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Law V, Smalley I, Evernden BR, Baldwin M, Smalley KSM, Forsyth PA. Ex Vivo Culture of Circulating Tumor Cells in the Cerebral Spinal Fluid from Melanoma Patients to Study Melanoma-Associated Leptomeningeal Disease. J Vis Exp 2024. [PMID: 38619274 DOI: 10.3791/66071] [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: 04/16/2024] Open
Abstract
Melanoma-associated leptomeningeal disease (M-LMD) occurs when circulating tumor cells (CTCs) enter into the cerebral spinal fluid (CSF) and colonize the meninges, the membrane layers that protect the brain and the spinal cord. Once established, the prognosis for M-LMD patients is dismal, with overall survival ranging from weeks to months. This is primarily due to a paucity in our understanding of the disease and, as a consequence, the availability of effective treatment options. Defining the underlying biology of M-LMD will significantly improve the ability to adapt available therapies for M-LMD treatment or design novel inhibitors for this universally fatal disease. A major barrier, however, lies in obtaining sufficient quantities of CTCs from the patient-derived CSF (CSF-CTCs) to conduct preclinical experiments, such as molecular characterization, functional analysis, and in vivo efficacy studies. Culturing CSF-CTCs ex vivo has also proven to be challenging. To address this, a novel protocol for the culture of patient-derived M-LMD CSF-CTCs ex vivo and in vivo is developed. The incorporation of conditioned media produced by human meningeal cells (HMCs) is found to be critical to the procedure. Cytokine array analysis reveals that factors produced by HMCs, such as insulin-like growth factor-binding proteins (IGFBPs) and vascular endothelial growth factor-A (VEGF-A), are important in supporting CSF-CTC survival ex vivo. Here, the usefulness of the isolated patient-derived CSF-CTC lines is demonstrated in determining the efficacy of inhibitors that target the insulin-like growth factor (IGF) and mitogen-activated protein kinase (MAPK) signaling pathways. In addition, the ability to intrathecally inoculate these cells in vivo to establish murine models of M-LMD that can be employed for preclinical testing of approved or novel therapies is shown. These tools can help unravel the underlying biology driving CSF-CTC establishment in the meninges and identify novel therapies to reduce the morbidity and mortality associated with M-LMD.
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Affiliation(s)
- Vincent Law
- Department of Tumor Biology, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute; Department of Neuro-Oncology, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute;
| | - Inna Smalley
- Department of Cancer Physiology, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute
| | - Brittany R Evernden
- Department of Neuro-Oncology, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute
| | - Margaret Baldwin
- Department of Comparative Medicine, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute
| | - Keiran S M Smalley
- Department of Tumor Biology, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute
| | - Peter A Forsyth
- Department of Tumor Biology, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute; Department of Neuro-Oncology, University of South Florida, H. Lee Moffitt Cancer Center & Research Institute
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Tang JD, Mills MN, Nakashima J, Dohm AE, Khushalani NI, Forsyth PA, Vogelbaum MA, Wuthrick EJ, Yu HHM, Oliver DE, Liu JKC, Ahmed KA. Clinical outcomes of melanoma brain metastases treated with nivolumab and ipilimumab alone versus nivolumab and ipilimumab with stereotactic radiosurgery. J Neurooncol 2024; 166:431-440. [PMID: 38310157 DOI: 10.1007/s11060-023-04543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 12/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Upfront dual checkpoint blockade with immune checkpoint inhibitors (ICI) has demonstrated efficacy for treating melanoma brain metastases (MBM) in asymptomatic patients. Whether the combination of stereotactic radiosurgery (SRS) with dual checkpoint blockade improves outcomes over dual-checkpoint blockade alone is unknown. We evaluated clinical outcomes of patients with MBM receiving ICI with nivolumab and ipilimumab, with and without SRS. METHODS 49 patients with 158 MBM receiving nivolumab and ipilimumab for untreated MBM between 2015 and 2022 were identified at our institution. Patient and tumor characteristics including age, Karnofsky Performance Status (KPS), presence of symptoms, cancer history, MBM burden, and therapy course were recorded. Outcomes measured from initiation of MBM-directed therapy included overall survival (OS), local control (LC), and distant intracranial control (DIC). Time-to-event analysis was conducted with the Kaplan-Meier method. RESULTS 25 patients with 74 MBM received ICI alone, and 24 patients with 84 MBM received concurrent SRS. Median follow-up was 24 months. No differences in age (p = 0.96), KPS (p = 0.85), presence of symptoms (p = 0.79), prior MBM (p = 0.68), prior MBM-directed surgery (p = 0.96) or SRS (p = 0.68), MBM size (p = 0.67), or MBM number (p = 0.94) were seen. There was a higher rate of nivolumab and ipilimumab course completion in the SRS group (54% vs. 24%; p = 0.029). The SRS group received prior immunotherapy more often than the ICI alone group (54% vs. 8.0%; p < 0.001). There was no significant difference in 1-year OS (72% vs. 71%, p = 0.20) and DIC (63% v 51%, p = 0.26) between groups. The SRS group had higher 1-year LC (92% vs. 64%; p = 0.002). On multivariate analysis, LC was improved with combination therapy (AHR 0.38, p = 0.01). CONCLUSION In our analysis, patients who received SRS with nivolumab and ipilimumab had superior LC without increased risk of toxicity or compromised immunotherapy treatment completion despite the SRS cohort having higher rates of prior immunotherapy. Further prospective study of combination nivolumab and ipilimumab with SRS is warranted.
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Affiliation(s)
- Joseph D Tang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA
| | - Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA
| | - Justyn Nakashima
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA
| | - Ammoren E Dohm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Evan J Wuthrick
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA
| | - Hsiang-Hsuan M Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA
| | - Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA
| | - James K C Liu
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr. , Tampa, FL, USA.
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Smalley I, Boire A, Brastianos P, Kluger HM, Hernando-Monge E, Forsyth PA, Ahmed KA, Smalley KSM, Ferguson S, Davies MA, Glitza Oliva IC. Leptomeningeal disease in melanoma: An update on the developments in pathophysiology and clinical care. Pigment Cell Melanoma Res 2024; 37:51-67. [PMID: 37622466 DOI: 10.1111/pcmr.13116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
Leptomeningeal disease (LMD) remains a major challenge in the clinical management of metastatic melanoma patients. Outcomes for patient remain poor, and patients with LMD continue to be excluded from almost all clinical trials. However, recent trials have demonstrated the feasibility of conducting prospective clinical trials in these patients. Further, new insights into the pathophysiology of LMD are identifying rational new therapeutic strategies. Here we present recent advances in the understanding of, and treatment options for, LMD from metastatic melanoma. We also annotate key areas of future focus to accelerate progress for this challenging but emerging field.
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Affiliation(s)
- Inna Smalley
- Department of Metabolism and Physiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Adrienne Boire
- Human Oncology and Pathogenesis Program, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Priscilla Brastianos
- Department of Medicine, MGH Cancer Center, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Harriet M Kluger
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Eva Hernando-Monge
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
- Interdisciplinary Melanoma Cooperative Group, Perlmutter Cancer Center, NYU Langone Health, New York, New York, USA
| | - Peter A Forsyth
- Department of Neuro-Oncology and Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology and Immunology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Keiran S M Smalley
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Sherise Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Khaled ML, Ren Y, Kundalia R, Alhaddad H, Chen Z, Wallace GC, Evernden B, Ospina OE, Hall M, Liu M, Darville LN, Izumi V, Chen YA, Pilon-Thomas S, Stewart PA, Koomen JM, Corallo SA, Jain MD, Robinson TJ, Locke FL, Forsyth PA, Smalley I. Branched-chain keto acids promote an immune-suppressive and neurodegenerative microenvironment in leptomeningeal disease. bioRxiv 2023:2023.12.18.572239. [PMID: 38187773 PMCID: PMC10769272 DOI: 10.1101/2023.12.18.572239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Leptomeningeal disease (LMD) occurs when tumors seed into the leptomeningeal space and cerebrospinal fluid (CSF), leading to severe neurological deterioration and poor survival outcomes. We utilized comprehensive multi-omics analyses of CSF from patients with lymphoma LMD to demonstrate an immunosuppressive cellular microenvironment and identified dysregulations in proteins and lipids indicating neurodegenerative processes. Strikingly, we found a significant accumulation of toxic branched-chain keto acids (BCKA) in the CSF of patients with LMD. The BCKA accumulation was found to be a pan-cancer occurrence, evident in lymphoma, breast cancer, and melanoma LMD patients. Functionally, BCKA disrupted the viability and function of endogenous T lymphocytes, chimeric antigen receptor (CAR) T cells, neurons, and meningeal cells. Treatment of LMD mice with BCKA-reducing sodium phenylbutyrate significantly improved neurological function, survival outcomes, and efficacy of anti-CD19 CAR T cell therapy. This is the first report of BCKA accumulation in LMD and provides preclinical evidence that targeting these toxic metabolites improves outcomes.
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Affiliation(s)
- Mariam Lotfy Khaled
- The Department of Metabolism and Physiology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
- Department of Biochemistry, Faculty of Pharmacy, Cairo University, Egypt
| | - Yuan Ren
- The Department of Metabolism and Physiology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Ronak Kundalia
- The Department of Metabolism and Physiology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Hasan Alhaddad
- The Department of Metabolism and Physiology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Zhihua Chen
- Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Gerald C. Wallace
- Department of Hematology/Oncology, Georgia Cancer Center at Medical College of Georgia, Augusta, GA, USA
| | - Brittany Evernden
- Department of Neuro Oncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Oscar E. Ospina
- Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - MacLean Hall
- Department of Immunology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Min Liu
- The Proteomics and Metabolomics Core, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Lancia N.F. Darville
- The Proteomics and Metabolomics Core, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Victoria Izumi
- The Proteomics and Metabolomics Core, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Y. Ann Chen
- Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Shari Pilon-Thomas
- Department of Immunology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Paul A. Stewart
- Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - John M. Koomen
- The Proteomics and Metabolomics Core, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
- Department of Molecular Oncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Salvatore A. Corallo
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Michael D. Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Timothy J. Robinson
- Therapeutic Radiology, Smilow Cancer Hospital at Yale New Haven, 35 Park Street, New Haven, CT, USA
| | - Fredrick L. Locke
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Peter A. Forsyth
- Department of Neuro Oncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
- The Department of Tumor Biology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
| | - Inna Smalley
- The Department of Metabolism and Physiology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
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Phadke MS, Li J, Chen Z, Rodriguez PC, Mandula JK, Karapetyan L, Forsyth PA, Chen YA, Smalley KSM. Differential requirements for CD4+ T cells in the efficacy of the anti-PD-1+LAG-3 and anti-PD-1+CTLA-4 combinations in melanoma flank and brain metastasis models. J Immunother Cancer 2023; 11:e007239. [PMID: 38056899 PMCID: PMC10711842 DOI: 10.1136/jitc-2023-007239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Although the anti-PD-1+LAG-3 and the anti-PD-1+CTLA-4 combinations are effective in advanced melanoma, it remains unclear whether their mechanisms of action overlap. METHODS We used single cell (sc) RNA-seq, flow cytometry and IHC analysis of responding SM1, D4M-UV2 and B16 melanoma flank tumors and SM1 brain metastases to explore the mechanism of action of the anti-PD-1+LAG-3 and the anti-PD-1+CTLA-4 combination. CD4+ and CD8+ T cell depletion, tetramer binding assays and ELISPOT assays were used to demonstrate the unique role of CD4+T cell help in the antitumor effects of the anti-PD-1+LAG-3 combination. RESULTS The anti-PD-1+CTLA-4 combination was associated with the infiltration of FOXP3+regulatory CD4+ cells (Tregs), fewer activated CD4+T cells and the accumulation of a subset of IFNγ secreting cytotoxic CD8+T cells, whereas the anti-PD-1+LAG-3 combination led to the accumulation of CD4+T helper cells that expressed CXCR4, TNFSF8, IL21R and a subset of CD8+T cells with reduced expression of cytotoxic markers. T cell depletion studies showed a requirement for CD4+T cells for the anti-PD-1+LAG-3 combination, but not the PD-1-CTLA-4 combination at both flank and brain tumor sites. In anti-PD-1+LAG-3 treated tumors, CD4+T cell depletion was associated with fewer activated (CD69+) CD8+T cells and impaired IFNγ release but, conversely, increased numbers of activated CD8+T cells and IFNγ release in anti-PD-1+CTLA-4 treated tumors. CONCLUSIONS Together these studies suggest that these two clinically relevant immune checkpoint inhibitor (ICI) combinations have differential effects on CD4+T cell polarization, which in turn, impacted cytotoxic CD8+T cell function. Further insights into the mechanisms of action/resistance of these clinically-relevant ICI combinations will allow therapy to be further personalized.
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Affiliation(s)
- Manali S Phadke
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jiannong Li
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Cancer Center and Research Institute, Tampa, FL, USA
| | - Zhihua Chen
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Cancer Center and Research Institute, Tampa, FL, USA
| | - Paulo C Rodriguez
- Department of Immunology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jessica K Mandula
- Department of Immunology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lilit Karapetyan
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter A Forsyth
- Department of Neurooncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Y Ann Chen
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Cancer Center and Research Institute, Tampa, FL, USA
| | - Keiran S M Smalley
- Department of Tumor Biology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Emmons MF, Bennett RL, Riva A, Gupta K, Carvalho LADC, Zhang C, Macaulay R, Dupéré-Richér D, Fang B, Seto E, Koomen JM, Li J, Chen YA, Forsyth PA, Licht JD, Smalley KSM. HDAC8-mediated inhibition of EP300 drives a transcriptional state that increases melanoma brain metastasis. Nat Commun 2023; 14:7759. [PMID: 38030596 PMCID: PMC10686983 DOI: 10.1038/s41467-023-43519-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Melanomas can adopt multiple transcriptional states. Little is known about the epigenetic drivers of these cell states, limiting our ability to regulate melanoma heterogeneity. Here, we identify stress-induced HDAC8 activity as driving melanoma brain metastasis development. Exposure of melanocytes and melanoma cells to multiple stresses increases HDAC8 activation leading to a neural crest-stem cell transcriptional state and an amoeboid, invasive phenotype that increases seeding to the brain. Using ATAC-Seq and ChIP-Seq we show that increased HDAC8 activity alters chromatin structure by increasing H3K27ac and enhancing accessibility at c-Jun binding sites. Functionally, HDAC8 deacetylates the histone acetyltransferase EP300, causing its enzymatic inactivation. This, in turn, increases binding of EP300 to Jun-transcriptional sites and decreases binding to MITF-transcriptional sites. Inhibition of EP300 increases melanoma cell invasion, resistance to stress and increases melanoma brain metastasis development. HDAC8 is identified as a mediator of transcriptional co-factor inactivation and chromatin accessibility that drives brain metastasis.
