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Kemeny MM, Zhao F, Forastiere AA, Catalano P, Hamilton SR, Miedema BW, Dawson NA, Weiner LM, Smith BD, Mason BA, Graziano SL, Gilman PB, Venook AP, Pinto HA, Whitehead RP, O’Dwyer PJ, Benson AB. Phase III Prospectively Randomized Trial of Perioperative 5-FU After Curative Resection for Colon Cancer: An Intergroup Trial of the ECOG-ACRIN Cancer Research Group (E1292). Ann Surg Oncol 2023; 30:1099-1109. [PMID: 36305992 PMCID: PMC9807536 DOI: 10.1245/s10434-022-12705-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 10/04/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Studies suggest that adjuvant chemotherapy should be initiated at the earliest possible time. The Eastern Cooperative Oncology Group (ECOG) and Intergroup evaluated the effect of perioperative fluorouracil (5-FU) on overall survival (OS) for colon cancer. PATIENTS AND METHODS This phase III trial randomized patients to receive continuous infusional 5-FU for 7 days starting within 24 h after curative resection (arm A) or no perioperative 5-FU (arm B). Patients with Dukes' B3 and C disease received adjuvant chemotherapy per standard of care. The primary endpoint of the trial was overall survival in patients with Dukes' B3 and C disease. The secondary objective was to determine whether a week of perioperative infusion would affect survival in patients with Dukes' B2 colon cancer with no additional chemotherapy. RESULTS From August 1993 to May 2000, 859 patients were enrolled and 855 randomized (arm A: 427; arm B: 428). The trial was terminated early due to slow accrual. The median follow-up is 15.4 years (0.03-20.3 years). Among patients with Dukes' B3 and C disease, there was no statistically significant difference in OS [median 10.3 years (95% CI 8.4, 13.2) for perioperative chemotherapy and 9.3 years (95% CI 5.7, 12.3) for no perioperative therapy, one-sided log-rank p = 0.178, HR = 0.88 (95% CI 0.66, 1.16)] or disease-free survival (DFS). For patients with Dukes' B2 disease, there was also no significant difference in OS (median 16.1 versus 12.9 years) or DFS. There was no difference between treatment arms in operative complications. One week of continuous infusion of 5-FU was tolerable; 18% of arm A patients experienced grade 3 or greater toxicity.
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Affiliation(s)
- M. Margaret Kemeny
- Icahn School of Medicine at Mount Sinai, Queens Cancer Center of NYC Health + Hospitals/Queens, Jamaica, NY USA
| | - Fengmin Zhao
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA USA
| | - Arlene A. Forastiere
- John Hopkins University and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD USA
| | - Paul Catalano
- Dana Farber Cancer Institute - ECOG-ACRIN Biostatistics Center, Boston, MA USA
| | | | | | | | | | | | | | | | | | - Alan P. Venook
- Helen Diller Family Comprehensive Cancer Center, USCF, San Francisco, CA USA
| | | | | | - Peter J. O’Dwyer
- University of Pennsylvania and Abramson Cancer Center, Philadelphia, PA USA
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O’Dwyer PJ. Modified Eligibility Criteria: Patient Access and Subpopulation Applicability vs Efficiency in Drug Development. J Natl Cancer Inst 2022; 114:1429-1430. [PMID: 36047853 PMCID: PMC9664182 DOI: 10.1093/jnci/djac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Peter J O’Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network Cancer Research Group, Philadelphia, PA, USA
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Romanello Joaquim M, Furth EE, Fan Y, Song HK, Pickup S, Cao J, Choi H, Gupta M, Cao Q, Shinohara R, McMenamin D, Clendenin C, Karasic TB, Duda J, Gee JC, O’Dwyer PJ, Rosen MA, Zhou R. DWI Metrics Differentiating Benign Intraductal Papillary Mucinous Neoplasms from Invasive Pancreatic Cancer: A Study in GEM Models. Cancers (Basel) 2022; 14:cancers14164017. [PMID: 36011011 PMCID: PMC9406679 DOI: 10.3390/cancers14164017] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
