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Xu Y, Wen N, Haddad RI, Sonis ST, Villa A. Comparisons of Non-Oral Immune-Related Adverse Events Among Patients With Cancer With Different Oral Toxicity Profiles. Oncologist 2024; 29:e382-e391. [PMID: 37874927 PMCID: PMC10911904 DOI: 10.1093/oncolo/oyad279] [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: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVES Immune-related adverse events (irAEs) are common. Oral irAEs tend to cluster in patients who experience concurrent toxicities. We aimed to characterize the frequency and trajectory of non-oral irAEs in patients who developed oral irAEs, assess their relationship with non-oral irAEs, and compare those characteristics with patients without oral irAEs. METHODS A retrospective chart review was conducted to identify patients who started ICIT between December 11, 2011, and September 15, 2019 (n = 4683) in the Mass General Brigham Registered Patient Data Registry. Demographic information, cancer diagnosis, ICIT regimen, treatment duration, and time and number of infusions to irAE onset were recorded. Non-oral irAEs were categorized into 13 groups. Patients with melanoma, pulmonary cancer, or head and neck cancer who had oral irAEs were then matched with those without oral irAEs to compare the prevalence of concomitant non-oral irAEs. RESULTS Three hundred and fourteen patients with oral irAEs with a mean age of 65.9 ± 12.6 years (43.3% females) were included. Patients with multiple oral irAEs were more likely to have non-oral irAEs (OR: 2.7, 95% CI, 1.3-3.5), including cutaneous (OR: 1.7, 95% CI, 1.1-3.0), rheumatological (OR: 2.2, 95% CI, 1.1-4.2), thyroid (OR: 2.4, 95% CI, 1.2-4.9), and neurological irAEs (OR: 2.5, 95% CI, 1.0-6.3). Compared to matched patients with non-oral irAEs, patients with oral irAEs were more likely to have cutaneous (OR: 1.7, 95% CI, 1.0-2.8) and thyroid (OR: 2.86, 95% CI, 1.1-7.5) irAEs. The development of oral and non-oral irAEs is often coincidental. CONCLUSION Patients who have non-oral irAEs should be monitored for development of oral irAEs for prompt management.
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Affiliation(s)
- Yuanming Xu
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Oral Medicine, Infection, and Immunity, Havard School of Dental Medicine, Boston, MA, USA
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA, USA
| | - Natalie Wen
- Department of Oral Medicine, Infection, and Immunity, Havard School of Dental Medicine, Boston, MA, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stephen T Sonis
- Department of Oral Medicine, Infection, and Immunity, Havard School of Dental Medicine, Boston, MA, USA
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alessandro Villa
- Oral Medicine and Oral Oncology, Miami Cancer Institute, Miami, FL, USA
- Department of Orofacial Sciences, University of California San Francisco, San Francisco, CA, USA
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2
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Hanna GJ, Villa A, Nandi SP, Shi R, ONeill A, Liu M, Quinn CT, Treister NS, Sroussi HY, Vacharotayangul P, Goguen LA, Annino DJ, Rettig EM, Jo VY, Wong KS, Lizotte P, Paweletz CP, Uppaluri R, Haddad RI, Cohen EEW, Alexandrov LB, William WN, Lippman SM, Woo SB. Nivolumab for Patients With High-Risk Oral Leukoplakia: A Nonrandomized Controlled Trial. JAMA Oncol 2024; 10:32-41. [PMID: 37971722 PMCID: PMC10654930 DOI: 10.1001/jamaoncol.2023.4853] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/07/2023] [Indexed: 11/19/2023]
Abstract
Importance Proliferative verrucous leukoplakia (PVL) is an aggressive oral precancerous disease characterized by a high risk of transformation to invasive oral squamous cell carcinoma (OSCC), and no therapies have been shown to affect its natural history. A recent study of the PVL immune landscape revealed a cytotoxic T-cell-rich microenvironment, providing strong rationale to investigate immune checkpoint therapy. Objective To determine the safety and clinical activity of anti-programmed cell death 1 protein (PD-1) therapy to treat high-risk PVL. Design, Setting, and Participants This nonrandomized, open-label, phase 2 clinical trial was conducted from January 2019 to December 2021 at a single academic medical center; median (range) follow-up was 21.1 (5.4-43.6) months. Participants were a population-based sample of patients with PVL (multifocal, contiguous, or a single lesion ≥4 cm with any degree of dysplasia). Intervention Patients underwent pretreatment biopsy (1-3 sites) and then received 4 doses of nivolumab (480 mg intravenously) every 28 days, followed by rebiopsy and intraoral photographs at each visit. Main Outcomes and Measures The primary end point was the change in composite score (size and degree of dysplasia) from before to after treatment (major response [MR]: >80% decrease in score; partial response: 40%-80% decrease). Secondary analyses included immune-related adverse