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Affiliation(s)
- Michael F Emmons
- Department of Tumor Biology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Richard L Bennett
- UF Health Cancer Center, 2033 Mowry Road, University of Florida, Gainesville, FL, 32610, USA
| | - Alberto Riva
- Bioinformatics Core, Interdisciplinary Center for Biotechnology Research, University of Florida, 2033 Mowry Road, Gainesville, FL, 32610, USA
| | - Kanchan Gupta
- UF Health Cancer Center, 2033 Mowry Road, University of Florida, Gainesville, FL, 32610, USA
| | | | - Chao Zhang
- Department of Tumor Biology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Robert Macaulay
- Department of Neuro-Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Daphne Dupéré-Richér
- UF Health Cancer Center, 2033 Mowry Road, University of Florida, Gainesville, FL, 32610, USA
| | - Bin Fang
- Proteomics & Metabolomics Core, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Edward Seto
- Department of Biochemistry & Molecular Medicine, School of Medicine & Health Sciences, George Washington Cancer Center, George Washington University, 2300 Eye Street, Washington, DC, 20037, USA
| | - John M Koomen
- Department of Molecular Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Jiannong Li
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Y Ann Chen
- Department of Bioinformatics and Biostatistics, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Jonathan D Licht
- UF Health Cancer Center, 2033 Mowry Road, University of Florida, Gainesville, FL, 32610, USA
| | - Keiran S M Smalley
- Department of Tumor Biology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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7
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Dohm AE, Nakashima JY, Kalagotla H, Jiang SX, Tang JD, Bhandari M, Kim Y, Graham JA, Khushalani NI, Forsyth PA, Etame AB, Liu JK, Tran ND, Vogelbaum MA, Wuthrick EJ, Yu HHM, Oliver DE, Ahmed KA. Stereotactic radiosurgery and anti-PD-1 + CTLA-4 therapy, anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK inhibitors, BRAF inhibitors, or conventional chemotherapy for the management of melanoma brain metastases. Eur J Cancer 2023; 192:113287. [PMID: 37657227 DOI: 10.1016/j.ejca.2023.113287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Immunotherapy and targeted BRAF/MEK inhibitors (i) have revolutionised the systemic management of advanced melanoma. Given the role of stereotactic radiosurgery (SRS) in the local management of brain metastases, we sought to evaluate clinical outcomes in patients with melanoma brain metastases (MBM) treated with SRS and various systemic therapies. METHODS Patients were included if MBM were diagnosed and treated with SRS within 3 months of receiving anti-PD-1+CTLA-4 therapy, anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK-i, BRAF-i, or conventional chemotherapy. Comparisons between groups were made for overall survival (OS), distant MBM control, local MBM, systemic progression-free survival (sPFS), and neurotoxicity. RESULTS In total, 257 patients with 1048 MBM treated over 368 SRS sessions between 2011 and 2020 were identified. On MVA, treatment with anti-PD1+anti-CTLA-4, anti-PD-1, and BRAF/MEK-i improved distant intracranial control over conventional chemotherapy. No significant differences were noted in local control (LC) between groups (p = 0.78). Kaplan-Meier OS at 12 months for anti-PD-1 + CTLA-4 therapy, anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK-i, BRAF-i, and conventional chemotherapy was 68%, 59%, 45%, 62%, 21%, and 15%, respectively (p = <0.0001). The sPFS rates at 12 months were 57%, 53%, 42%, 45%, 14%, and 6% (p = <0.0001). No significant differences were noted in rates of radiation necrosis (p = 0.93). CONCLUSIONS This is among the largest series evaluating MBM treated with SRS and various systemic therapy regimens. Our analysis noted significant differences in OS, distant MBM control, and sPFS by systemic therapy. No differences in LC or radiation necrosis risk were noted.
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Affiliation(s)
- Ammoren E Dohm
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Justyn Y Nakashima
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Hruday Kalagotla
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Shirley X Jiang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Joseph D Tang
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Menal Bhandari
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jasmine A Graham
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Peter A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Arnold B Etame
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - James K Liu
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Nam D Tran
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Evan J Wuthrick
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Khatri VM, Mills MN, Oliver DE, Yu HHM, Vogelbaum MA, Forsyth PA, Soliman HH, Han HS, Ahmed KA. Tucatinib and stereotactic radiosurgery in the management of HER2 positive breast cancer brain metastases. J Neurooncol 2023; 164:191-197. [PMID: 37490232 DOI: 10.1007/s11060-023-04402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE HER2-positive breast cancer has a high risk of brain metastasis. Stereotactic radiosurgery (SRS) is standard of care for limited brain metastases. Tucatinib, a HER2-targeted tyrosine kinase inhibitor, has demonstrated intracranial efficacy in the HER2-CLIMB Trial. However, it is unknown whether tucatinib with SRS is safe or effective. METHODS A retrospective analysis of HER2-positive breast cancer treated with SRS and tucatinib for brain metastases management was performed. All patients received tucatinib and SRS for the management of active brain metastases. The primary endpoint was local and distant brain tumor control. Secondary endpoints were intracranial progression free survival (CNS-PFS), systemic PFS, overall survival (OS), and neurotoxicity. RESULTS A total of 135 lesions treated with SRS over 39 treatment sessions in 22 patients were identified. Median follow-up from tucatinib initiation was 20.8 months. Local brain control was 94% at 12-months and 81% at 24-months. Distant brain control was 39% at 12-months and 26% at 24-months. Median survival was 21.2 months, with 12- and 24-month OS rates of 84% and 50%, respectively. Median CNS-PFS was 11.3 months, with 12- and 24-month CNS-PFS rates of 44.9% at both time points. Median systemic PFS was not reached, with 12- and 24-month systemic PFS rates of 86% and 57%, respectively. Symptomatic radiation necrosis occurred in 6 (4%) lesions. No additional unexpected toxicities were noted. CONCLUSIONS SRS in combination with tucatinib, capecitabine, and trastuzumab appears to be a safe and feasible treatment for HER2 + brain metastases. Further prospective evaluation of potential synergistic effects is warranted.
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Affiliation(s)
- Vaseem M Khatri
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Hatem H Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Hyo S Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
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9
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Chen YC, Jaffer M, Zhou L, Moslehi J, Forsyth PA, Fecher LA. A Brain, A Heart, and the Courage: Balancing Benefit and Toxicity of Immunotherapy in Melanoma. Am Soc Clin Oncol Educ Book 2023; 43:e390594. [PMID: 37229626 DOI: 10.1200/edbk_390594] [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: 05/27/2023]
Abstract
The overall survival of advanced melanoma has improved dramatically. Immunotherapies, specifically checkpoint inhibitors, have played a large role in this improvement. These agents have also shown benefit in the adjuvant setting, are approved for treatment of resected stage II, III, and IV melanoma, and play an evolving role in the neoadjuvant setting. Although generally well tolerated, immune-related adverse events occur and can be severe. Here we focus on some severe and potentially long term toxicities, including cardiovascular and neurologic toxicities. Our understanding of the acute and long-term toxicities of immune checkpoint inhibitors continues to evolve. Oncologists must continue to balance cancer risk and treatment-related toxicities.
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Affiliation(s)
- Yen-Chou Chen
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
- Division of Cardiology and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
| | - Muhammad Jaffer
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
| | - Lylybell Zhou
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Javid Moslehi
- Section of Cardio-Oncology and Immunology, Cardiovascular Research Institute (CVRI), University of California, San Francisco (UCSF), San Francisco, CA
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL
- Department of Oncology, Moffitt Cancer Center and University of South Florida, Tampa, FL
| | - Leslie A Fecher
- Rogel Cancer Center at the University of Michigan, Ann Arbor, MI
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10
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Khaled ML, Tarhini AA, Forsyth PA, Smalley I, Piña Y. Leptomeningeal Disease (LMD) in Patients with Melanoma Metastases. Cancers (Basel) 2023; 15:cancers15061884. [PMID: 36980770 PMCID: PMC10047692 DOI: 10.3390/cancers15061884] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Leptomeningeal disease (LMD) is a devastating complication caused by seeding malignant cells to the cerebrospinal fluid (CSF) and the leptomeningeal membrane. LMD is diagnosed in 5-15% of patients with systemic malignancy. Management of LMD is challenging due to the biological and metabolic tumor microenvironment of LMD being largely unknown. Patients with LMD can present with a wide variety of signs and/or symptoms that could be multifocal and include headache, nausea, vomiting, diplopia, and weakness, among others. The median survival time for patients with LMD is measured in weeks and up to 3-6 months with aggressive management, and death usually occurs due to progressive neurologic dysfunction. In melanoma, LMD is associated with a suppressive immune microenvironment characterized by a high number of apoptotic and exhausted CD4+ T-cells, myeloid-derived suppressor cells, and a low number of CD8+ T-cells. Proteomics analysis revealed enrichment of complement cascade, which may disrupt the blood-CSF barrier. Clinical management of melanoma LMD consists primarily of radiation therapy, BRAF/MEK inhibitors as targeted therapy, and immunotherapy with anti-PD-1, anti-CTLA-4, and anti-LAG-3 immune checkpoint inhibitors. This review summarizes the biology and anatomic features of melanoma LMD, as well as the current therapeutic approaches.
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Affiliation(s)
- Mariam Lotfy Khaled
- Metabolism and Physiology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Biochemistry Department, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt
| | - Ahmad A Tarhini
- Departments of Cutaneous Oncology and Immunology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Peter A Forsyth
- Neuro-Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Inna Smalley
- Metabolism and Physiology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Yolanda Piña
- Neuro-Oncology Department, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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11
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Ahmed KA, Kim Y, Armaghani A, Arrington J, Costa R, Czerniecki BJ, Diaz R, Forsyth PA, Khong H, Lee K, Loftus L, Rosa M, Soliman HH, Washington I, Soyano A, Han HS. Abstract OT3-19-01: Phase II Study of Screening Brain MRIs in Stage IV Breast Cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot3-19-01] [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: 03/06/2023]
Abstract
Abstract
Background: As systemic therapy improves, there has been an increasing number of breast cancer patients who develop brain metastasis. Screening of asymptomatic stage IV breast cancer patients with brain MRIs is not currently recommended by the National Comprehensive Cancer Network (NCCN) Guidelines. Retrospective reports suggest breast cancer patients are more likely to present with more advanced central nervous system disease at the time of brain metastasis diagnosis compared to melanoma and non-small cell lung cancer (NSCLC) patients. This may be in part due to routine screening recommendations in melanoma and NSCLC. Early detection and treatment of brain metastases may improve outcomes for breast cancer patients. Trial Design: The study is designed as a single arm, nonrandomized phase II study, with the goal of investigating the role of screening brain MRIs in neurologically asymptomatic patients with metastatic breast cancer. Breast cancer patients will be allocated based on receptor subtypes into triple negative (TN), HER2+, and hormone receptor (HR)+/HER2- breast cancer. Following study enrollment, patients will undergo a screening brain MRI. Patients will undergo a second brain MRI at first systemic progression or at 6 months whichever event occurs sooner. Eligibility: Asymptomatic, stage IV breast cancer patients that have progressed past first line therapy in the metastatic setting with an ECOG/= 6 months are eligible. Specific Aims: The primary objective is to determine the incidence of asymptomatic brain metastasis in metastatic breast cancer by subtype. Secondary objectives include determining the incidence of asymptomatic leptomeningeal disease, the number and size of brain metastases at diagnosis, the number of patients requiring whole brain radiation therapy vs. stereotactic radiation following diagnosis and overall survival and brain metastasis specific survival following brain metastasis diagnosis in metastatic breast cancer by subtype. Statistical Methods: A total of 30, 30, and 40 TN, HER2+, and HR+/HER2-, breast cancer patients will be enrolled, respectively. Using an incidence rate of 17%, the 95% CI by subtype will be (0.06,0.351), (0.06,0.351), and (0.07,0.322). Patient Accrual: This study is open with 30 patients enrolled at the time of submission. A total of 100 patients will be enrolled. Contact Information: Kamran A. Ahmed MD, Moffitt Cancer Center, email: kamran.ahmed@moffitt.org, Clinical trial information: NCT05115474. Funding: Florida Breast Cancer Foundation.