KPC (KrasG12D:Trp53R172H:Pdx1-Cre) and CKS (KrasG12D:Smad4L/L:Ptf1a-Cre) mice are genetically engineered mouse (GEM) models that capture features of human pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasms (IPMN), respectively. We compared these autochthonous tumors using quantitative imaging metrics from diffusion-weighted MRI (DW-MRI) and dynamic contrast enhanced (DCE)-MRI in reference to quantitative histological metrics including cell density, fibrosis, and microvasculature density. Our results revealed distinct DW-MRI metrics between the KPC vs. CKS model (mimicking human PDAC vs. IPMN lesion): the apparent diffusion coefficient (ADC) of CKS tumors is significantly higher than that of KPC, with little overlap (mean ± SD 2.24±0.2 vs. 1.66±0.2, p<10−10) despite intratumor and intertumor variability. Kurtosis index (KI) is also distinctively separated in the two models. DW imaging metrics are consistent with growth pattern, cell density, and the cystic nature of the CKS tumors. Coregistration of ex vivo ADC maps with H&E-stained sections allowed for regional comparison and showed a correlation between local cell density and ADC value. In conclusion, studies in GEM models demonstrate the potential utility of diffusion-weighted MRI metrics for distinguishing pancreatic cancer from benign pancreatic cysts such as IPMN.
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Affiliation(s)
| | - Emma E. Furth
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yong Fan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hee Kwon Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Stephen Pickup
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jianbo Cao
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hoon Choi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mamta Gupta
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Quy Cao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Russell Shinohara
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Deirdre McMenamin
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cynthia Clendenin
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas B. Karasic
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey Duda
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James C. Gee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter J. O’Dwyer
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mark A. Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rong Zhou
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Pancreatic Cancer Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence:
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Karasic TB, Brown TJ, Schneider C, Teitelbaum UR, Reiss KA, Mitchell TC, Massa RC, O’Hara MH, DiCicco L, Garcia-Marcano L, Amaravadi RK, O’Dwyer PJ. OUP accepted manuscript. Oncologist 2022; 27:716-e689. [PMID: 35552447 PMCID: PMC9438902 DOI: 10.1093/oncolo/oyac078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/14/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The antiangiogenic tyrosine kinase inhibitor regorafenib provides a survival benefit in patients with previously treated metastatic colorectal cancer (CRC). Antiangiogenic therapy causes hypoxic stress within tumor cells, which activates autophagy as a survival mechanism. The histone deacetylase inhibitor (HDAC) entinostat increases dependence on autophagy through epigenetic mechanisms. Hydroxychloroquine (HCQ) blocks autophagy by blunting lysosomal acidification. We hypothesized that HCQ and entinostat would be tolerable with regorafenib and potentiate the antitumor response. METHODS This was a 3+3 phase I trial of HCQ and entinostat with regorafenib in patients with metastatic CRC. The primary objective was safety, and the secondary objective was clinical efficacy. RESULTS Twenty patients received study therapy. Six evaluable patients were enrolled at each of the three planned dose levels, one patient at an intermediate dose level, and one additional patient withdrew consent after 4 days to receive treatment closer to home. One dose-limiting toxicity was noted in the study at dose level 2 (grade 3 fatigue). Seven patients discontinued therapy due to related toxicities; rapid weight loss was near universal, with a median weight loss of 4.4 kg (range 1.5-12.2 kg) in the first 2 weeks of treatment. No objective responses were observed. CONCLUSION The combination of regorafenib, HCQ, and entinostat was poorly tolerated without evident activity in metastatic CRC. CLINICALTRIALS.GOV IDENTIFIER NCT03215264.
