa M, Maulucci A, Getz G, Dandridge A, Klein R, La Point S, Holcomb M, Mazur-Mosiewicz A, Dean R, Bailey C, Samples H, Broshek D, Barth J, Freeman J, Schatz P, Neidzwski K, Moser R, Reesman J, Suli-Moci E, Wells C, Moneta L, Dean P, Gioia G, Belsher B, Hutson L, Greenberg L, Sullivan C, Hull A, Poole J, Schatz P, Pardini J, Lovell M, Strauser E, Parish R, Carr W, Paggi M, Anderson-Barnes V, Kelly M, Hutson L, Loughlin J, Sullivan C, Kelley E, Poole J, Hutson L, Loughlin J, Sullivan C, Belsher B, Hull A, Greenberg L, Poole J, Carr W, Parish R, Paggi M, Anderson-Barnes V, Ahlers S, Roebuck Spencer T, O'Neill D, Carter J, Bleiberg J, Lange R, Brubacher J, Iverson G, Madler B, Heran M, MacKay A, Andolfatto G, Krol A, Mrazik M, Lebby P, Johnson W, Sweatt J, Turitz M, Greenawald K, Lesser S, Ormonde A, Lavach J, Hart J, Demakis G, Rimland C, Lengenfelder J, Sumowski J, Smith A, Chiaravalloti N, DeLuca J, Pierson E, Koehn E, Lajiness-O'Neill R, Hyer L, Yeager C, Manatan K, Sherman S, Atkinson M, Massey-Connolly S, Gugnani M, Stack R, Carson A, Mirza N, Johnson E, Lovell M, Perna R, Jackson A, Roy S, Zebeigly A, Larochette A, Bowie C, Harrison A, Nippoldt-Baca L, Bleil J, Arffa S, Thompson J, Noggle C, Mark B, Maulucci A, Umaki T, Denney R, Greenberg L, Hull A, Belsher B, Lee H, Sullivan C, Poole J, Abrigo E, Hurewitz F, Kounios J, Noggle C, Barisa M, Thompson J, Maulucci A, Greve K, Aguerrevere L, Bianchini K, Etherton J, Heinly M, Kontos A, Covassin T, Elbin R, Larson E, Stearne D, Johnson D, Gilliland K, Vincent A, Chafetz M, Herkov M, Morais H, Schwait A, Mangiameli L, Greenhill T. Grand Rounds. Arch Clin Neuropsychol 2009. [DOI: 10.1093/arclin/acp045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kinlay S, Selwyn AP, Ganz P, O'Gara PT. Lack of compensatory enlargement at sites of coronary vasospasm: identification by ultrasound and successful treatment with stenting. Clin Cardiol 2009; 23:865-8. [PMID: 11097137 PMCID: PMC6655179 DOI: 10.1002/clc.4960231117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The case of a young man with spontaneous vasospasm at two sites in his left anterior descending coronary artery is described. Intravascular ultrasound demonstrated mild eccentric atherosclerosis with smaller total artery cross-sectional area (defined as the external elastic membrane) compared with reference segments. Impaired compensatory enlargement (remodeling) in response to mild atherosclerosis may derive from one or more biologic mechanisms that are also responsible for vasospasm. This characteristic is easily identified by intravascular ultrasound. In this case, coronary stenting of the vasospastic sites led to excellent long-term control of symptoms more than 1 year after intervention.
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Affiliation(s)
- S Kinlay
- Cardiovascular Division, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA
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Ganz PA, Land SR, Geyer CE, Costantino JP, Pajon ER, Fehrenbacher L, Atkins JN, Polikoff JA, Vogel VG, Erban JK, Livingston RB, Perez EA, Mamounas EP, Wolmark N, Swain SM. NSABP B-30: definitive analysis of quality of life (QOL) and menstrual history (MH) outcomes from a randomized trial evaluating different schedules and combinations of adjuvant therapy containing doxorubicin, docetaxel and cyclophosphamide in women with operable, node-positive breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #76
Background: QOL and MH outcomes were integrated into the NSABP B-30 trial as secondary outcomes to the efficacy analyses which are being presented separately. Explicit secondary aims of the NSABP B-30 study were 1) to compare toxicities among the regimens, 2) to compare QOL, and 3) to examine differences in amenorrhea and its relationship to symptoms, QOL, and efficacy. Here we examine the secondary aims of the study as a companion to the efficacy results that are presented separately.
 Materials and Methods: 5351 pts with cT1-3, N0-1, M0 were enrolled from 3/1/99 to 3/31/2004. 2170 were enrolled on the QOL study, and 2449 were enrolled on the MH study and were randomized to one of three treatment groups: Group 1 [doxorubicin (A) 60 mg/m2 and C 600 mg/m2 q 3 weeks (wks) x 4 followed by docetaxel (T) 100 mg/m2 q 3 wks x 4; Group 2 [A 50 mg/m2 and T 75 mg/m2 q 3 wks x 4]; Group 3 [A 50 mg/m2 T 75 mg/m2 and cyclophosphamide (C) 500 mg/m2 q 3 wks x 4]. All patients with ER-positive tumors received hormonal therapy after completing chemotherapy. Preliminary results from Group 1 have been reported previously (Swain, et al. Breast Cancer Res Treat, 2008).