Citation Format: Kamran A. Ahmed, Youngchul Kim, Avan Armaghani, John Arrington, Ricardo Costa, Brian J. Czerniecki, Roberto Diaz, Peter A. Forsyth, Hung Khong, Kimberley Lee, Loretta Loftus, Marilin Rosa, Hatem H. Soliman, Iman Washington, Aixa Soyano, Hyo S. Han. Phase II Study of Screening Brain MRIs in Stage IV Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-19-01.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hung Khong
- 9Moffit Cancer Center & Research Institute
| | | | | | | | | | | | | | - Hyo S. Han
- 16H. Lee Moffitt Cancer Center, Tampa, FL, USA
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12
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Tang JD, Mills MN, Thawani C, Oliver DE, Soyano A, Etame A, Yu HHM, Tran N, Vogelbaum MA, Forsyth PA, Czerniecki BJ, Soliman HH, Han HS, Ahmed KA. Abstract PD7-06: Characteristics of Long-Term Survival in Breast Cancer Brain Metastasis after Stereotactic Radiation. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd7-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Advances in imaging and systemic therapy have improved the survival for patients with breast cancer brain metastases (BCBM). However, an improved understanding of patients with long-term survival after stereotactic radiation (SRT) for BCBM is warranted and could allow for better prognostication and personalized treatment. Methods: This is a single institution retrospective review of 188 patients who underwent SRT sessions to 685 BCBM from August 2004 to June 2020. Patients who were lost to follow up within 2 years after SRT were excluded. Patients were stratified into 2 groups: those with overall survival (OS) from SRT less than 2 years (short-term survival, STS) and those with OS from SRT of at least 2 years (long-term survival, LTS). Patient, tumor, and treatment characteristics were compared between the 2 groups via the student t-test and Chi-square testing as appropriate. The Kaplan-Meier (KM) method was used to calculate OS, local control (LC), and distant intracranial control (DIC) from the date of SRT. The reverse KM method was used to estimate follow-up from SRT. Results: The median follow up from BCBM diagnosis was 52.8 months (95% CI: 40.5-75.2 months). Of the 685 treated BCBMs, 552 (81%) received stereotactic radiosurgery (SRS) to a median dose of 21 Gy (12-24 Gy) and 133 received fractionated stereotactic radiation therapy (FSRT) to a median dose of 25 Gy (20-35 Gy) in 3-5 fractions. The 2-year LC, DIC, and OS was 78.4%, 26.5%, and 38.3%, respectively. The 5-year OS was 19%. There were 72 patients (38%) in the LTS group and 116 patients (62%) in the STS group. The LTS group had lower rates of invasive lobular carcinoma (0% vs 6%, p=0.001) and higher rate of HER2+ disease (61% vs 30%, p< 0.001). The LTS group had lower rates of concurrent extracranial metastasis (74% vs 89%, p=0.008) and lung metastasis (33% vs 53%, p=0.009), though there were no differences in the rates of bone or liver metastasis. The LTS group had less BCBM at the time of SRT (mean 1.9 vs 2.5, p=0.013) and more often received SRT to a single BCBM (65% vs 42%, p=0.002). There were no significant differences in age or performance status between the groups. Conclusion: Prognosis for patients with BCBM is heterogeneous, as a minority of patients have prolonged OS after SRT. These patients more often have limited BCBM, HER2+ disease, and a lower extracranial disease burden.
Citation Format: Joseph D. Tang, Matthew N. Mills, Chetna Thawani, Daniel E. Oliver, Aixa Soyano, Arnold Etame, Hsiang-Hsuan Michael Yu, Nam Tran, Michael A. Vogelbaum, Peter A. Forsyth, Brian J. Czerniecki, Hatem H. Soliman, Hyo S. Han, Kamran A. Ahmed. Characteristics of Long-Term Survival in Breast Cancer Brain Metastasis after Stereotactic Radiation [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD7-06.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Hyo S. Han
- 13H. Lee Moffitt Cancer Center, Tampa, FL
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13
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Rubino S, Oliver DE, Tran ND, Vogelbaum MA, Forsyth PA, Yu HHM, Ahmed K, Etame AB. Improving Brain Metastases Outcomes Through Therapeutic Synergy Between Stereotactic Radiosurgery and Targeted Cancer Therapies. Front Oncol 2022; 12:854402. [PMID: 35311078 PMCID: PMC8924127 DOI: 10.3389/fonc.2022.854402] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Brain metastases are the most common form of brain cancer. Increasing knowledge of primary tumor biology, actionable molecular targets and continued improvements in systemic and radiotherapy regimens have helped improve survival but necessitate multidisciplinary collaboration between neurosurgical, medical and radiation oncologists. In this review, we will discuss the advances of targeted therapies to date and discuss findings of studies investigating the synergy between these therapies and stereotactic radiosurgery for non-small cell lung cancer, breast cancer, melanoma, and renal cell carcinoma brain metastases.
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Affiliation(s)
- Sebastian Rubino
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Daniel E Oliver
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Nam D Tran
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | | | - Kamran Ahmed
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Arnold B Etame
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, United States
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14
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Law V, Chen Z, Vena F, Smalley I, Macaulay R, Evernden BR, Tran N, Pina Y, Puskas J, Caceres G, Bayle S, Johnson J, Liu JKC, Etame A, Vogelbaum M, Rodriguez P, Duckett D, Czerniecki B, Chen A, Smalley KSM, Forsyth PA. A preclinical model of patient-derived cerebrospinal fluid circulating tumor cells for experimental therapeutics in leptomeningeal disease from melanoma. Neuro Oncol 2022; 24:1673-1686. [PMID: 35213727 PMCID: PMC9527526 DOI: 10.1093/neuonc/noac054] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Leptomeningeal disease (LMD) occurs as a late complication of several human cancers and has no rationally designed treatment options. A major barrier to developing effective therapies for LMD is the lack of cell-based or preclinical models that recapitulate human disease. Here, we describe the development of in vitro and in vivo cultures of patient-derived cerebrospinal fluid circulating tumor cells (PD-CSF-CTCs) from patients with melanoma as a preclinical model to identify exploitable vulnerabilities in melanoma LMD. METHODS CSF-CTCs were collected from melanoma patients with melanoma-derived LMD and cultured ex vivo using human meningeal cell-conditioned media. Using immunoassays and RNA-sequencing analyses of PD-CSF-CTCs, molecular signaling pathways were examined and new therapeutic targets were tested for efficacy in PD-CSF-CTCs preclinical models. RESULTS PD-CSF-CTCs were successfully established both in vitro and in vivo. Global RNA analyses of PD-CSF-CTCs revealed several therapeutically tractable targets. These studies complimented our prior proteomic studies highlighting IGF1 signaling as a potential target in LMD. As a proof of concept, combining treatment of ceritinib and trametinib in vitro and in vivo demonstrated synergistic antitumor activity in PD-CSF-CTCs and BRAF inhibitor-resistant melanoma cells. CONCLUSIONS This study demonstrates that CSF-CTCs can be grown in vitro and in vivo from some melanoma patients with LMD and used as preclinical models. These models retained melanoma expression patterns and had signaling pathways that are therapeutically targetable. These novel models/reagents may be useful in developing rationally designed treatments for LMD.
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Affiliation(s)
- Vincent Law
- Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA.,Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Zhihua Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Francesca Vena
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Inna Smalley
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Robert Macaulay
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Brittany R Evernden
- Department of Analytic Microscopy, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Nam Tran
- Department of Analytic Microscopy, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Yolanda Pina
- Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA.,Department of Analytic Microscopy, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - John Puskas
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Gisela Caceres
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Simon Bayle
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Joseph Johnson
- Department of Analytic Microscopy, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - James K C Liu
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Arnold Etame
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Michael Vogelbaum
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Paulo Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Derek Duckett
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Brian Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Ann Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Keiran S M Smalley
- Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
| | - Peter A Forsyth
- Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA.,Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, USF Magnolia Drive, Tampa, FL, USA
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15
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Ahmed KA, Kim Y, DeJesus M, Beyer SJ, Williams NO, Palmer J, Woodhouse KD, Murthy RK, Li J, Armaghani AJ, Arrington JA, Costa RL, Czerniecki BJ, Etame AB, Forsyth PA, Khong HT, Oliver DE, Rosa M, Sahebjam S, Soliman HH, Soyano AE, Vogelbaum MA, Yu M, Han HS. Abstract OT2-09-01: Phase I/II study of stereotactic radiation and abemaciclib in the management of hormone receptor positive HER2 negative breast cancer brain metastases. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-09-01] [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: Breast cancer patients with brain metastases have a high unmet clinical need and improved management strategies are needed. There has been interest in studying CDK 4/6 inhibitors in the management of breast cancer brain metastases. A phase II study has shown abemaciclib to have activity in the management of hormone receptor (HR)+/HER2- brain metastases. Pre-clinical data suggests a potential synergy with CDK inhibitors and radiation therapy. Stereotactic radiosurgery (SRS) is a cornerstone in the management of limited brain metastases. We hypothesize treatment with abemaciclib and SRS will be safe and improve intracranial progression free survival (PFS) compared to abemaciclib alone. Trial Design: The study is designed as a prospective, single-arm, nonrandomized, open-label, phase I/II trial of abemaciclib and endocrine therapy with SRS among patients with HR+/HER2- metastatic breast cancer brain metastases. Treatment will be initiated with one week of abemaciclib followed by stereotactic radiation to sites of brain metastases or post-operative cavities with continued abemaciclib. Safety will be monitored initially by a 3+3 design. If unexpected neurologic toxicities are noted, the dose of radiation therapy will be reduced. This will be followed by a phase II study to evaluate intracranial PFS. Eligibility: Eligible patients include those that are HR+/HER2-, ≥18, ECOG ≤2 with ≤15 breast cancer brain metastases with measurable disease per Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. Specific Aims: The primary objective of the phase I study is to evaluate the safety and feasibility of abemaciclib and SRS to sites of brain metastases in the management of HR+/HER2- metastatic breast cancer with brain metastases. The primary objective of the phase II portion is to determine PFS intracranially. Secondary objectives include evaluation of extracranial PFS, local and distant intracranial control, and overall survival. Statistical Methods: Safety and feasibility will be monitored in the phase I study using a 3 + 3 design followed by a phase II study to assess intracranial PFS. The phase II study is designed as a single-arm, two-stage trial using the Restricted-Kwak-and-Jung’s method. In the first stage, a total of 21 patients will be enrolled. If pre-specified endpoints are met, an additional 10 patients will be enrolled in the second stage. Patient Accrual: A total of up to 31 patients will be enrolled inclusive of patients in the phase I portion treated at the recommended phase II dose. Clinical trial information: NCT04923542.
Citation Format: Kamran A. Ahmed, Youngchul Kim, Michelle DeJesus, Sasha J. Beyer, Nicole O. Williams, Joshua Palmer, Kristina D. Woodhouse, Rashmi K. Murthy, Jing Li, Avan J. Armaghani, John A. Arrington, Ricardo L. Costa, Brian J. Czerniecki, Arnold B. Etame, Peter A. Forsyth, Hung T. Khong, Daniel E. Oliver, Marilin Rosa, Solmaz Sahebjam, Hatem H. Soliman, Aixa E. Soyano, Michael A. Vogelbaum, Michael Yu, Hyo S. Han. Phase I/II study of stereotactic radiation and abemaciclib in the management of hormone receptor positive HER2 negative breast cancer brain metastases [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-09-01.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jing Li
- MD Anderson Cancer Center, Houston, TX
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16
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Piña Y, Yadugiri S, Yeboa DN, Ferguson SD, Forsyth PA, Oliva ICG. Advances in Diagnosis and Treatment for Leptomeningeal Disease in Melanoma. Curr Oncol Rep 2022; 24:43-54. [DOI: 10.1007/s11912-021-01162-3] [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] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
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17
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Basu A, Albert GK, Awshah S, Datta J, Kodumudi KN, Gallen C, Beyer A, Smalley KS, Rodriguez PC, Duckett DR, Forsyth PA, Soyano A, Koski GK, Lima Barros Costa R, Han H, Soliman H, Lee MC, Kalinski P, Czerniecki BJ. Identification of Immunogenic MHC Class II Human HER3 Peptides that Mediate Anti-HER3 CD4 + Th1 Responses and Potential Use as a Cancer Vaccine. Cancer Immunol Res 2022; 10:108-125. [PMID: 34785506 PMCID: PMC9414303 DOI: 10.1158/2326-6066.cir-21-0454] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/01/2021] [Accepted: 11/16/2021] [Indexed: 01/11/2023]
Abstract
The HER3/ERBB3 receptor is an oncogenic receptor tyrosine kinase that forms heterodimers with EGFR family members and is overexpressed in numerous cancers. HER3 overexpression associates with reduced survival and acquired resistance to targeted therapies, making it a potential therapeutic target in multiple cancer types. Here, we report on immunogenic, promiscuous MHC class II-binding HER3 peptides, which can generate HER3-specific CD4+ Th1 antitumor immune responses. Using an overlapping peptide screening methodology, we identified nine MHC class II-binding HER3 epitopes that elicited specific Th1 immune response in both healthy donors and breast cancer patients. Most of these peptides were not identified by current binding algorithms. Homology assessment of amino acid sequence BLAST showed >90% sequence similarity between human and murine HER3/ERBB3 peptide sequences. HER3 peptide-pulsed dendritic cell vaccination resulted in anti-HER3 CD4+ Th1 responses that prevented tumor development, significantly delayed tumor growth in prevention models, and caused regression in multiple therapeutic models of HER3-expressing murine tumors, including mammary carcinoma and melanoma. Tumors were robustly infiltrated with CD4+ T cells, suggesting their key role in tumor rejection. Our data demonstrate that class II HER3 promiscuous peptides are effective at inducing HER3-specific CD4+ Th1 responses and suggest their applicability in immunotherapies for human HER3-overexpressing tumors.