events, cancer-free survival (CFS), PD-1 ligand 1 (PD-L1) expression, 9p21.3 deletion, and other exploratory immunologic and genomic associations of response. Results A total of 33 patients were enrolled (median [range] age, 63 [32-80] years; 18 [55%] were female), including 8 (24%) with previously resected early-stage OSCC. Twelve patients (36%) (95% CI, 20.4%-54.8%) had a response by composite score (3 MRs [9%]), 4 had progressive disease (>10% composite score increase, or cancer). Nine patients (27%) developed OSCC during the trial, with a 2-year CFS of 73% (95% CI, 53%-86%). Two patients (6%) discontinued because of toxic effects; 7 (21%) experienced grade 3 to 4 immune-related adverse events. PD-L1 combined positive scores were not associated with response or CFS. Of 20 whole-exome sequenced patients, all 6 patients who had progression to OSCC after nivolumab treatment exhibited 9p21.3 somatic copy-number loss on pretreatment biopsy, while only 4 of the 14 patients (29%) who did not develop OSCC had 9p21.3 loss. Conclusions and Relevance This immune checkpoint therapy precancer nonrandomized clinical trial met its prespecified response end point, suggesting potential clinical activity for nivolumab in high-risk PVL. Findings identified immunogenomic associations to inform future trials in this precancerous disease with unmet medical need that has been difficult to study. Trial Registration ClinicalTrials.gov Identifier: NCT03692325.
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Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alessandro Villa
- Miami Cancer Institute and Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Shuvro P. Nandi
- Moores Cancer Center, UC San Diego, La Jolla, California
- Department of Cellular and Molecular Medicine, UC San Diego, La Jolla, California
| | - Ruichao Shi
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anne ONeill
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mofei Liu
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Charles T. Quinn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nathaniel S. Treister
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
| | - Herve Y. Sroussi
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
| | - Piamkamon Vacharotayangul
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
| | - Laura A. Goguen
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donald J. Annino
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eleni M. Rettig
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Vickie Y. Jo
- Department of Pathology, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Kristine S. Wong
- Department of Pathology, Brigham & Women’s Hospital, Boston, Massachusetts
| | - Patrick Lizotte
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cloud P. Paweletz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ravindra Uppaluri
- Division of Otolaryngology–Head and Neck Surgery, Brigham & Women’s Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Ludmil B. Alexandrov
- Moores Cancer Center, UC San Diego, La Jolla, California
- Department of Cellular and Molecular Medicine, UC San Diego, La Jolla, California
- Department of Bioengineering, UC San Diego, La Jolla, California
| | - William N. William
- Oncology Center, Hospital BP, a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Sook-bin Woo
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute and Brigham & Women’s Hospital, Boston, Massachusetts
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3
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Saraf A, Ye Z, Likitlersuang J, Hoebers F, Tishler RB, Schoenfeld JD, Margalit DN, Haddad RI, Ravipati Y, Zha Y, Naser M, Wahid KA, Mak RH, Mäkitie A, Kaski K, Aerts H, Fuller CD, Kann BH. Automated Sarcopenia Assessment and Outcomes in Head and Neck Cancer with Deep Learning Analysis of Cervical Neck Skeletal Muscle. Int J Radiat Oncol Biol Phys 2023; 117:e623. [PMID: 37785866 DOI: 10.1016/j.ijrobp.2023.06.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Sarcopenia is an established prognostic factor in patients diagnosed with head and neck cancers (HNC), typically measured by the skeletal muscle index (SMI) from abdominal muscle mass at L3. While sarcopenia assessment could inform HNC management, it remains impractical, time- and labor-intensive, and operator-dependent. To overcome these challenges, we developed an automated deep learning (DL) platform to calculate SMI at L3 by quantifying cross-sectional cervical skeletal muscle area (SMA) at C3 through auto-segmentation, externally validated it, and evaluated associations with clinical outcomes. MATERIALS/METHODS Eight hundred twenty-one patients diagnosed with HNC from multiple institutes from 1999-2013, treated with definitive chemoradiation with baseline pre-treatment CT scans, were included for model development (335 training, 96 tuning) and for independent testing (48 internal, and 342 external). Ground truth single-slice segmentations of SM at the mid-C3 