 Results: The protocol specifies that 800 deaths are required for the definitive analysis of treatment, QOL, and MH outcomes, which are expected to occur by fall 2008. For this final report, results from a comparison of the three arms will be analyzed and presented.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 76.
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Affiliation(s)
- PA Ganz
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 2 UCLA Jonsson Comp. Cancer Cntr, Los Angeles, CA
| | - SR Land
- 3 NSABP Biostatistical Center and Dept of Biostatistics, Grad. School of Public Health, Univ of Pittsburgh, Pittsburgh, PA
| | - CE Geyer
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 4 Allegheny Gen. Hospital, Pittsburgh, PA
| | - JP Costantino
- 3 NSABP Biostatistical Center and Dept of Biostatistics, Grad. School of Public Health, Univ of Pittsburgh, Pittsburgh, PA
| | - ER Pajon
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 5 Colarado Cancer Res Prog, Denver, CO
| | - L Fehrenbacher
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 6 Kaiser Permanente, Northern Calif., Vallejo, CA
| | - JN Atkins
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 7 Southeast Cancer Control Consortium CCOP, Goldsboro, NC
| | - JA Polikoff
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 8 Southern California Kaiser Permanente, San Diego, CA
| | - VG Vogel
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 9 University of Pittsburgh, Pittsburgh, PA
| | - JK Erban
- 10 ECOG, Philadelphia, PA
- 11 Massachusetts Gen. Hospital Cancer Cntr, Boston, MA
| | - RB Livingston
- 12 SWOG, Ann Arbor, MI
- 13 Arizona Cancer Cntr/Univ of AZ/Arizona Health Sciences Cntr, Tucson, AZ
| | - EA Perez
- 14 NCCTG, Rochester, MN
- 15 Mayo Clinic Jacksonville, Jacksonville, FL
| | - EP Mamounas
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 16 Aultman Health Foundation, Canton, OH
| | - N Wolmark
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 4 Allegheny Gen. Hospital, Pittsburgh, PA
| | - SM Swain
- 1 National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA
- 17 Washington Cancer Inst./Washington Hosp. Cntr., Washington, DC
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Carpenter CL, Ganz PA, Bernstein L. Complementary and alternative therapies among very long-term breast cancer survivors. Breast Cancer Res Treat 2008; 116:387-96. [PMID: 18712472 DOI: 10.1007/s10549-008-0158-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Abstract
Breast cancer patients may have different complementary and alternative medicine (CAM) usage rates and may turn to CAM for different reasons than healthy adults. CAM has mostly been studied in recently diagnosed women; no studies have included survivors 10 years post-diagnosis. We examined very long-term breast cancer survivors to determine whether CAM users had dissimilar patterns of association with survivorship factors. Interviews of 374 breast cancer case patients from a population-based case-control breast cancer study of young women from Los Angeles County, California, during the 1980s occurred at follow-up; 371 patients with complete information were included. CAM represented 28 herbal remedies. Quality-of-life originated from the Medical Outcomes Study Short Form 36 questionnaire (SF-36). Higher rates of CAM (59%) usage occurred compared to nationwide estimates. CAM users resembled non-users on follow-up age, exercise, original disease, treatment, smoking, body-mass index, alcohol, and fear of recurrence. CAM users had a higher prevalence of medical co-morbidities (P = 0.0005), and scored significantly lower on the SF-36 emotional well-being subscale than non-CAM users (P = 0.01). CAM users and non-users did not differ on the SF-36 physical sub-scale. Very long-term breast cancer survivors who use CAM may have poorer emotional functioning and more medical problems than non-users.
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Affiliation(s)
- C L Carpenter
- Center for Human Nutrition, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA.