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Affiliation(s)
- Amrita Basu
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gabriella K. Albert
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Sabrina Awshah
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jashodeep Datta
- Department of Surgery, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Krithika N. Kodumudi
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Oncological Sciences, University of South Florida, Tampa, Florida
| | - Corey Gallen
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Amber Beyer
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Keiran S.M. Smalley
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Paulo C. Rodriguez
- Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Derek R. Duckett
- Department of Drug Discovery, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A. Forsyth
- Department of NeuroOncology and the NeuroOncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aixa Soyano
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Gary K. Koski
- Department of Biological Sciences, Kent State University, Kent, Ohio
| | | | - Heather Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Hatem Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Marie Catherine Lee
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Pawel Kalinski
- Department of Immunology, Roswell Park Comprehensive Cancer Center, New York, New York
| | - Brian J. Czerniecki
- Clinical Science Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Immunology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Corresponding Author: Brian J. Czerniecki, Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612. E-mail:
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18
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Tawbi HA, Forsyth PA, Hodi FS, Algazi AP, Hamid O, Lao CD, Moschos SJ, Atkins MB, Lewis K, Postow MA, Thomas RP, Glaspy J, Jang S, Khushalani NI, Pavlick AC, Ernstoff MS, Reardon DA, Kudchadkar R, Tarhini A, Chung C, Ritchings C, Durani P, Askelson M, Puzanov I, Margolin KA. Long-term outcomes of patients with active melanoma brain metastases treated with combination nivolumab plus ipilimumab (CheckMate 204): final results of an open-label, multicentre, phase 2 study. Lancet Oncol 2021; 22:1692-1704. [PMID: 34774225 DOI: 10.1016/s1470-2045(21)00545-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Combination nivolumab plus ipilimumab was efficacious in patients with asymptomatic melanoma brain metastases (MBM) in CheckMate 204, but showed low efficacy in patients with symptomatic MBM. Here, we provide final 3-year follow-up data from the trial. METHODS This open-label, multicentre, phase 2 study (CheckMate 204) included adults (aged ≥18 years) with measurable MBM (0·5-3·0 cm in diameter). Asymptomatic patients (cohort A) had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 and no neurological symptoms or baseline corticosteroid use; symptomatic patients (cohort B) had an ECOG performance status of 0-2 with stable neurological symptoms and could be receiving low-dose dexamethasone. Nivolumab 1 mg/kg plus ipilimumab 3 mg/kg was given intravenously every 3 weeks for four doses, followed by nivolumab 3 mg/kg every 2 weeks for up to 2 years, until disease progression or unacceptable toxicity. The primary endpoint was intracranial clinical benefit rate (complete responses, partial responses, or stable disease lasting ≥6 months) assessed in all treated patients. Intracranial progression-free survival and overall survival were key secondary endpoints. This study is registered with ClinicalTrials.gov, NCT02320058. FINDINGS Between Feb 19, 2015, and Nov 1, 2017, 119 (72%) of 165 screened patients were enrolled and treated: 101 patients were asymptomatic (cohort A; median follow-up 34·3 months [IQR 14·7-36·4]) and 18 were symptomatic (cohort B; median follow-up 7·5 months [1·2-35·2]). Investigator-assessed intracranial clinical benefit was observed in 58 (57·4% [95% CI 47·2-67·2]) of 101 patients in cohort A and three (16·7% [3·6-41·4]) of 18 patients in cohort B; investigator-assessed objective response was observed in 54 (53·5% [43·3-63·5]) patients in cohort A and three (16·7% [3·6-41·4]) patients in cohort B. 33 (33%) patients in cohort A and three (17%) patients in cohort B had an investigator-assessed intracranial complete response. For patients in cohort A, 36-month intracranial progression-free survival was 54·1% (95% CI 42·7-64·1) and overall survival was 71·9% (61·8-79·8). For patients in cohort B, 36-month intracranial progression-free survival was 18·9% (95% CI 4·6-40·5) and overall survival was 36·6% (14·0-59·8). The most common grade 3-4 treatment-related adverse events (TRAEs) were increased alanine aminotransferase and aspartate aminotransferase (15 [15%] of 101 patients each) in cohort A; no grade 3 TRAEs occurred in more than one patient each in cohort B, and no grade 4 events occurred. The most common serious TRAEs were colitis, diarrhoea, hypophysitis, and increased alanine aminotransferase (five [5%] of each among the 101 patients in cohort A); no serious TRAE occurred in more than one patient each in cohort B. There was one treatment-related death (myocarditis in cohort A). INTERPRETATION The durable 3-year response, overall survival, and progression-free survival rates for asymptomatic patients support first-line use of nivolumab plus ipilimumab. Symptomatic disease in patients with MBM remains difficult to treat, but some patients achieve a long-term response with the combination. FUNDING Bristol Myers Squibb.
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Affiliation(s)
- Hussein A Tawbi
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | - Alain P Algazi
- Melanoma Center, University of California-San Francisco, San Francisco, CA, USA
| | - Omid Hamid
- Melanoma Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA
| | - Christopher D Lao
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Stergios J Moschos
- Division of Hematology & Oncology, The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Michael B Atkins
- Department of Medical Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Karl Lewis
- Department of Medical Oncology, University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Reena P Thomas
- Department of Neurology, Stanford University Cancer Center, Stanford, CA, USA
| | - John Glaspy
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
| | - Sekwon Jang
- Inova Schar Cancer Institute, Fairfax, VA, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H Lee Moffitt Cancer Center, Tampa, FL USA
| | - Anna C Pavlick
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Marc S Ernstoff
- Department of Immuno-Oncology, Division of Cancer Treatment and Diagnosis, National Cancer Institute at the National Institutes of Health, Rockville, MD, USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ragini Kudchadkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Ahmad Tarhini
- Departments of Cutaneous Oncology and Immunology, Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Caroline Chung
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Igor Puzanov
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kim A Margolin
- Department of Medical Oncology, City of Hope, Duarte, CA, USA
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19
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Ahmed KA, Kim Y, Arrington JA, Kim S, DeJesus M, Soyano AE, Armaghani AJ, Costa RL, Khong HT, Loftus LS, Rosa M, Caudell JJ, Diaz R, Robinson TJ, Etame AB, Tran ND, Sahebjam S, Soliman HH, Czerniecki BJ, Forsyth PA, Yu HM, Han HS. Nivolumab and Stereotactic Radiosurgery for Patients With Breast Cancer Brain Metastases: A Nonrandomized, Open-Label Phase 1b Study. Adv Radiat Oncol 2021; 6:100798. [PMID: 34934864 PMCID: PMC8655428 DOI: 10.1016/j.adro.2021.100798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose Methods and Materials Results Conclusions
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20
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Mills MN, Potluri TK, Kawahara Y, Fahey M, Figura NB, Soyano AE, Washington IR, Diaz R, Oliver DE, Yu HHM, Etame AB, Vogelbaum MA, Czerniecki BJ, Arrington JA, Sahebjam S, Forsyth PA, Soliman HH, Han HS, Ahmed KA. The presentation of brain metastases in melanoma, non-small cell lung cancer, and breast cancer and potential implications for screening brain MRIs. Breast Cancer Res Treat 2021; 191:209-217. [PMID: 34669082 DOI: 10.1007/s10549-021-06420-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE This study assessed the presentation and institutional outcomes treating brain metastases (BM) of breast cancer (BC), non-small cell lung cancer (NSCLC), and melanoma origin. METHODS Patients with brain metastases treated between 2014 and 2019 with primary melanoma, NSCLC, and BC were identified. Overall survival (OS) was calculated from dates of initial BM diagnosis using the Kaplan-Meier method. RESULTS A total of 959 patients were identified including melanoma (31%), NSCLC (51%), and BC (18%). Patients with BC were younger at BM diagnosis (median age: 57) than NSCLC (65) and melanoma patients (62, p < 0.0001). Breast cancer patients were more likely to present with at least 5 BM (27%) than NSCLC (14%) and melanoma (13%), leptomeningeal disease (23%, 6%, and 6%, p = 0.0004) and receive whole brain radiation therapy (WBRT) (58%, 37%, and 22%, p < 0.0001). There were no differences in surgical resection (24%, 24%, and 29%, p = 0.166). Median OS was shorter for BC patients (9.9, 10.3, and 13.7 months, p = 0.0006). CONCLUSION Breast cancer patients were more likely to be younger, present with advanced disease, require WBRT, and have poorer OS than NSCLC and melanoma patients. Further investigation is needed to determine which BC patients are at sufficient risk for brain MRI screening.
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Affiliation(s)
- Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Thrisha K Potluri
- University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Yuki Kawahara
- University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Matthew Fahey
- University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Nicholas B Figura
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Aixa E Soyano
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Iman R Washington
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Roberto Diaz
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Arnold B Etame
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Brian J Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - John A Arrington
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Solmaz Sahebjam
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hatem H Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hyo S Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.
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21
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Smalley I, Chen Z, Phadke M, Li J, Yu X, Wyatt C, Evernden B, Messina JL, Sarnaik A, Sondak VK, Zhang C, Law V, Tran N, Etame A, Macaulay RJB, Eroglu Z, Forsyth PA, Rodriguez PC, Chen YA, Smalley KSM. Single-Cell Characterization of the Immune Microenvironment of Melanoma Brain and Leptomeningeal Metastases. Clin Cancer Res 2021; 27:4109-4125. [PMID: 34035069 DOI: 10.1158/1078-0432.ccr-21-1694] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Melanoma brain metastases (MBM) and leptomeningeal melanoma metastases (LMM) are two different manifestations of melanoma CNS metastasis. Here, we used single-cell RNA sequencing (scRNA-seq) to define the immune landscape of MBM, LMM, and melanoma skin metastases. EXPERIMENTAL DESIGN scRNA-seq was undertaken on 43 patient specimens, including 8 skin metastases, 14 MBM, and 19 serial LMM specimens. Detailed cell type curation was performed, the immune landscapes were mapped, and key results were validated by IHC and flow cytometry. Association analyses were undertaken to identify immune cell subsets correlated with overall survival. RESULTS The LMM microenvironment was characterized by an immune-suppressed T-cell landscape distinct from that of brain and skin metastases. An LMM patient with long-term survival demonstrated an immune repertoire distinct from that of poor survivors and more similar to normal cerebrospinal fluid (CSF). Upon response to PD-1 therapy, this extreme responder showed increased levels of T cells and dendritic cells in their CSF, whereas poor survivors showed little improvement in their T-cell responses. In MBM patients, therapy led to increased immune infiltrate, with similar T-cell transcriptional diversity noted between skin metastases and MBM. A correlation analysis across the entire immune landscape identified the presence of a rare population of dendritic cells (DC3) that was associated with increased overall survival and positively regulated the immune environment through modulation of activated T cells and MHC expression. CONCLUSIONS Our study provides the first atlas of two distinct sites of melanoma CNS metastases and defines the immune cell landscape that underlies the biology of this devastating disease.
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Affiliation(s)
- Inna Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Zhihua Chen
- Department of Bioinformatics and Biostatistics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Manali Phadke
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jiannong Li
- Department of Bioinformatics and Biostatistics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Xiaoqing Yu
- Department of Bioinformatics and Biostatistics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Clayton Wyatt
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Brittany Evernden
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jane L Messina
- Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Pathology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Amod Sarnaik
- Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vernon K Sondak
- Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Chaomei Zhang
- Molecular Genomics Core, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vincent Law
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nam Tran
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Arnold Etame
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Robert J B Macaulay
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida.,Department of Pathology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zeynep Eroglu
- Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A Forsyth
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Paulo C Rodriguez
- Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Y Ann Chen
- Department of Bioinformatics and Biostatistics, The Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Keiran S M Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida. .,Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
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22
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Sahebjam S, Forsyth PA, Tran ND, Arrington JA, Macaulay R, Etame AB, Walko CM, Boyle T, Peguero EN, Jaglal M, Mokhtari S, Enderling H, Raghunand N, Gatewood T, Long W, Dzierzeski JL, Evernden B, Robinson T, Wicklund MC, Kim S, Thompson ZJ, Chen DT, Chinnaiyan P, Yu HHM. Hypofractionated stereotactic re-irradiation with pembrolizumab and bevacizumab in patients with recurrent high-grade gliomas: results from a phase I study. Neuro Oncol 2021; 23:677-686. [PMID: 33173935 DOI: 10.1093/neuonc/noaa260] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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: 12/12/2022] Open
Abstract
BACKGROUND Radiotherapy may synergize with programmed cell death 1 (PD1)/PD1 ligand (PD-L1) blockade. The purpose of this study was to determine the recommended phase II dose, safety/tolerability, and preliminary efficacy of combining pembrolizumab, an anti-PD1 monoclonal antibody, with hypofractionated stereotactic irradiation (HFSRT) and bevacizumab in patients with recurrent high-grade gliomas (HGGs). METHODS Eligible subjects with recurrent glioblastoma or anaplastic astrocytoma were treated with pembrolizumab (100 or 200 mg based on dose level Q3W) concurrently with HFSRT (30 Gy in 5 fractions) and bevacizumab 10 mg/kg Q2W. RESULTS Thirty-two patients were enrolled (bevacizumab-naïve, n = 24; bevacizumab-resistant, n = 8). The most common treatment-related adverse events (TRAEs) were proteinuria (40.6%), fatigue (25%), increased alanine aminotransferase (25%), and hypertension (25%). TRAEs leading to discontinuation occurred in 1 patient who experienced a grade 3 elevation of aspartate aminotransferase. In the bevacizumab-naïve cohort, 20 patients (83%) had a complete response or partial response. The median overall survival (OS) and progression-free survival (PFS) were 13.45 months (95% CI: 9.46-18.46) and 7.92 months (95% CI: 6.31-12.45), respectively. In the bevacizumab-resistant cohort, PR was achieved in 5 patients (62%). Median OS was 9.3 months (95% CI: 8.97-18.86) with a median PFS of 6.54 months (95% CI: 5.95-18.86). The majority of patients (n = 20/26; 77%) had tumor-cell/tumor-microenvironment PD-L1 expression <1%. CONCLUSIONS The combination of HFSRT with pembrolizumab and bevacizumab in patients with recurrent HGG is generally safe and well tolerated. These findings merit further investigation of HFSRT with immunotherapy in HGGs.