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Affiliation(s)
- Thomas B Karasic
- Corresponding author: Thomas B. Karasic, MD, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA. Tel.: +1 215 615 1594;
| | - Timothy J Brown
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Charles Schneider
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Kim A Reiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Tara C Mitchell
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan C Massa
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark H O’Hara
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa DiCicco
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ravi K Amaravadi
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Kalinsky K, Hong F, McCourt CK, Sachdev JC, Mitchell EP, Zwiebel JA, Doyle LA, McShane LM, Li S, Gray RJ, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Conley BA, O’Dwyer PJ, Harris LN, Arteaga CL, Chen AP, Flaherty KT. Effect of Capivasertib in Patients With an AKT1 E17K-Mutated Tumor: NCI-MATCH Subprotocol EAY131-Y Nonrandomized Trial. JAMA Oncol 2021; 7:271-278. [PMID: 33377972 PMCID: PMC7774047 DOI: 10.1001/jamaoncol.2020.6741] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 06/10/2020] [Accepted: 09/30/2020] [Indexed: 01/15/2023]
Abstract
Importance In the National Cancer Institute Molecular Analysis for Therapy Choice (NCI-MATCH) trial, agents targeting genetic tumor abnormalities are administered to patients. In the NCI-MATCH subprotocol EAY131-Y trial, patients with an AKT1 E17K-mutated metastatic tumor received the pan-AKT inhibitor capivasertib. Objective To assess the objective response rate (ORR) of capivasertib in patients with an AKT1 E17K-mutated tumor. Design, Setting, and Participants Between July 13, 2016, and August 10, 2017, patients in the NCI-MATCH trial were enrolled and assigned to the subprotocol EAY131-Y nonrandomized trial. Patients included adults with an AKT1 E17K-mutated metastatic tumor that had progressed with standard treatment, and these patients were assigned to receive capivasertib. Tumor assessments were repeated every 2 cycles. Data analysis of this evaluable population was performed from November 8, 2019, to March 12, 2020. Interventions The study treatment was capivasertib, 480 mg, orally twice daily for 4 days on and 3 days off weekly in 28-day cycles until disease progression or unacceptable toxic effect. If patients continued hormone therapy for metastatic breast cancer, the capivasertib dose was 400 mg. Main Outcomes and Measures The primary end point was the ORR (ie, complete response [CR] and partial response) according to the Response Evaluation Criteria in Solid Tumors criteria, version 1.1. Secondary end points included progression-free survival (PFS), 6-month PFS, overall survival, and safety. Results In total, 35 evaluable and analyzable patients were included, of whom 30 were women (86%), and the median (range) age was 61 (32-73) years. The most prevalent cancers were breast (18 [51%]), including 15 patients with hormone receptor (HR)-positive/ERBB2-negative and 3 with triple-negative disease, and gynecologic (11 [31%]) cancers. The ORR rate was 28.6% (95% CI, 15%-46%). One patient with endometrioid endometrial adenocarcinoma achieved a CR and remained on therapy at 35.6 months. Patients with confirmed partial response had the following tumor types: 7 had HR-positive/ERBB2-negative breast cancer, 1 had uterine leiomyosarcoma, and 1 had oncocytic parotid gland carcinoma and continued receiving treatment at 28.8 months. Sixteen patients (46%) had stable disease as the best response, 2 (6%) had progressive disease, and 7 (20%) were not evaluable. With a median follow-up of 28.4 months, the overall 6-month PFS rate was 50% (95% CI, 35%-71%). Capivasertib was discontinued because of adverse events in 11 of 35 patients (31%). Grade 3 treatment-related adverse events included hyperglycemia (8 [23%]) and rash (4 [11%]). One grade 4 hyperglycemic adverse event was reported. Conclusions and Relevance This nonrandomized trial found that, in patients with an AKT1 E17K-mutated tumor treated with capivasertib, a clinically significant ORR was achieved, including 1 CR. Clinically meaningful activity with single-agent capivasertib was demonstrated in refractory malignant neoplasms, including rare cancers. Trial Registration ClinicalTrials.gov Identifier: NCT00700882.