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Geyer C, Mamounas E, Jeong JH, Wickerham L, Ganz P, Hutchins L, Eisen A, Ingle J, Costantino J, Wolmark N. P117 Exemestane (EXE) as extended adjuvant therapy after 5 years of tamoxifen (TAM): results of NSABP B-33. Breast 2007. [DOI: 10.1016/s0960-9776(07)70177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kostis J, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett A, Carson C, Cheitlin M, Debusk R, Fonseca V, Ganz P, Goldstein I, Guay A, Hatzichristou D, Hollander J, Hutter A, Katz S, Kloner R, Mittleman M, Montorsi F, Montorsi P, Nehra A, Sadovsky R, Shabsigh R. Sexual Dysfunction and Cardiac Risk (the Second Princeton Consensus Conference). J Urol 2006. [DOI: 10.1016/s0022-5347(05)00878-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J.B. Kostis
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - G. Jackson
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - R. Rosen
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - E. Barrett-Connor
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - K. Billups
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - A.L. Burnett
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - C. Carson
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - M. Cheitlin
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - R. Debusk
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - V. Fonseca
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - P. Ganz
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - I. Goldstein
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - A. Guay
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - D. Hatzichristou
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - J.E. Hollander
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - A. Hutter
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - S. Katz
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - R.A. Kloner
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - M. Mittleman
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - F. Montorsi
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - P. Montorsi
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - A. Nehra
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - R. Sadovsky
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - R. Shabsigh
- University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Abstract
Compared to mean values from a US database, premenopausal breast cancer survivors (BCS) had significantly higher whole body bone mineral density (BMD) compared to age and ethnicity matched referents; higher whole body BMD was present in all premenopausal BCS, including those who received chemotherapy, tamoxifen+chemotherapy, or no adjuvant therapy. Postmenopausal BCS who had received no adjuvant therapy also had higher whole body BMD compared to similarly aged women. In contrast, hip and lumbar spine BMD values in BCS were similar to those of the population-based database.
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Affiliation(s)
- C Crandall
- Division of General Internal Medicine, Jonsson Comprehensive Cancer Center at UCLA, Los Angeles, CA, USA.
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Avis NE, Assmann SF, Kravitz HM, Ganz PA, Ory M. Quality of life in diverse groups of midlife women: assessing the influence of menopause, health status and psychosocial and demographic factors. Qual Life Res 2004; 13:933-46. [PMID: 15233507 DOI: 10.1023/b:qure.0000025582.91310.9f] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper examines whether menopausal status is associated with global quality of life (QOL) among women aged 40-55 and whether this association varies by race/ethnicity. We further examine the contributions of other health-related and psychosocial factors to QOL and whether these associations vary by racial/ethnic group. Analyses are based on 13,874 women who participated in the multi-ethnic, multi-race study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include global QOL, menstrual history (to assess menopausal status), sociodemographics, health status, lifestyle, and psychosocial variables. Results showed that in unadjusted analyses, early perimenopausal women reported lower QOL compared with premenopausal women, but menopausal status was no longer associated with QOL when analyses were adjusted for other variables. In multivariable models, being married and having low levels of perceived stress were associated with better QOL across all racial/ethnic groups. While there were many consistencies across racial/ethnic groups, we also found that the nature of the associations between QOL and education, marital status, perceived stress and social support varied across racial/ethnic groups.
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Affiliation(s)
- N E Avis
- Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Spiridonidis H, Tao M, Laufman L, Laufman H, Weiss M, Ganz P. Symptomatic response to a non-platinum doublet in performance status 2 (PS 2) patients (pts) with non-small lung cancer (NSCLC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- H. Spiridonidis
- Hematology Oncology Consultants Inc, Columbus, OH; UCLA, Los Angeles, CA
| | - M. Tao
- Hematology Oncology Consultants Inc, Columbus, OH; UCLA, Los Angeles, CA
| | - L. Laufman
- Hematology Oncology Consultants Inc, Columbus, OH; UCLA, Los Angeles, CA
| | - H. Laufman
- Hematology Oncology Consultants Inc, Columbus, OH; UCLA, Los Angeles, CA
| | - M. Weiss
- Hematology Oncology Consultants Inc, Columbus, OH; UCLA, Los Angeles, CA
| | - P. Ganz
- Hematology Oncology Consultants Inc, Columbus, OH; UCLA, Los Angeles, CA
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34
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Tao ML, Malin J, Ganz P, Adams J, Tisnado D, Hickey S, Kahn K. Predictors of use of sentinel lymph node biopsy (SNB) in a population-based cohort of breast cancer (BC) patients (pts). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. L. Tao
- Valley Radiotherapy Associates, El Segundo, CA; UCLA, Los Angeles, CA; RAND, Santa Monica, CA
| | - J. Malin
- Valley Radiotherapy Associates, El Segundo, CA; UCLA, Los Angeles, CA; RAND, Santa Monica, CA
| | - P. Ganz
- Valley Radiotherapy Associates, El Segundo, CA; UCLA, Los Angeles, CA; RAND, Santa Monica, CA
| | - J. Adams
- Valley Radiotherapy Associates, El Segundo, CA; UCLA, Los Angeles, CA; RAND, Santa Monica, CA
| | - D. Tisnado
- Valley Radiotherapy Associates, El Segundo, CA; UCLA, Los Angeles, CA; RAND, Santa Monica, CA
| | - S. Hickey
- Valley Radiotherapy Associates, El Segundo, CA; UCLA, Los Angeles, CA; RAND, Santa Monica, CA
| | - K. Kahn
- Valley Radiotherapy Associates, El Segundo, CA; UCLA, Los Angeles, CA; RAND, Santa Monica, CA
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Abstract
This paper provides a rationale for the importance of studying health outcomes in cancer survivors, including their growing numbers, the need for detailed information on the short and long-term effects of treatment, and the interactions of cancer with other comorbid conditions. However, there are a number of challenges associated with this research. Identification and recruitment of cancer survivors is not always easy, and linking their current health status to details of medical treatment is important, but not always feasible. National surveys and databases are a potential source of information on survivors, but may not provide sufficient details for this type of research. Strategies need to be developed to plan for long-term outcome studies in cancer patients from the very beginning of treatment to obtain the most comprehensive data on the outcomes of survivors.