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Affiliation(s)
- Solmaz Sahebjam
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Peter A Forsyth
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Nam D Tran
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - John A Arrington
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Robert Macaulay
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Arnold B Etame
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Christine M Walko
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Theresa Boyle
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Edwin N Peguero
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Michael Jaglal
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Sepideh Mokhtari
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Heiko Enderling
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Natarajan Raghunand
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Tyra Gatewood
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Wendy Long
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | | | - Timothy Robinson
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | | | - Sungjune Kim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
| | | | - Dung-Tsa Chen
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Prakash Chinnaiyan
- Beaumont Health and Oakland University School of Medicine, Royal Oak, Michigan, USA
| | - Hsiang-Hsuan Michael Yu
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,University of South Florida, Tampa, Florida
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23
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Mills MN, Naz A, Thawani C, Walker C, Figura NB, Kushchayev S, Oliver DE, Etame AB, Yu HHM, Robinson TJ, Liu JKC, Vogelbaum MA, Forsyth PA, Czerniecki BJ, Soliman HH, Han HS, Ahmed KA. Capecitabine and stereotactic radiation in the management of breast cancer brain metastases. BMC Cancer 2021; 21:552. [PMID: 33992087 PMCID: PMC8126143 DOI: 10.1186/s12885-021-08302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM). Methods Twenty-three patients with BCBM underwent 31 stereotactic sessions to 90 lesions from 2005 to 2019 with receipt of capecitabine. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of stereotactic radiation. Imaging was independently reviewed by a neuro-radiologist. Results Median follow-up from stereotactic radiation was 9.2 months. Receptor types of patients treated included triple negative (n = 7), hormone receptor (HR)+/HER2- (n = 7), HR+/HER2+ (n = 6), and HR−/HER2+ (n = 3). Fourteen patients had stage IV disease prior to BCBM diagnosis. The median number of brain metastases treated per patient was 3 (1 to 12). The median dose of stereotactic radiosurgery (SRS) was 21 Gy (range: 15–24 Gy) treated in a single fraction and for lesions treated with fractionated stereotactic radiation therapy (FSRT) 25 Gy (24–30 Gy) in a median of 5 fractions (range: 3–5). Of the 31 stereotactic sessions, 71% occurred within 1 month of capecitabine. No increased toxicity was noted in our series with no cases of radionecrosis. The 1-year OS, LC, and DIC were 46, 88, and 30%, respectively. Conclusions In our single institution experience, we demonstrate stereotactic radiation and capecitabine to be a safe treatment for patients with BCBM with adequate LC. Further study is needed to determine the potential synergy between stereotactic radiation and capecitabine in the management of BCBM.
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Affiliation(s)
- Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Afrin Naz
- Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Chetna Thawani
- Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Chelsea Walker
- Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Nicholas B Figura
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Sergiy Kushchayev
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Daniel E Oliver
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Arnold B Etame
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Timothy J Robinson
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - James K C Liu
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Michael A Vogelbaum
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Department of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Brian J Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hatem H Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hyo S Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
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Tawbi HA, Forsyth PA, Hodi FS, Lao CD, Moschos SJ, Hamid O, Atkins MB, Lewis K, Thomas RP, Glaspy JA, Jang S, Algazi AP, Khushalani NI, Postow MA, Pavlick AC, Ernstoff MS, Reardon DA, Puzanov I, Kudchadkar RR, Tarhini AA, Sumbul A, Rizzo JI, Margolin KA. Safety and Efficacy of the Combination of Nivolumab Plus Ipilimumab in Patients With Melanoma and Asymptomatic or Symptomatic Brain Metastases (CheckMate 204). Neuro Oncol 2021; 23:1961-1973. [PMID: 33880555 PMCID: PMC8563325 DOI: 10.1093/neuonc/noab094] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background In patients with melanoma and asymptomatic brain metastases (MBM), nivolumab plus ipilimumab provided an intracranial response rate of 55%. Here, we present the first report for patients who were symptomatic and/or required corticosteroids and updated data for asymptomatic patients. Methods Patients with measurable MBM, 0.5-3.0 cm, were enrolled into Cohort A (asymptomatic) or Cohort B (stable neurologic symptoms and/or receiving corticosteroids). Nivolumab, 1 mg/kg, and ipilimumab, 3 mg/kg, were given intravenously every 3 weeks ×4, followed by nivolumab, 3 mg/kg, every 2 weeks until progression, unacceptable toxicity, or 24 months. The primary endpoint was intracranial clinical benefit rate (CBR; complete response [CR], partial response [PR], or stable disease ≥6 months). Results Symptomatic patients (N = 18) received a median of one nivolumab and ipilimumab combination dose and had an intracranial CBR of 22.2%. Two of 12 patients on corticosteroids had CR; 2 responded among the 6 not on corticosteroids. Median intracranial progression-free survival (PFS) and overall survival (OS) were 1.2 and 8.7 months, respectively. In contrast, with 20.6 months of follow-up, we confirmed an intracranial CBR of 58.4% in asymptomatic patients (N = 101); median duration of response, PFS, and OS were not reached. No new safety signals were observed. Conclusions Nivolumab plus ipilimumab provides durable clinical benefit for asymptomatic patients with MBM and should be considered for first-line therapy. This regimen has limited activity in MBM patients with neurologic symptoms and/or requiring corticosteroids, supporting the need for alternative approaches and methods to reduce the dependency on corticosteroids. Clinical trial registration. ClinicalTrials.gov, NCT02320058.
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Affiliation(s)
- Hussein A Tawbi
- Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Stergios J Moschos
- Division of Hematology & Oncology, The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Omid Hamid
- Department of Translational Research & Immunotherapy, The Angeles Clinic and Research Institute, A Cedars-Sinai Affilliate, Los Angeles, CA
| | - Michael B Atkins
- Department of Medical Oncology,Georgetown-Lombardi Comprehensive Cancer Center, Washington DC
| | - Karl Lewis
- Department of Medical Oncology, University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Reena P Thomas
- Department of Neurology, Stanford University Cancer Center, Stanford, CA
| | - John A Glaspy
- Department of Medicine, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA
| | - Sekwon Jang
- Department of Medicine, Inova Schar Cancer Institute, Virginia Commonwealth University, Fairfax, VA
| | - Alain P Algazi
- Department of Hematology & Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Michael A Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna C Pavlick
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Marc S Ernstoff
- Department of Immuno-Oncology, Division of Cancer Treatment and Diagnosis, National Cancer Institute at the National Institutes of Health, Rockville, MD
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Igor Puzanov
- Department of Medical Oncology, Roswell Park Cancer Institute, Buffalo, NY
| | - Ragini R Kudchadkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Ahmad A Tarhini
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Anne Sumbul
- Biostatistics, Bristol Myers Squibb Company, Princeton, NJ
| | - Jasmine I Rizzo
- Oncology Clinical Development, Bristol Myers Squibb Company, Princeton, NJ
| | - Kim A Margolin
- Department of Medical Oncology, City of Hope, Duarte, CA
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25
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Mills MN, Walker C, Thawani C, Naz A, Figura NB, Kushchayev S, Etame A, Yu HHM, Robinson TJ, Liu J, Vogelbaum MA, Forsyth PA, Czerniecki BJ, Soliman HH, Han HS, Ahmed KA. Trastuzumab Emtansine (T-DM1) and stereotactic radiation in the management of HER2+ breast cancer brain metastases. BMC Cancer 2021; 21:223. [PMID: 33663447 PMCID: PMC7934378 DOI: 10.1186/s12885-021-07971-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/24/2021] [Indexed: 12/21/2022] Open
Abstract
Background Due to recent concerns about the toxicity of trastuzumab emtansine (T-DM1) with stereotactic radiation, we assessed our institutional outcomes treating HER2-positive breast cancer brain metastases (BCBM) with T-DM1 and stereotactic radiation. Methods This is a single institution series of 16 patients with HER2-positive breast cancer who underwent 18 stereotactic sessions to 40 BCBM from 2013 to 2019 with T-DM1 delivered within 6 months. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), distant intracranial control (DIC), and systemic progression-free survival (sPFS) from the date of SRS. A neuro-radiologist independently reviewed follow-up imaging. Results One patient had invasive lobular carcinoma, and 15 patients had invasive ductal carcinoma. All cases were HER2-positive, while 10 were hormone receptor (HR) positive. Twenty-four lesions were treated with stereotactic radiosurgery (SRS) to a median dose of 21 Gy (14–24 Gy). Sixteen lesions were treated with fractionated stereotactic radiation (FSRT) with a median dose of 25 Gy (20-30Gy) delivered in 3 to 5 fractions. Stereotactic radiation was delivered concurrently with T-DM1 in 19 lesions (48%). Median follow up time was 13.2 months from stereotactic radiation. The 1-year LC, DIC, sPFS, and OS were 75, 50, 30, and 67%, respectively. There was 1 case of leptomeningeal progression and 1 case (3%) of symptomatic radionecrosis. Conclusions We demonstrate that stereotactic radiation and T-DM1 is well-tolerated and effective for patients with HER2-positive BCBM. An increased risk for symptomatic radiation necrosis was not noted in our series.
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Affiliation(s)
- Matthew N Mills
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.
| | - Chelsea Walker
- University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Chetna Thawani
- University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Afrin Naz
- University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Nicholas B Figura
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Sergiy Kushchayev
- Departments of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Arnold Etame
- Departments of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Timothy J Robinson
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - James Liu
- Departments of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Michael A Vogelbaum
- Departments of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Departments of Neuro Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Brian J Czerniecki
- Departments of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hatem H Soliman
- Departments of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hyo S Han
- Departments of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Kamran A Ahmed
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
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26
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Phadke MS, Chen Z, Li J, Mohamed E, Davies MA, Smalley I, Duckett DR, Palve V, Czerniecki BJ, Forsyth PA, Noyes D, Adeegbe DO, Eroglu Z, Nguyen KT, Tsai KY, Rix U, Burd CE, Chen YA, Rodriguez PC, Smalley KSM. Targeted Therapy Given after Anti-PD-1 Leads to Prolonged Responses in Mouse Melanoma Models through Sustained Antitumor Immunity. Cancer Immunol Res 2021; 9:554-567. [PMID: 33653716 DOI: 10.1158/2326-6066.cir-20-0905] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/14/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Immunotherapy (IT) and targeted therapy (TT) are both effective against melanoma, but their combination is frequently toxic. Here, we investigated whether the sequence of IT (anti-PD-1)→ TT (ceritinib-trametinib or dabrafenib-trametinib) was associated with improved antitumor responses in mouse models of BRAF- and NRAS-mutant melanoma. Mice with NRAS-mutant (SW1) or BRAF-mutant (SM1) mouse melanomas were treated with either IT, TT, or the sequence of IT→TT. Tumor volumes were measured, and samples from the NRAS-mutant melanomas were collected for immune-cell analysis, single-cell RNA sequencing (scRNA-seq), and reverse phase protein analysis (RPPA). scRNA-seq demonstrated that the IT→TT sequence modulated the immune environment, leading to increased infiltration of T cells, monocytes, dendritic cells and natural killer cells, and decreased numbers of tumor-associated macrophages, myeloid-derived suppressor cells, and regulatory T cells. Durable responses to the IT→TT sequence were dependent on T-cell activity, with depletion of CD8+, but not CD4+, T cells abrogating the therapeutic response. An analysis of transcriptional heterogeneity in the melanoma compartment showed the sequence of IT→TT enriched for a population of melanoma cells with increased expression of MHC class I and melanoma antigens. RPPA analysis demonstrated that the sustained immune response induced by IT→TT suppressed tumor-intrinsic signaling pathways required for therapeutic escape. These studies establish that upfront IT improves the responses to TT in BRAF- and NRAS-mutant melanoma models.
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Affiliation(s)
- Manali S Phadke
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zhihua Chen
- The Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jiannong Li
- The Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eslam Mohamed
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michael A Davies
- The Department of Melanoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Inna Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Derek R Duckett
- The Department of Drug Discovery, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vinayak Palve
- The Department of Drug Discovery, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Brian J Czerniecki
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A Forsyth
- The Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - David Noyes
- The Department of Malignant Hematology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Dennis O Adeegbe
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zeynep Eroglu
- The Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kimberly T Nguyen
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kenneth Y Tsai
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
- The Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Uwe Rix
- The Department of Drug Discovery, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christin E Burd
- Department of Cancer Biology and Genetics, Ohio State University, Columbus, Ohio
| | - Yian A Chen
- The Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Paulo C Rodriguez
- The Department of Immunology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Keiran S M Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida.
- The Department of Cutaneous Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
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27
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Kawahara Y, Fahey M, Potluri TK, Mills MN, Figura NB, Washington IR, Diaz R, Robinson TJ, Yu HHM, Etame AB, Liu J, Vogelbaum MA, Czerniecki BJ, Forsyth PA, Soliman HH, Han HS, Ahmed KA. Abstract PS14-19: Characteristics of breast cancer brain metastases presentation by subtype and validation of the modified breast graded prognostic assessment. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps14-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Breast cancer brain metastases (BCBM) diagnosis is increasing in frequency due to improved systemic control and imaging techniques. Differences have been noted in rates of central nervous system (CNS) relapse and biologic subtype. The modified breast graded prognostic assessment (breast-GPA) was initially validated in patients treated between 1996-2013 and considers biologic subtype. In this study, we characterize patients diagnosed with BCBM by subtype and validate the breast-GPA in a modern cohort of patients.
Methods: All patients with BCBM treated at our institution with radiotherapy between 2016 and 2019 were identified. Characteristics of patients’ initial brain metastasis diagnosis were retrieved from the clinical chart and radiologic examinations. To test differences between cohorts, the Kruskal-Wallis and Pearson’s chi-square tests were used when appropriate. Overall survival (OS) was calculated from the date of brain metastasis diagnosis to the date of death using the Kaplan-Meier (KM) method, with the log-rank test used to examine differences between groups.
Results: A total of 122 BCBM patients were identified. Breast cancer subtypes included hormone receptor (HR)+/HER2- (45%), triple negative (TN) (25%), HR-/HER2+ (16%), and HR+/HER2+ (14%). The first treatment for BCBM patients following diagnosis was whole brain radiation (51%), surgery followed by stereotactic radiation (28%), and stereotactic radiation (21%). The interval between breast cancer diagnosis and diagnosis of BCBM was longest for HR+/HER2- 4.5 years, followed by TN 2.8 years, HR+/HER2+ 2.3 years, HR-/HER2+ 1.9 years, p=0.003. The interval from systemic metastases to BCBM diagnosis trended towards the shortest for TN patients 6.6 months, p=0.15. A total of 34 patients (28%) were diagnosed with leptomeningeal disease (LMD) at initial brain metastases presentation. LMD was diagnosed most commonly at presentation in HR+/HER2- (36%) followed by , TN (26%), HR-/HER2+ (26%), and HR+/HER2+ (6%), p=0.06. No differences were noted based on receptor typessubtype and age, symptomatic intracranial disease, number of brain metastases, type of first intracranial treatment or concurrent systemic metastases at initial BCBM presentation, all p > 0.05. Twenty-four month KM OS rates following diagnosis of brain metastasis for breast-GPA 0-1, 1.5-2, 2.5-3, and 3.5-4 groups were 14%, 27%, 33%, and 86% (p=0.0005), respectively.