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Affiliation(s)
- Kevin Kalinsky
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Now with Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Fangxin Hong
- Department of Biostatistics, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn K. McCourt
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jasgit C. Sachdev
- Department of Medicine, TGen/HonorHealth Research Institute, Scottsdale, Arizona
| | - Edith P. Mitchell
- Department of Medicine, Thomas Jefferson University Health, Philadelphia, Pennsylvania
| | - James A. Zwiebel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - L. Austin Doyle
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Lisa M. McShane
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Shuli Li
- Department of Biostatistics, Dana-Farber Cancer Institute–ECOG (Eastern Cooperative Oncology Group)–ACRIN (American College of Radiology Imaging Network) Biostatistics Center, Boston, Massachusetts
| | - Robert J. Gray
- Department of Biostatistics, Dana-Farber Cancer Institute–ECOG (Eastern Cooperative Oncology Group)–ACRIN (American College of Radiology Imaging Network) Biostatistics Center, Boston, Massachusetts
| | - Larry V. Rubinstein
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - David Patton
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Paul M. Williams
- Division of Cancer Therapeutics and Diagnosis, Molecular Characterization and Assay Development Laboratory, Leidos, Frederick, Maryland
| | - Stanley R. Hamilton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Barbara A. Conley
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Peter J. O’Dwyer
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Lyndsay N. Harris
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Carlos L. Arteaga
- Department of Medicine, University of Texas Southwestern Simmons Cancer Center, Dallas
| | - Alice P. Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
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Chen A, Flaherty K, O’Dwyer PJ, Giantonio B, Marinucci DM, Lee JW, Railey E, Smith ML, White C, Conley B. Tumor Genomic Profiling Practices and Perceptions: A Survey of Physicians Participating in the NCI-MATCH Trial. JCO Precis Oncol 2020; 4:PO.20.00217. [PMID: 33163848 PMCID: PMC7608510 DOI: 10.1200/po.20.00217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify factors that may influence physician participation in tumor profiling studies and to assess the routine use of tumor profiling in clinical practice. METHODS Physicians in the National Cancer Institute-Molecular Analysis for Therapy Choice (NCI-MATCH) were invited to participate in an electronic survey consisting of 73 questions related to participation in genomic profiling studies, tumor profiling practices and education during usual patient care, and physician background and practice characteristics. RESULTS The survey response rate was 8.9% (171 surveys returned of 1,931 sent). A majority of respondents practiced in academic medical centers (AMCs). Participation in NCI-MATCH increased workload and cost but resulted in increased professional satisfaction, confidence in treatment recommendation, and subsequent use of tumor profiling. Barriers to patient participation included length of wait time for results and lack of a therapeutic option from the testing. Physicians who worked in AMCs reported a higher use of tumor profiling than did those who worked in non-AMC settings (43% v 18%; P = .0009). Access to a molecular tumor board was perceived as valuable by 56%. The study identified a need for educational materials to guide both physicians and patients in the field of genomic profiling. CONCLUSION Physicians who participate in NCI-MATCH perceive value to patient treatment that outweighs the additional effort required; survey results help identify barriers that may limit participation. The current findings have implications for the design of future genomic and other profiling studies.
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Affiliation(s)
- Alice Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Keith Flaherty
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Peter J. O’Dwyer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Bruce Giantonio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Barbara Conley
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Chew C, O’Dwyer PJ. Undergraduate medical education: a national survey of consultant radiologists. Br J Radiol 2020; 93:20200380. [PMID: 32463292 PMCID: PMC7446011 DOI: 10.1259/bjr.20200380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Rising clinical demand and changes to Radiologists' job plans mean it is becoming ever more difficult for Radiologists to teach medical students.The aim of this study was to assess the current role of Radiologists in undergraduate medical education in Scotland. METHODS Consultant Radiologists working across all 14 Scottish Health Boards were invited by email to participate in an anonymous short online survey. The survey ran for 6 weeks from November 2019. One reminder email was sent a week before the survey closed. RESULTS 102 responses were recorded, representing 34% of the total whole time equivalent Radiologists in Scotland. All agreed Radiology should be taught to medical students. Over 70% (n = 73) taught medical students, most often during supporting professional activity time. 76 percent of Radiologists who did not teach expressed a desire to do so. The most common barrier to teaching was not having enough time in their job plan. Scottish Radiologists delivered a median of 10 h (IQR 0-22) a year of teaching to medical students. Thematic analysis of free comments revealed staffing/time constraints severely limiting ability to teach. CONCLUSION This is the first national survey to assess the current role of Radiologists in teaching medical students. While most are teaching or want to teach, there is a large drop-off between current Scottish and previously reported UK median teaching hours. Engagement from Universities, Royal College of Radiologists and Health Boards is urgently needed to reverse this trend. ADVANCES IN KNOWLEDGE This is the first national survey into the current role of Radiologists in undergraduate medical education. There is a large drop-off between current Scottish and previously reported UK median teaching hours.