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Affiliation(s)
- P A Ganz
- Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, UCLA Schools of Medicine & Public Health, 650 Charles Young Drive South, Rm A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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Abstract
This article reviews the symptoms and everyday problems associated with tamoxifen adjuvant therapy and their impact on patients' quality of life. In addition, the purported toxic effects of tamoxifen therapy (e.g., premature menopause, weight gain, and depression) are discussed, and data are presented that refute claims of the toxicity of tamoxifen therapy. From randomized controlled trials of adjuvant therapy, we know that tamoxifen therapy increases the rate of hot flashes, night sweats, and vaginal discharge; however, in observational studies these symptoms do not have a statistically significant impact on patients' quality of life as measured by standardized, self-report questionnaires. The Breast Cancer Prevention Trial found no evidence of excessive rates of depression or clinically significant differences in sexual functioning between women receiving placebo and those receiving tamoxifen therapy. Although several serious medical risks from tamoxifen therapy exist (e.g., uterine cancer, blood clots, stroke, and cataracts), there are additional benefits from tamoxifen therapy in addition to an increase in disease-free survival rates and overall survival rates, including a decrease in contralateral breast cancer and fractures. Ultimately, the decision to receive tamoxifen therapy is a personal choice for each woman to make on the basis of the evidence of tamoxifen therapy's benefits and risks, along with her own motivation to receive therapy. When the benefits of such therapy are small, some women may choose to avoid treatment, but others may wish to try therapy to determine whether possible side effects are relevant. For women in whom the absolute survival benefits are large, there may be less difficulty in making this decision.
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Affiliation(s)
- P A Ganz
- Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center at University of California-Los Angeles, Box 956900, Rm. A2-125 CHS, Los Angeles, CA 90095-6900, USA.
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Moinpour CM, Lyons B, Grevstad PK, Lovato LC, Crowley J, Czaplicki K, Buckner ZM, Ganz PA, Kelly K, Gandara DR. Quality of life in advanced non-small-cell lung cancer: results of a Southwest Oncology Group randomized trial. Qual Life Res 2002; 11:115-26. [PMID: 12018735 DOI: 10.1023/a:1015048908822] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The main purpose of this paper is to present the results of a randomized trial comparing the effects of two chemotherapy regimens on the Quality of life (QOL) of patients with advanced non-small-cell lung cancer (NSCLC). Trials in advanced stage disease represent an important treatment context for QOL assessment. A second purpose of this paper is to examine methods for handling the level of missing data commonly observed in the advanced stage disease context. METHODS Patients were randomized to receive cisplatin plus vinorelbine or carboplatin plus paclitaxel. The QOL of 222 patients was assessed with the Functional Assessment of Cancer Therapy-Lung (FACT-L) prior to randomization; follow-up assessments occurred at 13 and 25 weeks. Three methods were used to analyze the QOL data: (1) cross-sectional analysis of four patient categories (improved, stable, missing, and declined) based on changes in the FACT-L score, (2) a mixed linear model, and (3) a pattern mixture model. The longitudinal analyses addressed two potential data biases. RESULTS Questionnaire submission rates were 91% at baseline, 68% at 13 weeks, and 47% at 25 weeks. The cross-sectional and mixed linear model analyses did not show significant differences by treatment arm in patient-reported QOL. The pattern mixture model analysis, more appropriate given non-ignorable missing data, also found no statistically significant effect of treatment on patient QOL. CONCLUSION We present a sensitivity analysis approach with multiple methods for analyzing treatment effects on patient QOL in the presence of substantial, non-ignorable missing data in an advanced stage disease clinical trial. We conclude that the two treatment arms did not differ statistically in their effects on patient QOL over a 25-week treatment period.