Conclusions: In our institutional analysis, similarities were noted in the initial presentation of BCBM based on receptor typesubtype. Significant differences were noted in OS based on the modified breast-GPA. Further investigation is needed to determine which subtypes of asymptomatic breast cancer patients are at sufficient risk to warrant brain MRI screening.
Citation Format: Yuki Kawahara, Matthew Fahey, Thrisha K Potluri, Matthew N Mills, Nicholas B Figura, Iman R Washington, Roberto Diaz, Timothy J Robinson, Hsiang-Hsuan M Yu, Arnold B Etame, James Liu, Michael A Vogelbaum, Brian J Czerniecki, Peter A Forsyth, Hatem H Soliman, Hyo S Han, Kamran A Ahmed. Characteristics of breast cancer brain metastases presentation by subtype and validation of the modified breast graded prognostic assessment [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-19.
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Affiliation(s)
- Yuki Kawahara
- 1University of South Florida Morsani College of Medicine, Tampa, FL
| | - Matthew Fahey
- 1University of South Florida Morsani College of Medicine, Tampa, FL
| | | | - Matthew N Mills
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Roberto Diaz
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Arnold B Etame
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - James Liu
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Peter A Forsyth
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Hatem H Soliman
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Hyo S Han
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kamran A Ahmed
- 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Law V, Baldwin M, Ramamoorthi G, Kodumudi K, Tran N, Smalley I, Duckett D, Kalinski P, Czerniecki B, Smalley KSM, Forsyth PA. A Murine Ommaya Xenograft Model to Study Direct-Targeted Therapy of Leptomeningeal Disease. J Vis Exp 2021. [PMID: 33586709 PMCID: PMC9014476 DOI: 10.3791/62033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Leptomeningeal disease (LMD) is an uncommon type of central nervous system (CNS) metastasis to the cerebral spinal fluid (CSF). The most common cancers that cause LMD are breast and lung cancers and melanoma. Patients diagnosed with LMD have a very poor prognosis and generally survive for only a few weeks or months. One possible reason for the lack of efficacy of systemic therapy against LMD is the failure to achieve therapeutically effective concentrations of drug in the CSF because of an intact and relatively impermeable blood-brain barrier (BBB) or blood-CSF barrier across the choroid plexus. Therefore, directly administering drugs intrathecally or intraventricularly may overcome these barriers. This group has developed a model that allows for the effective delivery of therapeutics (i.e., drugs, antibodies, and cellular therapies) chronically and the repeated sampling of CSF to determine drug concentrations and target modulation in the CSF (when the tumor microenvironment is targeted in mice). The model is the murine equivalent of a magnetic resonance imaging-compatible Ommaya reservoir, which is used clinically. This model, which is affixed to the skull, has been designated as the "Murine Ommaya." As a therapeutic proof of concept, human epidermal growth factor receptor 2 antibodies (clone 7.16.4) were delivered into the CSF via the Murine Ommaya to treat mice with LMD from human epidermal growth factor receptor 2-positive breast cancer. The Murine Ommaya increases the efficiency of drug delivery using a miniature access port and prevents the wastage of excess drug; it does not interfere with CSF sampling for molecular and immunological studies. The Murine Ommaya is useful for testing novel therapeutics in experimental models of LMD.
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Affiliation(s)
- Vincent Law
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute; Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute
| | - Margi Baldwin
- Department of Comparative Medicine, University of South Florida
| | - Ganesan Ramamoorthi
- Department of Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute
| | - Krithika Kodumudi
- Department of Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute
| | - Nam Tran
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute
| | - Inna Smalley
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center & Research Institute
| | - Derek Duckett
- Department of Drug Discovery, H. Lee Moffitt Cancer Center & Research Institute
| | - Pawel Kalinski
- Department of Medical Oncology, Roswell Park Comprehensive Cancer Center
| | - Brian Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center & Research Institute
| | - Keiran S M Smalley
- Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute
| | - Peter A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute; Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute;
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29
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Fusco MJ, Piña Y, Macaulay RJ, Sahebjam S, Forsyth PA, Peguero E, Walko CM. Durable Progression-Free Survival With the Use of BRAF and MEK Inhibitors in Four Cases With BRAF V600E-Mutated Gliomas. Cancer Control 2021; 28:10732748211040013. [PMID: 34620004 PMCID: PMC8506147 DOI: 10.1177/10732748211040013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION BRAF V600 E mutations have been identified in a subset of patients with primary brain tumors. Combination therapy with BRAF and Mitogen-activated protein kinase (MEK) inhibitors (BRAF/MEKi) targeting sequential steps in the MAPK pathway has replaced BRAFi monotherapy as the standard of care in multiple tumors with BRAF V600 E mutations, and clinical evidence for this strategy continues to grow in primary brain tumors. CASE SERIES We describe four patients with BRAF V600 E mutated gliomas, including a 21-year-old woman with a ganglioglioma WHO grade I, a 19-year-old man with a pleomorphic xanthoastrocytoma WHO grade III, and 21-year-old and 33-year-old women with epithelioid GBM WHO grade IV, who achieved durable progression-free survival with combination BRAF/MEKi. CONCLUSION Combination of BRAF/MEK inhibition can be a novel, promising approach as targeted therapy in gliomas with BRAF V600 E mutations, especially those that are resistant to standard therapy. Our cases, along with other early reports utilizing dabrafenib/trametinib, highlight the importance of somatic next-generation sequencing, particularly in younger patients. Interim results from clinical trials utilizing dabrafenib/trametinib have been promising thus far, and our case series suggests that durable clinical benefit is possible, even in the setting of glioblastoma, WHO grade IV.
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Affiliation(s)
- Michael J. Fusco
- Department of Individualized Cancer Medicine, Moffitt Cancer Center, Tampa, FL, USA
| | - Yolanda Piña
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Robert J. Macaulay
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA
| | - Solmaz Sahebjam
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Peter A. Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Edwin Peguero
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Christine M. Walko
- Department of Individualized Cancer Medicine, Moffitt Cancer Center, Tampa, FL, USA
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Zhang C, Smalley I, Emmons MF, Sharma R, Izumi V, Messina J, Koomen JM, Pasquale EB, Forsyth PA, Smalley KSM. Noncanonical EphA2 Signaling Is a Driver of Tumor-Endothelial Cell Interactions and Metastatic Dissemination in BRAF Inhibitor‒Resistant Melanoma. J Invest Dermatol 2020; 141:840-851.e4. [PMID: 32890629 DOI: 10.1016/j.jid.2020.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Received: 05/08/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022]
Abstract
Acquired BRAF/MAPK/extracellular signal‒regulated kinase inhibitor resistance in melanoma results in a new transcriptional state associated with an increased risk of metastasis. In this study, we identified noncanonical ephrin receptor (Eph) EphA2 signaling as a driver of the resistance-associated metastatic state. We used mass spectrometry‒based proteomic and phenotypic assays to demonstrate that the expression of active noncanonical EphA2-S897E in melanoma cells led to a mesenchymal-to-amoeboid transition driven by Cdc42 activation. The induction of mesenchymal-to-amoeboid transition promoted melanoma cell invasion, survival under shear stress, adhesion to endothelial cells under continuous-flow conditions, increased permeability of endothelial cell monolayers, and stimulated melanoma transendothelial cell migration. In vivo, melanoma cells expressing EphA2-S897E or active Cdc42 showed superior lung retention after tail-vain injection. Analysis of BRAF inhibitor‒sensitive and ‒resistant melanoma cells demonstrated resistance to be associated with a mesenchymal-to-amoeboid transition switch, upregulation of Cdc42 activity, increased invasion, and transendothelial migration. The drug-resistant metastatic state was dependent on histone deacetylase 8 activity. Silencing of histone deacetylase 8 led to the inhibition of EphA2 and protein kinase B phosphorylation, reduced invasion, and impaired melanoma cell-endothelial cell interactions. In summary, we have demonstrated that the metastatic state associated with acquired BRAF inhibitor resistance is dependent on noncanonical EphA2 signaling, leading to increased melanoma-endothelial cell interactions and enhanced tumor dissemination.
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Affiliation(s)
- Chao Zhang
- The Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Inna Smalley
- The Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
| | - Michael F Emmons
- The Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Ritin Sharma
- The Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Victoria Izumi
- The Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Jane Messina
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - John M Koomen
- The Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Elena B Pasquale
- Department of Tumor Initiation and Maintenance, Sanford Burnham Prebys Medical Discovery Institute, San Diego, California, USA
| | - Peter A Forsyth
- The Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA; The Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA; Tom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | - Keiran S M Smalley
- The Department of Tumor Biology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA; The Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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Glazar DJ, Grass GD, Arrington JA, Forsyth PA, Raghunand N, Yu HHM, Sahebjam S, Enderling H. Tumor Volume Dynamics as an Early Biomarker for Patient-Specific Evolution of Resistance and Progression in Recurrent High-Grade Glioma. J Clin Med 2020; 9:E2019. [PMID: 32605050 PMCID: PMC7409184 DOI: 10.3390/jcm9072019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/16/2022] Open
Abstract
Recurrent high-grade glioma (HGG) remains incurable with inevitable evolution of resistance and high inter-patient heterogeneity in time to progression (TTP). Here, we evaluate if early tumor volume response dynamics can calibrate a mathematical model to predict patient-specific resistance to develop opportunities for treatment adaptation for patients with a high risk of progression. A total of 95 T1-weighted contrast-enhanced (T1post) MRIs from 14 patients treated in a phase I clinical trial with hypo-fractionated stereotactic radiation (HFSRT; 6 Gy × 5) plus pembrolizumab (100 or 200 mg, every 3 weeks) and bevacizumab (10 mg/kg, every 2 weeks; NCT02313272) were delineated to derive longitudinal tumor volumes. We developed, calibrated, and validated a mathematical model that simulates and forecasts tumor volume dynamics with rate of resistance evolution as the single patient-specific parameter. Model prediction performance is evaluated based on how early progression is predicted and the number of false-negative predictions. The model with one patient-specific parameter describing the rate of evolution of resistance to therapy fits untrained data ( R 2 = 0.70 ). In a leave-one-out study, for the nine patients that had T1post tumor volumes ≥1 cm3, the model was able to predict progression on average two imaging cycles early, with a median of 9.3 (range: 3-39.3) weeks early (median progression-free survival was 27.4 weeks). Our results demonstrate that early tumor volume dynamics measured on T1post MRI has the potential to predict progression following the protocol therapy in select patients with recurrent HGG. Future work will include testing on an independent patient dataset and evaluation of the developed framework on T2/FLAIR-derived data.
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Affiliation(s)
- Daniel J. Glazar
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
| | - G. Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
| | - John A. Arrington
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
- Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL 33612, USA
- Department of Radiology, University of South Florida, Tampa, FL 33612, USA
| | - Peter A. Forsyth
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Natarajan Raghunand
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Cancer Physiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
| | - Solmaz Sahebjam
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (G.D.G.); (H.-H.M.Y.)
- Department of Oncologic Sciences, University of South Florida, Tampa, FL 33612, USA; (J.A.A.); (P.A.F.); (N.R.)
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Smalley I, Law V, Wyatt C, Evernden B, Fang B, Koomen JM, Welsh EA, Macaulay RJB, Forsyth PA, Smalley KSM. Proteomic Analysis of CSF from Patients with Leptomeningeal Melanoma Metastases Identifies Signatures Associated with Disease Progression and Therapeutic Resistance. Clin Cancer Res 2020; 26:2163-2175. [PMID: 31924735 PMCID: PMC7196498 DOI: 10.1158/1078-0432.ccr-19-2840] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/24/2019] [Accepted: 01/08/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The development of leptomeningeal melanoma metastases (LMM) is a rare and devastating complication of the late-stage disease, for which no effective treatments exist. Here, we performed a multi-omics analysis of the cerebrospinal fluid (CSF) from patients with LMM to determine how the leptomeningeal microenvironment shapes the biology and therapeutic responses of melanoma cells. EXPERIMENTAL DESIGN A total of 45 serial CSF samples were collected from 16 patients, 8 of these with confirmed LMM. Of those with LMM, 7 had poor survival (<4 months) and one was an extraordinary responder (still alive with survival >35 months). CSF samples were analyzed by mass spectrometry and incubated with melanoma cells that were subjected to RNA sequencing (RNA-seq) analysis. Functional assays were performed to validate the pathways identified. RESULTS Mass spectrometry analyses showed the CSF of most patients with LMM to be enriched for pathways involved in innate immunity, protease-mediated damage, and IGF-related signaling. All of these were anticorrelated in the extraordinary responder. RNA-seq analysis showed CSF to induce PI3K/AKT, integrin, B-cell activation, S-phase entry, TNFR2, TGFβ, and oxidative stress responses in the melanoma cells. ELISA assays confirmed that TGFβ expression increased in the CSF of patients progressing with LMM. CSF from poorly responding patients conferred tolerance to BRAF inhibitor therapy in apoptosis assays. CONCLUSIONS These analyses identified proteomic/transcriptional signatures in the CSF of patients who succumbed to LMM. We further showed that the CSF from patients with LMM has the potential to modulate BRAF inhibitor responses and may contribute to drug resistance.See related commentary by Glitza Oliva and Tawbi, p. 2083.
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Affiliation(s)
- Inna Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vincent Law
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Clayton Wyatt
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Brittany Evernden
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bin Fang
- Proteomics and Metabolomics Core, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - John M Koomen
- Department of Molecular Oncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Eric A Welsh
- Department of Biostatistics and Bioinformatics, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Robert J B Macaulay
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Peter A Forsyth
- Department of Neurooncology, The Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Keiran S M Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center and Research Institute, Tampa, Florida.