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Affiliation(s)
| | - PJ O’Dwyer
- Emeritus Professor Gastrointestinal Surgery, University of Glasgow, Glasgow, Scotland
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Piha-Paul SA, Hann CL, French CA, Cousin S, Braña I, Cassier PA, Moreno V, de Bono JS, Harward SD, Ferron-Brady G, Barbash O, Wyce A, Wu Y, Horner T, Annan M, Parr NJ, Prinjha RK, Carpenter CL, Hilton J, Hong DS, Haas NB, Markowski MC, Dhar A, O’Dwyer PJ, Shapiro GI. Phase 1 Study of Molibresib (GSK525762), a Bromodomain and Extra-Terminal Domain Protein Inhibitor, in NUT Carcinoma and Other Solid Tumors. JNCI Cancer Spectr 2020; 4:pkz093. [PMID: 32328561 PMCID: PMC7165800 DOI: 10.1093/jncics/pkz093] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/21/2019] [Accepted: 10/31/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Bromodomain and extra-terminal domain proteins are promising epigenetic anticancer drug targets. This first-in-human study evaluated the safety, recommended phase II dose, pharmacokinetics, pharmacodynamics, and preliminary antitumor activity of the bromodomain and extra-terminal domain inhibitor molibresib (GSK525762) in patients with nuclear protein in testis (NUT) carcinoma (NC) and other solid tumors. METHODS This was a phase I and II, open-label, dose-escalation study. Molibresib was administered orally once daily. Single-patient dose escalation (from 2 mg/d) was conducted until the first instance of grade 2 or higher drug-related toxicity, followed by a 3 + 3 design. Pharmacokinetic parameters were obtained during weeks 1 and 3. Circulating monocyte chemoattractant protein-1 levels were measured as a pharmacodynamic biomarker. RESULTS Sixty-five patients received molibresib. During dose escalation, 11% experienced dose-limiting toxicities, including six instances of grade 4 thrombocytopenia, all with molibresib 60-100 mg. The most frequent treatment-related adverse events of any grade were thrombocytopenia (51%) and gastrointestinal events, including nausea, vomiting, diarrhea, decreased appetite, and dysgeusia (22%-42%), anemia (22%), and fatigue (20%). Molibresib demonstrated an acceptable safety profile up to 100 mg; 80 mg once daily was selected as the recommended phase II dose. Following single and repeat dosing, molibresib showed rapid absorption and elimination (maximum plasma concentration: 2 hours; t1/2: 3-7 hours). Dose-dependent reductions in circulating monocyte chemoattractant protein-1 levels were observed. Among 19 patients with NC, four achieved either confirmed or unconfirmed partial response, eight had stable disease as best response, and four were progression-free for more than 6 months. CONCLUSIONS Once-daily molibresib was tolerated at doses demonstrating target engagement. Preliminary data indicate proof-of-concept in NC.