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Affiliation(s)
- C M Moinpour
- Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Melter M, Exeni A, Reinders ME, Fang JC, McMahon G, Ganz P, Hancock WW, Briscoe DM. Expression of the chemokine receptor CXCR3 and its ligand IP-10 during human cardiac allograft rejection. Circulation 2001; 104:2558-64. [PMID: 11714650 DOI: 10.1161/hc4601.098010] [Citation(s) in RCA: 172] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chemokines play an essential role in regulating the infiltration of leukocytes into allografts in experimental models. Little is known of their expression or function after human cardiac transplantation. METHODS AND RESULTS We analyzed 169 sequential human endomyocardial biopsies by immunocytochemistry for infiltration by CD3(+) T cells and the expression of the chemokine receptors CCR1, CCR3, CCR5, and CXCR3. In both cross-sectional and longitudinal analyses, the expression of each of the chemokine receptors correlated with the degree of CD3(+) T-cell infiltration. In particular, the expression of CXCR3 was temporally and spatially associated with CD3(+) T-cell infiltrates and correlated with the histopathological diagnosis of acute rejection (OR, 11.73 and 4.05, respectively; P<0.001). Of 7 patients followed up longitudinally for 1 year, 4 with consecutive biopsies developed intimal thickening by intravascular ultrasound. In these patients, there was a trend for persistent expression of CD3- and CXCR3-expressing infiltrates in the later part of the first posttransplant year. The chemokines eotaxin, IP-10, lymphotactin, MCP-1, Mig, RANTES, and SDF-1 were examined in an additional 35 biopsies by RT-PCR. Eotaxin, lymphotactin, MCP-1, Mig, and SDF-1 were present in both normal and rejecting biopsies. However, the CXCR3 ligand IP-10, which was rarely expressed in normal biopsies, was markedly induced in acute rejection (OR, 19.43; P=0.01). CONCLUSIONS The presence of CXCR3(+) T cells and the CXCR3 ligand IP-10 within endomyocardial biopsies is strongly associated with acute rejection. The CXCR3-IP-10 interaction warrants consideration as a therapeutic target in the management of cardiac allograft recipients.
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Affiliation(s)
- M Melter
- Division of Nephrology, Department of Medicine, Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Day R, Ganz PA, Costantino JP. Tamoxifen and depression: more evidence from the National Surgical Adjuvant Breast and Bowel Project's Breast Cancer Prevention (P-1) Randomized Study. J Natl Cancer Inst 2001; 93:1615-23. [PMID: 11698565 DOI: 10.1093/jnci/93.21.1615] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Concerns have been raised that tamoxifen may be associated with depression. To investigate this question, we examined the psychological effects of tamoxifen treatment for breast cancer prevention on women at different levels of risk for clinical depression who were enrolled in the National Surgical Adjuvant Breast and Bowel Project's Breast Cancer Prevention (P-1) Study. METHODS A total of 11 064 women were randomly assigned to receive for 5 years daily doses of 20 mg of tamoxifen or placebo in the P-1 study, a multicenter, double-blind, placebo-controlled chemoprevention trial. Each woman was prospectively assessed for depression risk on the basis of medical history items collected at the baseline examination and placed in a high-, medium-, or low-risk group. Every 6 months, for a total of 36 months, the participants were assessed for depressive symptoms by completing the Center for Epidemiological Studies-Depression (CES-D) questionnaire. Scores of 16 or higher were indicative of an episode of affective distress. Differences between the risk groups and treatment arms were analyzed by logistic regression. All statistical tests were two-sided. RESULTS Women in the higher risk depression groups were more likely to score 16 or higher on the CES-D (percent follow-up examinations with a score of > or = 16: high-risk group = 35.7%, with 95% confidence interval [CI] = 32.5% to 38.9%; medium-risk group = 19.2%, with 95% CI = 18.1% to 20.3%; and low-risk group = 8.7%, with 95% CI = 8.3 to 9.1%) and to have these scores more frequently and for longer periods than women in the lower risk groups. Within each depression risk group, there was no difference in the proportion of women scoring 16 or higher by treatment assignment (tamoxifen versus placebo) (odds ratio = 0.98; 95% CI = 0.93 to 1.02). A post-hoc analysis indicated that the lack of a tamoxifen effect was not a result of differential missing data. CONCLUSIONS Physicians need not be overly concerned that treatment with tamoxifen will increase the risk for or exacerbate existing depression in women. Nevertheless, physicians should continue to screen for and treat or refer potential cases of depression encountered in routine clinical practice.
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Affiliation(s)
- R Day
- National Surgical Adjuvant Breast and Bowel Project Biostatistical Center, Pittsburgh, PA, USA.