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Ahmed KA, Kim Y, Armaghani AJ, Arrington JA, Caudell JJ, Costa RL, Czerniecki BJ, Etame AB, Forsyth PA, Khong HT, Kim S, Loftus L, Robinson TJ, Rosa M, Sahebjam S, Soliman HH, Soyano AE, Tran ND, Yu HM, Han HS. Abstract OT3-10-01: Phase Ib study of stereotactic radiation and nivolumab in the management of metastatic breast cancer with brain metastases. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot3-10-01] [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:Patients with breast cancer brain metastases represent a poor prognosis cohort with a high unmet clinical need. Standard-of-care treatments for patients with breast cancer brain metastases include local treatments, such as surgical resection and radiation treatment modalities that include stereotactic radiosurgery (SRS) or whole brain radiotherapy. Numerous pre-clinical studies have provided evidence to combine radiation therapy with immune checkpoint inhibition to improve response rates. The evidence is strongest for short course, hypofractionated radiation regimens. We hypothesize treatment with nivolumab and SRS will be feasible and well tolerated and may improve intracranial tumor control rates compared to SRS alone. Trial Design:The study is designed as a prospective, single-arm, nonrandomized, open-label, phase Ib trial of nivolumab and SRS among patients with metastatic breast cancer brain metastases. Treatment will be initiated with a dose of nivolumab (480 mg IV) that will be repeated every 4 weeks. The initial dose of nivolumab will be followed 1 week later by SRS at sites of brain metastases or post-operative cavities. Patients will be allowed to continue endocrine and HER2-targeted therapies if brain metastases progression was noted on these agents.Eligibility:Eligible patients include those ≥18, ECOG ≤2 with ≤10 breast cancer brain metastases of all subtypes eligible for stereotactic radiation. Specific Aims:The primary objective is to evaluate the safety and feasibility of nivolumab and SRS to sites of brain metastases. Secondary objectives include evaluation of intracranial progression free survival (PFS), extracranial PFS, overall survival, local control, and distant brain control. Correlative aims include assessing blood and tissue biomarkers (i.e. PD-L1, mutation burden, TCR repertoire etc.) for association with clinical benefit.Statistical Methods:Safety and feasibility will be monitored by a 3 + 3 design followed by a dose expansion phase. Patient Accrual:This study is open with 4 patients enrolled at the time of submission. A total of 12 patients will be enrolled.Contact Information:Kamran A. Ahmed MD, Moffitt Cancer Center, email: kamran.ahmed@moffitt.org, Clinical trial information: NCT03807765.
Citation Format: Kamran A Ahmed, Youngchul Kim, Avan J. Armaghani, John A. Arrington, Jimmy J. Caudell, Ricardo L. Costa, Brian J. Czerniecki, Arnold B. Etame, Peter A. Forsyth, Hung T. Khong, Sungjune Kim, Loretta Loftus, Timothy J. Robinson, Marilin Rosa, Solmaz Sahebjam, Hatem H. Soliman, Aixa E. Soyano, Nam D. Tran, H. Michael Yu, Hyo S. Han. Phase Ib study of stereotactic radiation and nivolumab in the management of metastatic breast cancer with brain metastases [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT3-10-01.
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Mills MN, Figura NB, Arrington JA, Yu HHM, Etame AB, Vogelbaum MA, Soliman H, Czerniecki BJ, Forsyth PA, Han HS, Ahmed KA. Management of brain metastases in breast cancer: a review of current practices and emerging treatments. Breast Cancer Res Treat 2020; 180:279-300. [PMID: 32030570 DOI: 10.1007/s10549-020-05552-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 10/28/2019] [Accepted: 01/30/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Breast cancer brain metastases (BCBM) are becoming an increasingly common diagnosis due to improved systemic control and more routine surveillance imaging. Treatment continues to require a multidisciplinary approach managing systemic and intracranial disease burden. Although, improvements have been made in the diagnosis and management of BCBM, brain metastasis patients continue to pose a challenge for practitioners. METHODS In this review, a group of medical oncologists, radiation oncologists, radiologists, breast surgeons, and neurosurgeons specializing in the treatment of breast cancer reviewed the available published literature and compiled a comprehensive review on the current state of BCBM. RESULTS We discuss the pathogenesis, epidemiology, diagnosis, treatment options (including systemic, surgical, and radiotherapy treatment modalities), and treatment response evaluation for BCBM. Furthermore, we discuss the ongoing prospective trials enrolling BCBM patients and their biologic rationale. CONCLUSIONS BCBM management is an increasing clinical concern. Multidisciplinary management combining the strengths of surgical, systemic, and radiation treatment modalities with prospective trials incorporating knowledge from the basic and translational sciences will ultimately lead to improved clinical outcomes for BCBM patients.
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Affiliation(s)
- Matthew N Mills
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Nicholas B Figura
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - John A Arrington
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hsiang-Hsuan Michael Yu
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA
| | - Arnold B Etame
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hatem Soliman
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Brian J Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Hyo S Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, Tampa, FL, 33612, USA.
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Figura NB, Potluri TK, Mohammadi H, Oliver DE, Arrington JA, Robinson TJ, Etame AB, Tran ND, Liu JK, Soliman H, Forsyth PA, Sahebjam S, Yu HM, Han HS, Ahmed KA. CDK 4/6 inhibitors and stereotactic radiation in the management of hormone receptor positive breast cancer brain metastases. J Neurooncol 2019; 144:583-589. [DOI: 10.1007/s11060-019-03260-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/03/2019] [Indexed: 12/18/2022]
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Figura NB, Rizk VT, Armaghani AJ, Arrington JA, Etame AB, Han HS, Czerniecki BJ, Forsyth PA, Ahmed KA. Breast leptomeningeal disease: a review of current practices and updates on management. Breast Cancer Res Treat 2019; 177:277-294. [PMID: 31209686 DOI: 10.1007/s10549-019-05317-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Leptomeningeal disease (LMD) is an advanced metastatic disease presentation portending a poor prognosis with minimal treatment options. The advent and widespread use of new systemic therapies for metastatic breast cancer has improved systemic disease control and extended survival; however, as patients live longer, the rates of breast cancer LMD are increasing. METHODS In this review, a group of medical oncologists, radiation oncologists, radiologists, breast surgeons, and neurosurgeons specializing in treatment of breast cancer reviewed the available published literature and compiled a comprehensive review on the current state of breast cancer LMD. RESULTS We discuss the pathogenesis, epidemiology, diagnosis, treatment options (including systemic, intrathecal, surgical, and radiotherapy treatment modalities), and treatment response evaluation specific to breast cancer patients. Furthermore, we discuss the controversies within this unique clinical setting and identify potential clinical opportunities to improve upon the diagnosis, treatment, and treatment response evaluation in the management of breast LMD. CONCLUSIONS We recognize the shortcomings in our current understanding of the disease and explore the future role of genomic/molecular disease characterization, technological innovations, and ongoing clinical trials attempting to improve the prognosis for this advanced disease state.
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Affiliation(s)
- Nicholas B Figura
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Victoria T Rizk
- Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Avan J Armaghani
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - John A Arrington
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Arnold B Etame
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Hyo S Han
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Brian J Czerniecki
- Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA
| | - Peter A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA.
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Eroglu Z, Holmen SL, Chen Q, Khushalani NI, Amaravadi R, Thomas R, Ahmed KA, Tawbi H, Chandra S, Markowitz J, Smalley I, Liu JK, Chen YA, Najjar YG, Karreth FA, Abate-Daga D, Glitza IC, Sosman JA, Sondak VK, Bosenberg M, Herlyn M, Atkins MB, Kluger H, Margolin K, Forsyth PA, Davies MA, Smalley KSM. Melanoma central nervous system metastases: An update to approaches, challenges, and opportunities. Pigment Cell Melanoma Res 2019; 32:458-469. [PMID: 30712316 PMCID: PMC7771318 DOI: 10.1111/pcmr.12771] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 02/06/2023]
Abstract
In February 2018, the Melanoma Research Foundation and the Moffitt Cancer Center hosted the Second Summit on Melanoma Central Nervous System (CNS) Metastases in Tampa, Florida. In this white paper, we outline the current status of basic science, translational, and clinical research into melanoma brain metastasis development and therapeutic management. We further outline the important challenges that remain for the field and the critical barriers that need to be overcome for continued progress to be made in this clinically difficult area.
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Affiliation(s)
| | - Sheri L. Holmen
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Qing Chen
- The Wistar Institute, Philadelphia, Pennsylvania
| | | | - Ravi Amaravadi
- The University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | - Yana G. Najjar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | | - Michael B. Atkins
- Georgetown University Cancer Center, Washington, District of Columbia
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Figura NB, Rizk VT, Mohammadi H, Evernden B, Mokhtari S, Yu HM, Robinson TJ, Etame AB, Tran ND, Liu J, Washington I, Diaz R, Czerniecki BJ, Soliman H, Han HS, Sahebjam S, Forsyth PA, Ahmed KA. Clinical outcomes of breast leptomeningeal disease treated with intrathecal trastuzumab, intrathecal chemotherapy, or whole brain radiation therapy. Breast Cancer Res Treat 2019; 175:781-788. [DOI: 10.1007/s10549-019-05170-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
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Forsyth PA, Abate-Daga D. Viral Therapy Gets Personal: A Potential Gene Signature to Predict Susceptibility to Measles Virus Oncolysis. J Natl Cancer Inst 2018; 110:1139-1140. [PMID: 29757401 DOI: 10.1093/jnci/djy061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Daniel Abate-Daga
- Immunology, Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Tawbi HA, Forsyth PA, Algazi A, Hamid O, Hodi FS, Moschos SJ, Khushalani NI, Lewis K, Lao CD, Postow MA, Atkins MB, Ernstoff MS, Reardon DA, Puzanov I, Kudchadkar RR, Thomas RP, Tarhini A, Pavlick AC, Jiang J, Avila A, Demelo S, Margolin K. Combined Nivolumab and Ipilimumab in Melanoma Metastatic to the Brain. N Engl J Med 2018; 379:722-730. [PMID: 30134131 PMCID: PMC8011001 DOI: 10.1056/nejmoa1805453] [Citation(s) in RCA: 837] [Impact Index Per Article: 139.5] [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: 12/16/2022]
Abstract
BACKGROUND Brain metastases are a common cause of disabling neurologic complications and death in patients with metastatic melanoma. Previous studies of nivolumab combined with ipilimumab in metastatic melanoma have excluded patients with untreated brain metastases. We evaluated the efficacy and safety of nivolumab plus ipilimumab in patients with melanoma who had untreated brain metastases. METHODS In this open-label, multicenter, phase 2 study, patients with metastatic melanoma and at least one measurable, nonirradiated brain metastasis (tumor diameter, 0.5 to 3 cm) and no neurologic symptoms received nivolumab (1 mg per kilogram of body weight) plus ipilimumab (3 mg per kilogram) every 3 weeks for up to four doses, followed by nivolumab (3 mg per kilogram) every 2 weeks until progression or unacceptable toxic effects. The primary end point was the rate of intracranial clinical benefit, defined as the percentage of patients who had stable disease for at least 6 months, complete response, or partial response. RESULTS Among 94 patients with a median follow-up of 14.0 months, the rate of intracranial clinical benefit was 57% (95% confidence interval [CI], 47 to 68); the rate of complete response was 26%, the rate of partial response was 30%, and the rate of stable disease for at least 6 months was 2%. The rate of extracranial clinical benefit was 56% (95% CI, 46 to 67). Treatment-related grade 3 or 4 adverse events were reported in 55% of patients, including events involving the central nervous system in 7%. One patient died from immune-related myocarditis. The safety profile of the regimen was similar to that reported in patients with melanoma who do not have brain metastases. CONCLUSIONS Nivolumab combined with ipilimumab had clinically meaningful intracranial efficacy, concordant with extracranial activity, in patients with melanoma who had untreated brain metastases. (Funded by Bristol-Myers Squibb and the National Cancer Institute; CheckMate 204 ClinicalTrials.gov number, NCT02320058 .).
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Affiliation(s)
- Hussein A Tawbi
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Peter A Forsyth
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Alain Algazi
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Omid Hamid
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - F Stephen Hodi
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Stergios J Moschos
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Nikhil I Khushalani
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Karl Lewis
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Christopher D Lao
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Michael A Postow
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Michael B Atkins
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Marc S Ernstoff
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - David A Reardon
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Igor Puzanov
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Ragini R Kudchadkar
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Reena P Thomas
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Ahmad Tarhini
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Anna C Pavlick
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Joel Jiang
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Alexandre Avila
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Sheena Demelo
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
| | - Kim Margolin
- From the University of Texas M.D. Anderson Cancer Center, Houston (H.A.T.); Moffitt Cancer Center and Research Institute, Tampa, FL (P.A.F., N.I.K.); University of California-San Francisco, San Francisco (A. Algazi), the Angeles Clinic and Research Institute, Los Angeles (O.H.), Stanford University Hospital, Palo Alto (R.P.T.), and the Department of Medical Oncology, City of Hope, Duarte (K.M.) - all in California; Dana-Farber Cancer Institute, Boston (F.S.H., D.A.R.); University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill (S.J.M.); University of Colorado Comprehensive Cancer Center, Aurora (K.L.); University of Michigan, Ann Arbor (C.D.L.); Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York (M.A.P.), Roswell Park Cancer Institute, Buffalo (M.S.E., I.P.), and New York University, Lake Success (A.C.P.) - all in New York; Georgetown-Lombardi Comprehensive Cancer Center, Washington DC (M.B.A.); Winship Cancer Institute of Emory University, Atlanta (R.R.K.); University of Pittsburgh Medical Center, Pittsburgh (A.T.); Bristol-Myers Squibb, Princeton, NJ (J.J., A. Avila, S.D.); and Cleveland Clinic-Taussig Cancer Institute, Cleveland (A.T.)