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Affiliation(s)
| | | | - Christopher A French
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sophie Cousin
- Medical Oncology, Institute Bergonié, Bordeaux, France
| | - Irene Braña
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Victor Moreno
- Medical Oncology, START Madrid-FJD, Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Johann S de Bono
- The Institute of Cancer Research and Royal Marsden Hospital, London, UK
| | | | | | | | | | | | | | | | | | - Rabinder K Prinjha
- Division of Medical Oncology, Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | | | - John Hilton
- Division of Medical Oncology, Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | | | - Naomi B Haas
- Abramson Cancer Center at University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Yu S, Agarwal P, Mamtani R, Symecko H, Spielman K, O’Hara M, O’Dwyer PJ, Schneider C, Teitelbaum U, Nathanson KL, Domchek SM, Reiss KA. Retrospective Survival Analysis of Patients With Resected Pancreatic Ductal Adenocarcinoma and a Germline BRCA or PALB2 Mutation. JCO Precis Oncol 2019; 3:1-11. [PMID: 35100679 DOI: 10.1200/po.18.00271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Germline mutations in the homologous recombination genes BRCA1, BRCA2, and PALB2 confer an increased risk for pancreatic ductal adenocarcinoma (PDAC). Tumors associated with mutations in homologous recombination genes are sensitive to DNA-damaging agents. We retrospectively studied patients with resected PDAC and a pathogenic germline mutation in one of these three genes. The planned analyses included overall survival (OS) and changes therein when platinum chemotherapy was used in the perioperative setting. MATERIALS AND METHODS Thirty-two individuals with pathogenic germline mutations in BRCA1, BRCA2, or PALB2 and resected PDAC (mutation positive) were matched in a 1:2 fashion to patients who were noncarriers or untested (mutation negative) by age, year of diagnosis, stage, and sex. Patients were identified via one of two available databases at University of Pennsylvania: the Basser Center for BRCA Registry or the electronic medical record. The primary outcome was OS. RESULTS Patients in the mutation-positive group had a median OS (mOS) of 46.6 months; those in the mutation-negative group had an mOS of 23.2 months (hazard ratio [HR], 0.49; 95% CI, 0.27 to 0.88). With platinum exposure in the perioperative setting, mOS in the mutation-positive group had not yet been met versus a mOS of 23.1 months in the mutation-negative group (HR, 0.12; 95% CI, 0.01 to 1.00). When neither group was treated with platinum, there was no significant OS difference between groups (HR, 0.52; 95% CI 0.12 to 2.24). Patients in the mutation-positive group who received perioperative treatment with platinum had a trend toward improved mOS compared with those who did not (HR, 0.15; 95% CI, 0.02 to 1.23; P = .07). CONCLUSION Platinum-based chemotherapy may confer a survival benefit in patients with resected PDAC and a pathogenic germline BRCA1, BRCA2, or PALB2 mutation. Knowledge of a germline mutation may be important to determine best choice of perioperative chemotherapy.
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Affiliation(s)
- Shun Yu
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | | | - Ronac Mamtani
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Heather Symecko
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Kelsey Spielman
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Mark O’Hara
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Peter J. O’Dwyer
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Charles Schneider
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Ursina Teitelbaum
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Katherine L. Nathanson
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Susan M. Domchek
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
| | - Kim A. Reiss
- University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, University of Pennsylvania, West Chester, PA
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Furuse J, Goyal L, Bahleda R, Valle J, Moehler M, Oh DY, Chang HM, Kelley RK, Javle M, Borad M, Chen LT, Uboha N, Klümpen HJ, O’Dwyer PJ, Li D, Morizane C, Huang J, Bridgewater JA. AB040. P-08. FOENIX-CCA2: a phase 2 study of TAS-120 in patients with intrahepatic cholangiocarcinoma harboring FGFR2 gene rearrangements. Hepatobiliary Surg Nutr 2019. [DOI: 10.21037/hbsn.2019.ab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
The oncology community remembers, with great affection, Dr. Robert L. Comis, and his many contributions to the field.