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40
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Dooley WC, Ljung BM, Veronesi U, Cazzaniga M, Elledge RM, O'Shaughnessy JA, Kuerer HM, Hung DT, Khan SA, Phillips RF, Ganz PA, Euhus DM, Esserman LJ, Haffty BG, King BL, Kelley MC, Anderson MM, Schmit PJ, Clark RR, Kass FC, Anderson BO, Troyan SL, Arias RD, Quiring JN, Love SM, Page DL, King EB. Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst 2001; 93:1624-32. [PMID: 11698566 DOI: 10.1093/jnci/93.21.1624] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Breast cancer originates in breast epithelium and is associated with progressive molecular and morphologic changes. Women with atypical breast ductal epithelial cells have an increased relative risk of breast cancer. In this study, ductal lavage, a new procedure for collecting ductal cells with a microcatheter, was compared with nipple aspiration with regard to safety, tolerability, and the ability to detect abnormal breast epithelial cells. METHODS Women at high risk for breast cancer who had nonsuspicious mammograms and clinical breast examinations underwent nipple aspiration followed by lavage of fluid-yielding ducts. All statistical tests were two-sided. RESULTS The 507 women enrolled included 291 (57%) with a history of breast cancer and 199 (39%) with a 5-year Gail risk for breast cancer of 1.7% or more. Nipple aspirate fluid (NAF) samples were evaluated cytologically for 417 women, and ductal lavage samples were evaluated for 383 women. Adequate samples for diagnosis were collected from 111 (27%) and 299 (78%) women, respectively. A median of 13,500 epithelial cells per duct (range, 43-492,000 cells) was collected by ductal lavage compared with a median of 120 epithelial cells per breast (range, 10-74,300) collected by nipple aspiration. For ductal lavage, 92 (24%) subjects had abnormal cells that were mildly (17%) or markedly (6%) atypical or malignant (<1%). For NAF, corresponding percentages were 6%, 3%, and fewer than 1%. Ductal lavage detected abnormal intraductal breast cells 3.2 times more often than nipple aspiration (79 versus 25 breasts; McNemar's test, P<.001). No serious procedure-related adverse events were reported. CONCLUSIONS Large numbers of ductal cells can be collected by ductal lavage to detect atypical cellular changes within the breast. Ductal lavage is a safe and well-tolerated procedure and is a more sensitive method of detecting cellular atypia than nipple aspiration.
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Affiliation(s)
- W C Dooley
- Institute for Breast Health, University of Oklahoma Health Sciences Center, Oklahoma City, 73104, USA.
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41
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Kinlay S, Creager MA, Fukumoto M, Hikita H, Fang JC, Selwyn AP, Ganz P. Endothelium-derived nitric oxide regulates arterial elasticity in human arteries in vivo. Hypertension 2001; 38:1049-53. [PMID: 11711496 DOI: 10.1161/hy1101.095329] [Citation(s) in RCA: 255] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Arterial elasticity is determined by structural characteristics of the artery wall and by vascular smooth muscle tone. The identity of endogenous vasoactive substances that regulate elasticity has not been defined in humans. We hypothesized that NO, a vasodilator released constitutively by the endothelium, augments arterial elasticity. Seven healthy young men were studied. A 20-MHz intravascular ultrasound catheter was introduced through an arterial sheath to measure brachial artery cross-sectional area, wall thickness, and intra-arterial pressure. After control was established, indices of elasticity (pressure-area relationship, instantaneous compliance, and stress-strain, pressure-incremental elastic modulus (E(inc)), and pressure-pulse wave velocity relationships) were examined over 0 to 100 mm Hg transmural pressure obtained by inflation of an external cuff. Thereafter, the basal production of endothelium-derived NO was inhibited by N(G)-monomethyl-L-arginine (L-NMMA) (4 and 8 mg/min). Finally, nitroglycerin (2.5 and 12.5 microgram/min), an exogenous donor of NO, was given to relax the vascular smooth muscle. Elasticity was measured under all of these conditions. L-NMMA (8 mg/min) decreased brachial artery area (P=0.016) and compliance (P<0.0001) and increased E(inc) (P<0.01) and pulse wave velocity (P<0.0001). Nitroglycerin (12.5 microgram/min) increased brachial artery area (P<0.001) and compliance (P<0.001) and decreased pulse wave velocity (P=0.02). NO, an endothelium-derived vasodilator, augments arterial elasticity in the human brachial artery. Loss of constitutively released NO associated with cardiovascular risk factors may adversely affect arterial elasticity in humans.
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Affiliation(s)
- S Kinlay
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Abstract
OBJECTIVES To review the common physical and psychosocial late effects of treatment in adult and childhood cancer survivors. DATA SOURCES Published articles and research studies. CONCLUSIONS More than half of individuals diagnosed with cancer can be expected to survive for more than 5 years. These survival gains have occurred because of more complex and multimodal therapy that may increase long-term toxicities. IMPLICATIONS FOR NURSING PRACTICE Health care providers must be familiar with these late effects to offer preventive care and health promotion strategies to this patient population.