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Affiliation(s)
- Peter A. Forsyth
- Peter A. Forsyth and Daniel Abate-Daga, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Daniel Abate-Daga
- Peter A. Forsyth and Daniel Abate-Daga, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Sloot S, Chen YA, Zhao X, Weber JL, Benedict JJ, Mulé JJ, Smalley KS, Weber JS, Zager JS, Forsyth PA, Sondak VK, Gibney GT. Reply to Improving the survival of patients with American Joint Committee on Cancer stage III and IV melanoma. Cancer 2018. [PMID: 29543319 DOI: 10.1002/cncr.31261] [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: 11/08/2022]
Affiliation(s)
- Sarah Sloot
- Department of General Surgery, Groningen University Medical Center, Groningen, The Netherlands.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Yian A Chen
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Xiuhua Zhao
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Jamie L Weber
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jacob J Benedict
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - James J Mulé
- Department of Immunology, Moffitt Cancer Center, Tampa, Florida
| | - Keiran S Smalley
- Department of Cutaneous Oncology; Department of Tumor Biology, Moffitt Cancer Center, Tampa, Florida
| | - Jeffrey S Weber
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, New York
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center; Department of Oncologic Sciences; Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Peter A Forsyth
- Department of Neurooncology, Moffitt Cancer Center, Tampa, Florida; Department of Neurooncology, Southern Alberta Cancer Research Institute, Calgary, Alberta, Canada
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center; Department of Oncologic Sciences; Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Geoffrey T Gibney
- Georgetown Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC
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Affiliation(s)
- Keiran S M Smalley
- The Department of Tumor Biology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA; The Department of Cutaneous Oncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA.
| | - Peter A Forsyth
- The Department of Neurooncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA
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Forsyth PA, Smalley KSM, Sondak VK. BRAF-MEK inhibition in melanoma brain metastases: a new hope. Lancet Oncol 2017; 18:836-837. [DOI: 10.1016/s1470-2045(17)30449-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 11/29/2022]
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Groshev A, Padalia D, Patel S, Garcia-Getting R, Sahebjam S, Forsyth PA, Vrionis FD, Etame AB. Clinical outcomes from maximum-safe resection of primary and metastatic brain tumors using awake craniotomy. Clin Neurol Neurosurg 2017; 157:25-30. [DOI: 10.1016/j.clineuro.2017.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/03/2017] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Leptomeningeal metastasis is a consequence of advanced solid malignancies and has limited treatment options. It is possible that it is becoming more common as the leptomeninges act as a sanctuary site for recurrence from systemic cancer. METHODS Potential targeted and immunotherapy agents for the most common types of solid-tumor leptomeningeal metastasis are reviewed, as are their dosing/delivery strategies and novel, immunological approaches. RESULTS Historically, patients with leptomeningeal metastasis have been excluded from clinical trials, and data on the management of leptomeningeal metastasis come from single case reports and retrospective analyses. CONCLUSION For the first time ever, published reports suggest the tide may be turning in this challenging disease.
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Affiliation(s)
- Solmaz Sahebjam
- Department of Neuro-Oncology, Moffitt Cancer Center and Department of Oncologic, University of South Florida Morsani College of Medicine, Tampa, FL.
| | - Peter A Forsyth
- Department of Neuro-Oncology, Moffitt Cancer Center and Department of Oncologic, University of South Florida Morsani College of Medicine, Tampa, FL, and the Tom Baker Cancer Center and University of Calgary, Alberta, Canada
| | - Keiran S Smalley
- Departments of Tumor Biology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Nam D Tran
- Department of Neuro-Oncology, Moffitt Cancer Center and Department of Oncologic, University of South Florida Morsani College of Medicine, Tampa, FL
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Ahmed KA, Abuodeh YA, Echevarria MI, Arrington JA, Stallworth DG, Hogue C, Naghavi AO, Kim S, Kim Y, Patel BG, Sarangkasiri S, Johnstone PAS, Sahebjam S, Khushalani NI, Forsyth PA, Harrison LB, Yu M, Etame AB, Caudell JJ. Clinical outcomes of melanoma brain metastases treated with stereotactic radiosurgery and anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK inhibitors, BRAF inhibitor, or conventional chemotherapy. Ann Oncol 2016; 27:2288-2294. [PMID: 27637745 DOI: 10.1093/annonc/mdw417] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/30/2016] [Accepted: 08/22/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The effect of immunologic and targeted agents on intracranial response rates in patients with melanoma brain metastases (MBMs) is not yet clearly understood. This report analyzes outcomes of intact MBMs treated with single-session stereotactic radiosurgery (SRS) and anti-PD-1 therapy, anti-CTLA-4 therapy, BRAF/MEK inhibitors(i), BRAFi, or conventional chemotherapy. PATIENTS AND METHODS Patients were included if MBMs were treated with single-session SRS within 3 months of receiving systemic therapy. The primary end point of this study was distant MBM control. Secondary end points were local MBM control defined as a >20% volume increase on follow-up MRI, systemic progression-free survival, overall survival (OS) from both SRS and cranial metastases diagnosis, and neurotoxicity. Images were reviewed alongside two neuro-radiologists at our institution. RESULTS Ninety-six patients were treated to 314 MBMs over 119 SRS treatment sessions between January 2007 and August 2015. No significant differences were noted in age (P = 0.27), gender (P = 0.85), treated gross tumor volume (P = 0.26), or the diagnosis-specific graded prognostic assessment (P = 0.51) between the treatment cohorts. Twelve-month Kaplan-Meier (KM) distant MBM control rates were 38%, 21%, 20%, 8%, and 5% (P = 0.008) for SRS with anti-PD-1 therapies, anti-CTLA-4 therapy, BRAF/MEKi, BRAFi, and conventional chemotherapy, respectively. No significant differences were noted in the KM local MBM control rates among treatment groups (P = 0.25). Treatment with anti-PD-1 therapy, anti-CTLA-4 therapy, or BRAF/MEKi significantly improved OS on both univariate and multivariate analyses when compared with conventional chemotherapy. CONCLUSION In our institutional analysis of patients treated with SRS and various systemic immunologic and targeted melanoma agents, significant differences in distant MBM control and OS are noted. Prospective evaluation of the potential synergistic effect between these agents and SRS is warranted.
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Affiliation(s)
| | | | | | - J A Arrington
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa
| | - D G Stallworth
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa
| | - C Hogue
- Department of School of Medicine, University of Louisville, Louisville
| | | | - S Kim
- Department of Radiation Oncology
| | - Y Kim
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa
| | - B G Patel
- Department of Morsani College of Medicine, University of South Florida, Tampa
| | | | | | - S Sahebjam
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa
| | - N I Khushalani
- Department of Cutaneous-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - P A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa
| | | | - M Yu
- Department of Radiation Oncology
| | - A B Etame
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa
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Smalley KSM, Fedorenko IV, Kenchappa RS, Sahebjam S, Forsyth PA. Managing leptomeningeal melanoma metastases in the era of immune and targeted therapy. Int J Cancer 2016; 139:1195-201. [PMID: 27084046 DOI: 10.1002/ijc.30147] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/24/2016] [Accepted: 04/08/2016] [Indexed: 12/11/2022]
Abstract
Melanoma frequently metastasizes to the brain, with CNS involvement being clinically evident in ∼30% of patients (as high as 75% at autopsy). In ∼5% cases melanoma cells also metastasize to the leptomeninges, the sub-arachnoid space and cerebrospinal fluid (CSF). Patients with leptomeningeal melanoma metastases (LMM) have the worst prognosis and are characterized by rapid disease progression (mean survival 8-10 weeks) and a death from neurological causes. The recent years have seen tremendous progress in the development of targeted and immune therapies for melanoma that has translated into an increased survival benefit. Despite these gains, the majority of patients fail therapy and there is a suspicion that the brain and the leptomeninges are a "sanctuary" sites for melanoma cells that escape both targeted therapy and immunologic therapies. Emerging evidence suggests that (1) Cancer cells migrating to the CNS may have unique molecular properties and (2) the CNS/leptomeningeal microenvironment represents a pro-survival niche that influences therapeutic response. In this Mini-Review, we will outline the clinical course of LMM development and will describe how the intracranial immune and cellular microenvironments offer both opportunities and challenges for the successful management of this disease. We will further discuss the latest data demonstrating the potential use of BRAF inhibitors and immune therapy in the management of LMM, and will review future potential therapeutic strategies for the management of this most devastating complication of advanced melanoma.
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Affiliation(s)
- Keiran S M Smalley
- The Department of Tumor Biology, Moffitt Cancer Center & Research Institute, Tampa, FL.,Department of Cutaneous Oncology, Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Inna V Fedorenko
- The Department of Tumor Biology, Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Rajappa S Kenchappa
- The Department of Tumor Biology, Moffitt Cancer Center & Research Institute, Tampa, FL.,Department of NeuroOncology, Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Solmaz Sahebjam
- Department of NeuroOncology, Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Peter A Forsyth
- The Department of Tumor Biology, Moffitt Cancer Center & Research Institute, Tampa, FL.,Department of NeuroOncology, Moffitt Cancer Center & Research Institute, Tampa, FL.,Department of Oncology, Tom Baker Cancer Center & University of Calgary, Calgary, AB, Canada
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49
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Pisklakova A, McKenzie B, Zemp F, Lun X, Kenchappa RS, Etame AB, Rahman MM, Reilly K, Pilon-Thomas S, McFadden G, Kurz E, Forsyth PA. M011L-deficient oncolytic myxoma virus induces apoptosis in brain tumor-initiating cells and enhances survival in a novel immunocompetent mouse model of glioblastoma. Neuro Oncol 2016; 18:1088-1098. [PMID: 26962017 DOI: 10.1093/neuonc/now006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 11/14/2022] Open
Abstract
BACKGROUND Myxoma virus (MYXV) is a promising oncolytic agent and is highly effective against immortalized glioma cells but less effective against brain tumor initiating cells (BTICs), which are believed to mediate glioma development/recurrence. MYXV encodes various proteins to attenuate host cell apoptosis, including an antiapoptotic Bcl-2 homologue known as M011L. Such proteins may limit the ability of MYXV to kill BTICs, which have heightened resistance to apoptosis. We hypothesized that infecting BTICs with an M011L-deficient MYXV construct would overcome BTIC resistance to MYXV. METHODS We used patient-derived BTICs to evaluate the efficacy of M011L knockout virus (vMyx-M011L-KO) versus wild-type MYXV (vMyx-WT) and characterized the mechanism of virus-induced cell death in vitro. To extend our findings in a novel immunocompetent animal model, we derived, cultured, and characterized a C57Bl/6J murine BTIC (mBTIC0309) from a spontaneous murine glioma and evaluated vMyx-M011L-KO efficacy with and without temozolomide (TMZ) in mBTIC0309-bearing mice. RESULTS We demonstrated that vMyx-M011L-KO induces apoptosis in BTICs, dramatically increasing sensitivity to the virus. vMyx-WT failed to induce apoptosis as M011L protein prevented Bax activation and cytochrome c release. In vivo, intracranial implantation of mBTIC0309 generated tumors that closely recapitulated the pathological and molecular profile of human gliomas. Treatment of tumor-bearing mice with vMyx-M011L-KO significantly prolonged survival in immunocompetent-but not immunodeficient-mouse models, an effect that is significantly enhanced in combination with TMZ. CONCLUSIONS Our data suggest that vMyx-M011L-KO is an effective, well-tolerated, proapoptotic oncolytic virus and a strong candidate for clinical translation.
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Affiliation(s)
- Alexandra Pisklakova
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Brienne McKenzie
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Franz Zemp
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Xueqing Lun
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Rajappa S Kenchappa
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Arnold B Etame
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Masmudur M Rahman
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Karlyne Reilly
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Shari Pilon-Thomas
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Grant McFadden
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Ebba Kurz
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
| | - Peter A Forsyth
- Department of Neuro-Oncology and Tumor Biology, Moffitt Cancer Center, Tampa, Florida (A.P., R.S.K., A.B.E., P.A.F.); Southern Alberta Cancer Research Institute, University of Calgary, Calgary, Alberta, Canada (B.M., F.Z., X.L., E.K., P.A.F.); Department of Molecular Genetics and Microbiology, University of Florida, Gainesville, Florida (M.M.R., G.M.); Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (K.R.); Department of Immunology, Moffitt Cancer Center, Tampa, Florida (S.P.-T.)
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50
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Egan KM, Nabors LB, Thompson ZJ, Rozmeski CM, Anic GA, Olson JJ, LaRocca RV, Chowdhary SA, Forsyth PA, Thompson RC. Analgesic use and the risk of primary adult brain tumor. Eur J Epidemiol 2016; 31:917-25. [PMID: 26894804 DOI: 10.1007/s10654-016-0129-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/13/2016] [Indexed: 12/21/2022]
Abstract
Glioma and meningioma are uncommon tumors of the brain with few known risk factors. Regular use of aspirin has been linked to a lower risk of gastrointestinal and other cancers, though evidence for an association with brain tumors is mixed. We examined the association of aspirin and other analgesics with the risk of glioma and meningioma in a large US case-control study. Cases were persons recently diagnosed with glioma or meningioma and treated at medical centers in the southeastern US. Controls were persons sampled from the same communities as the cases combined with friends and other associates of the cases. Information on past use of analgesics (aspirin, other anti-inflammatory agents, and acetaminophen) was collected in structured interviews. Logistic regression was used to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for analgesic use adjusted for potential confounders. All associations were considered according to indication for use. A total of 1123 glioma cases, 310 meningioma cases and 1296 controls were included in the analysis. For indications other than headache, glioma cases were less likely than controls to report regular use of aspirin (OR 0.69; CI 0.56, 0.87), in a dose-dependent manner (P trend < 0.001). No significant associations were observed with other analgesics for glioma, or any class of pain reliever for meningioma. Results suggest that regular aspirin use may reduce incidence of glioma.
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Affiliation(s)
- Kathleen M Egan
- Division of Population Sciences, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, USA.
| | - Louis B Nabors
- Neuro-Oncology Program, University of Alabama at Birmingham, FOT 1020, 510 20th St. South, Birmingham, AL, 35294, USA
| | - Zachary J Thompson
- Division of Population Sciences, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, USA
| | - Carrie M Rozmeski
- Division of Population Sciences, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, USA
| | - Gabriella A Anic
- Division of Population Sciences, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, 1365-B Clifton Rd., NE, Ste. 2200, Atlanta, GA, 30322, USA
| | - Renato V LaRocca
- Department of Hematology-Oncology, Norton Cancer Institute, 315 E. Broadway, Louisville, KY, 40202, USA
| | - Sajeel A Chowdhary
- Neuro-Oncology Program, Lynn Cancer Institute and the Boca Raton Regional Hospital, 701 NW 13th Street, Boca Raton, FL, 33486, USA
| | - Peter A Forsyth
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, 691 Preston Building, Nashville, TN, 37232, USA
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