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Affiliation(s)
- Monica M. Bertagnolli
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Correspondence: Monica M. Bertagnolli, M.D., Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA. Telephone: 617–732‐8991; e‐mail:
| | - Peter J. O’Dwyer
- Department of Medicine, Hospital of the University of Pennsylvania and the Presbyterian Medical Center of Philadelphia, Philadelphia, Pennsylvania, USA
- Correspondence: Monica M. Bertagnolli, M.D., Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA. Telephone: 617–732‐8991; e‐mail:
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O’Dwyer PJ, Piha-Paul SA, French C, Harward S, Ferron-Brady G, Wu Y, Barbash O, Wyce A, Annan M, Horner T, Parr NJ, Prinjha RK, Carpenter C, Shapiro G, Dhar A, Hann C. Abstract CT014: GSK525762, a selective bromodomain (BRD) and extra terminal protein (BET) inhibitor: results from part 1 of a phase I/II open-label single-agent study in patients with NUT midline carcinoma (NMC) and other cancers. Clin Trials 2016. [DOI: 10.1158/1538-7445.am2016-ct014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Sun W, Metz JM, Gallagher M, O’Dwyer PJ, Giantonio B, Whittington R, Haller DG. Two phase I studies of concurrent radiation therapy with continuous-infusion 5-fluorouracil plus epirubicin, and either cisplatin or irinotecan for locally advanced upper gastrointestinal adenocarcinomas. Cancer Chemother Pharmacol 2010; 67:621-7. [DOI: 10.1007/s00280-010-1365-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 05/06/2010] [Indexed: 11/29/2022]
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Amaravadi RK, Schuchter LM, McDermott DF, Kramer A, Giles L, Gramlich K, Carberry M, Troxel AB, Letrero R, Nathanson KL, Atkins MB, O’Dwyer PJ, Flaherty KT. Phase II Trial of Temozolomide and Sorafenib in Advanced Melanoma Patients with or without Brain Metastases. Clin Cancer Res 2009; 15:7711-7718. [PMID: 19996224 PMCID: PMC2795076 DOI: 10.1158/1078-0432.ccr-09-2074] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE: The combination of the oral alkylating agent temozolomide and the oral multikinase inhibitor sorafenib was evaluated in advanced melanoma patients. EXPERIMENTAL DESIGN: Patients with metastatic melanoma (n = 167) were treated on four arms. All patients received sorafenib at 400 mg p.o. twice daily without interruption. Patients without brain metastases or prior temozolomide were randomized between arm A: extended dosing of temozolomide (75 mg/m(2) temozolomide daily for 6 of every 8 weeks) and arm B: standard dosing (150 mg/m(2) temozolomide daily for 5 of every 28 days). Patients previously treated with temozolomide were enrolled on arm C: extended dosing of temozolomide. Patients with brain metastases and no prior temozolomide were assigned to arm D: standard dosing. The primary end point was 6-month progression-free survival (PFS) rate. Secondary end points included response rate, toxicity rates, and the rates of BRAF or NRAS mutations. RESULTS: The 6-month PFS rate for arms A, B, C, and D were 50%, 40%, 11%, and 23%. The median PFS for patients on arm A, B, C, and D was 5.9, 4.2, 2.2, and 3.5 months, respectively. No significant differences were observed between arms A and B in 6-month PFS rate, median PFS, or response rates. Treatment was well tolerated in all arms. No significant differences in toxicity were observed between arms A and B except for more grade 3 to 4 lymphopenia in arm A. CONCLUSION: Temozolomide plus sorafenib was well tolerated and showed activity in melanoma patients without prior history of temozolomide. The activity of this combination regimen warrants further investigation. (Clin Cancer Res 2009;15(24):7711-8).
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Affiliation(s)
- Ravi K. Amaravadi
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - Lynn M. Schuchter
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - David F. McDermott
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Amy Kramer
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - Lydia Giles
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - Kristi Gramlich
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - Mary Carberry
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - Andrea B. Troxel
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - Richard Letrero
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Division of Medical Genetics, University of Pennsylvania, Philadelphia, PA
| | - Katherine L. Nathanson
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
- Department of Medicine, Division of Medical Genetics, University of Pennsylvania, Philadelphia, PA
| | - Michael B. Atkins
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Peter J. O’Dwyer
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
| | - Keith T. Flaherty
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, PA
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O’Dwyer PJ, Hamilton TC, Yao KS, Tew KD, Ozols RF. Modulation of Glutathione and Related Enzymes in Reversal of Resistance to Anticancer Drugs. Hematol Oncol Clin North Am 1995. [DOI: 10.1016/s0889-8588(18)30100-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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