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Affiliation(s)
- P A Ganz
- University of California-Los Angeles Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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Beckman JA, Ganz J, Creager MA, Ganz P, Kinlay S. Relationship of clinical presentation and calcification of culprit coronary artery stenoses. Arterioscler Thromb Vasc Biol 2001; 21:1618-22. [PMID: 11597935 DOI: 10.1161/hq0901.095554] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coronary artery calcification is increased in the presence of atherosclerosis. However, there is great variability in the calcification of individual coronary stenoses, and the clinical significance of this finding remains unknown. We tested the hypothesis that culprit lesions associated with myocardial infarction or unstable angina are less calcified than are stenoses associated with stable angina. The study consisted of 78 patients who underwent intravascular ultrasound imaging of culprit stenoses after the placement of a stent. Seventeen patients presented with stable angina; 43, with unstable angina; and 18, with myocardial infarction. The extent of coronary calcification was measured by the angle of its arc and was quantified with a computer-based protractor. The arc of calcium was measured in the stented area at the point of maximal calcification and also as an average of the calcification found at proximal, middle, and distal stent segments. The maximal arc of calcium decreased progressively from patients with stable angina (91+/-10 degrees ) to those with unstable angina (59+/-8 degrees ) and to those with myocardial infarction (49+/-11 degrees, P=0.014). Similarly, the average arc of calcium was greatest (32+/-7 degrees ) in patients with stable angina, less (15+/-4 degrees ) in patients with unstable angina, and least (10+/-5 degrees ) in patients with acute myocardial infarction (P=0.014). These associations remained significant after adjustment for other factors that potentially affect arterial calcification. Acute coronary syndromes are associated with a relative lack of calcium in the culprit stenoses compared with stenoses of patients with stable angina. These findings have implications for the understanding of the biology of acute coronary syndromes as well as for the identification of coronary stenoses by methods that rely solely on the presence of calcium.
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Affiliation(s)
- J A Beckman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Kinlay S, Behrendt D, Wainstein M, Beltrame J, Fang JC, Creager MA, Selwyn AP, Ganz P. Role of endothelin-1 in the active constriction of human atherosclerotic coronary arteries. Circulation 2001; 104:1114-8. [PMID: 11535565 DOI: 10.1161/hc3501.095707] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atherosclerotic coronary arteries are prone to constriction but the underlying causes are incompletely understood. We tested the hypothesis that endothelin-1 (ET-1), a potent vasoconstrictor, contributes to the heightened tone of atherosclerotic human coronary arteries. METHODS AND RESULTS In 8 patients with coronary artery disease (CAD) and 8 patients with angiographically smooth coronary arteries (normal), we infused BQ-123, an antagonist of the ET(A) receptor, into a major coronary artery (infused artery) at 40 nmol/min for 60 minutes. The infused artery in the CAD patients contained a >50% stenosis. Using quantitative angiography, we compared the dilation of the infused artery with another, noninfused coronary artery. To estimate the magnitude of the contribution of ET-1 to coronary tone, we compared the dilation to BQ-123 with that elicited by intracoronary nitroglycerin (200 microgram). BQ-123 induced significant dilation in the normal arteries (7.3% at 60 minutes, P<0.001 versus noninfused arteries) and a greater dilation in the CAD arteries (16.3% at 60 minutes, P<0.001 versus infused normal arteries). The dilation at stenoses was particularly pronounced (21.6% at 60 minutes, P<0.001 versus infused CAD arteries). Compared with the dilation from nitroglycerin, ET-1 contributed to 39% of the coronary tone in normal arteries, 74% of tone in CAD arteries, and 106% of tone at stenoses (P<0.01). CONCLUSIONS ET-1 accounts for nearly all the resting tone in atherosclerotic coronary arteries, especially at stenoses. Inhibitors of ET-1, by relieving constriction, may significantly lessen the hemodynamic significance of coronary stenoses and thereby reduce myocardial ischemia.
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Affiliation(s)
- S Kinlay
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Bromberger JT, Meyer PM, Kravitz HM, Sommer B, Cordal A, Powell L, Ganz PA, Sutton-Tyrrell K. Psychologic distress and natural menopause: a multiethnic community study. Am J Public Health 2001; 91:1435-42. [PMID: 11527777 PMCID: PMC1446800 DOI: 10.2105/ajph.91.9.1435] [Citation(s) in RCA: 193] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2000] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the association between psychologic distress and natural menopause in a community sample of African American, White, Chinese, Hispanic, and Japanese women participating in a national women's health study. METHODS A cohort of 16,065 women aged 40 to 55 years provided information on menstrual regularity in the previous year, psychosocial factors, health, and somatic-psychologic symptoms. Psychologic distress was defined as feeling tense, depressed, and irritable in the previous 2 weeks. RESULTS Rates of psychologic distress were highest in early perimenopause (28.9%) and lowest in premenopause (20.9%) and postmenopause (22%). In comparison with premenopausal women, early perimenopausal women were at a greater risk of distress, with and without adjustment for vasomotor and sleep symptoms and covariates. Odds of distress were significantly higher for Whites than for the other racial/ethnic groups. CONCLUSIONS Psychologic distress is associated with irregular menses in midlife. It is important to determine whether distress is linked to alterations in hormone levels and to what extent a mood-hormone relationship may be influenced by socioeconomic and cultural factors.
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Affiliation(s)
- J T Bromberger
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA 15213, USA.
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Abstract
BACKGROUND The growing number of cancer survivors has created an increased need for survivorship research; however, the identification and recruitment of cancer survivors present some challenges. This report describes how two hospital cancer registries were used to recruit a large sample of breast cancer survivors (BCS) for a study examining the late reproductive effects of breast cancer treatments. Limitations and opportunities associated with this type of recruitment strategy are described, and the overall success of recruitment using this approach is presented. METHODS Tumor registries from a comprehensive cancer center and a community hospital were used to identify BCS who met the study screening criteria. Invitations and response forms were mailed to all potentially eligible women, and those who did not respond by mail also were contacted by telephone. Women who indicated interest and met the study requirements were asked to give written consent, were enrolled in the study, and were sent a self-report questionnaire. RESULTS Seventy percent of the eligible women (n = 733 women) responded to the mailing. Seventy-seven percent of the 512 respondents indicated a willingness to participate and were sent a questionnaire. Of these, 78% (n = 368 women) completed questionnaires. BCS recruited from the cancer center registry were more likely than those from the community hospital registry to respond to the invitation form (P = 0.033) and were more likely to return a completed questionnaire (P = 0.001). However, the community hospital provided access to a more ethnically diverse sample of survivors. CONCLUSIONS The two participating cancer registries were an excellent source for identifying a large sample of long-term BCS, and the different types of registries provided greater sample size and diversity. Although there are some limitations to this approach, including nonresponse of a significant number of BCS, tumor registries represent an important resource for the rapid identification of cancer survivors for research studies. Findings from this study suggest several enhancements for future studies that may increase the yield from registry recruitment.
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Affiliation(s)
- A T Pakilit
- Division of Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California 90095-6900, USA
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Abstract
BACKGROUND The growing number of cancer survivors has created an increased need for survivorship research; however, the identification and recruitment of cancer survivors present some challenges. This report describes how two hospital cancer registries were used to recruit a large sample of breast cancer survivors (BCS) for a study examining the late reproductive effects of breast cancer treatments. Limitations and opportunities associated with this type of recruitment strategy are described, and the overall success of recruitment using this approach is presented. METHODS Tumor registries from a comprehensive cancer center and a community hospital were used to identify BCS who met the study screening criteria. Invitations and response forms were mailed to all potentially eligible women, and those who did not respond by mail also were contacted by telephone. Women who indicated interest and met the study requirements were asked to give written consent, were enrolled in the study, and were sent a self-report questionnaire. RESULTS Seventy percent of the eligible women (n = 733 women) responded to the mailing. Seventy-seven percent of the 512 respondents indicated a willingness to participate and were sent a questionnaire. Of these, 78% (n = 368 women) completed questionnaires. BCS recruited from the cancer center registry were more likely than those from the community hospital registry to respond to the invitation form (P = 0.033) and were more likely to return a completed questionnaire (P = 0.001). However, the community hospital provided access to a more ethnically diverse sample of survivors. CONCLUSIONS The two participating cancer registries were an excellent source for identifying a large sample of long-term BCS, and the different types of registries provided greater sample size and diversity. Although there are some limitations to this approach, including nonresponse of a significant number of BCS, tumor registries represent an important resource for the rapid identification of cancer survivors for research studies. Findings from this study suggest several enhancements for future studies that may increase the yield from registry recruitment.
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Affiliation(s)
- A T Pakilit
- Division of Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, California 90095-6900, USA
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Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, Zeiher A, Chaitman BR. Atorvastatin for acute coronary syndromes. JAMA 2001; 286:533-5. [PMID: 11476650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Abstract
The endothelium produces a number of vasodilator and vasoconstrictor substances that not only regulate vasomotor tone, but also the recruitment and activity of inflammatory cells and the propensity towards thrombosis. Endothelial vasomotor function is a convenient way to assess these other functions, and is related to the long-term risk of cardiovascular disease. Lipids (particularly low density lipoprotein cholesterol) and oxidant stress play a major role in impairing these functions, by reducing the bioavailability of nitric oxide and activating pro-inflammatory signalling pathways such as nuclear factor kappa B. Biomechanical forces on the endothelium, including low shear stress from disturbed blood flow, also activate the endothelium increasing vasomotor dysfunction and promoting inflammation by upregulating pro-atherogenic genes. In contrast, normal laminar shear stress promotes the expression of genes that may protect against atherosclerosis. The sub-cellular structure of endothelial cells includes caveolae that play an integral part in regulating the activity of endothelial nitric oxide synthase. Low density lipoprotein cholesterol and oxidant stress impair caveolae structure and function and adversely affect endothelial function. Lipid-independent pathways of endothelial cell activation are increasingly recognized, and may provide new therapeutic targets. Endothelial vasoconstrictors, such as endothelin, antagonize endothelium-derived vasodilators and contribute to endothelial dysfunction. Some but not all studies have linked certain genetic polymorphisms of the nitric oxide synthase enzyme to vascular disease and impaired endothelial function. Such genetic heterogeneity may nonetheless offer new insights into the variability of endothelial function.
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Affiliation(s)
- S Kinlay
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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