vertebral level were manually annotated by radiation oncologists using an established protocol. A multi-stage DL pipeline was developed, with a 2D DenseNet to select the middle slice of C3 section and a 2D UNet to segment the SM, from which SMA was calculated. The model was evaluated using the Dice Similarity Coefficient (DC) for the internal test set, and human acceptability testing on the external test set was performed by two radiation oncologists not involved in annotations. SMI was calculated from C3 SMA based on prior literature, and sarcopenia was defined by an established, sex-specific SMI cutoff. Sarcopenia associations with overall survival (OS) and toxicities were assessed on the external dataset with Cox and logistic multivariable regressions, as indicated. RESULTS Model DC on the internal test set as 0.90 [95% CI: 0.90-0.91], with an intra-class coefficient of 0.96 for SMA. Human acceptability testing showed a pass rate of 94.4%. Of the 342 patients in the clinical analysis, 261 (76.3%) patients had sarcopenia. Five-year survival was 84.4% in patients without sarcopenia vs 73.1% in patients with sarcopenia (HR 2.21, p = 0.028) (median f/u: 44 mo (IQR: 25 - 66 mo)). On multivariable regression, sarcopenia (HR 2.06, p = 0.037), ACE-27 score 2+ (HR 2.25, p = 0.001), non-oropharynx diagnosis (HR 3.96, p<0.001), and T3-4 stage (HR 2.37, p<0.001) were associated with worse OS. Sarcopenia was associated with longer PEG tube duration on multivariable analysis (HR 1.59, p = 0.003), along with ACE-27 score (HR 1.20, p = 0.012) and non-oropharynx primary site (HR 1.46, p = 0.034). Sarcopenia was associated with higher risk of having PEG tube at last follow up (OR 2.25, p = 0.046). An observed increase in risk of hospitalization <3 months after RT was non-significant (OR 2.18, p = 0.117). CONCLUSION We developed and externally validated a fully-automated platform for sarcopenia assessment that can be used on routine HNC imaging. This algorithm is positioned for prospective testing to determine if use will inform HNC management.
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Affiliation(s)
- A Saraf
- Brigham and Women's Hospital/Dana Farber Cancer Institute, Boston, MA; Harvard Radiation Oncology Program, Boston, MA
| | - Z Ye
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
| | - J Likitlersuang
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA
| | - F Hoebers
- Brigham and Women's Hospital, Boston, MA
| | - R B Tishler
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - J D Schoenfeld
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - D N Margalit
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - R I Haddad
- Dana-Farber Cancer Institute, Boston, MA
| | - Y Ravipati
- Brigham and Women's Hospital, Boston, MA
| | - Y Zha
- Brigham and Women's Hospital, Boston, MA
| | - M Naser
- MD Anderson Cancer Center, Houston, TX
| | - K A Wahid
- MD Anderson Cancer Center, Houston, TX
| | - R H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - K Kaski
- Aalto University School of Science, Aalto, Finland
| | - H Aerts
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - C D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - B H Kann
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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4
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Oliveira G, Egloff AM, Afeyan AB, Wolff JO, Zeng Z, Chernock RD, Zhou L, Messier C, Lizotte P, Pfaff KL, Stromhaug K, Penter L, Haddad RI, Hanna GJ, Schoenfeld JD, Goguen LA, Annino DJ, Jo V, Oppelt P, Pipkorn P, Jackson R, Puram SV, Paniello RC, Rich JT, Webb J, Zevallos JP, Mansour M, Fu J, Dunn GP, Rodig SJ, Ley J, Morris LG, Dunn L, Paweletz CP, Kallogjeri D, Piccirillo JF, Adkins DR, Wu CJ, Uppaluri R. Preexisting tumor-resident T cells with cytotoxic potential associate with response to neoadjuvant anti-PD-1 in head and neck cancer. Sci Immunol 2023; 8:eadf4968. [PMID: 37683037 PMCID: PMC10794154 DOI: 10.1126/sciimmunol.adf4968] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/31/2023] [Indexed: 09/10/2023]
Abstract
About 50% of patients with locally advanced head and neck squamous cell carcinoma (HNSCC) experience recurrences after definitive therapy. The presurgical administration of anti-programmed cell death protein 1 (PD-1) immunotherapy results in substantial pathologic tumor responses (pTR) within the tumor microenvironment (TME). However, the mechanisms underlying the dynamics of antitumor T cells upon neoadjuvant PD-1 blockade remain unresolved, and approaches to increase pathologic responses are lacking. In a phase 2 trial (NCT02296684), we observed that 45% of patients treated with two doses of neoadjuvant pembrolizumab experienced marked pTRs (≥50%). Single-cell analysis of 17,158 CD8+ T cells from 14 tumor biopsies, including 6 matched pre-post neoadjuvant treatment, revealed that responding tumors had clonally expanded putative tumor-specific exhausted CD8+ tumor-infiltrating lymphocytes (TILs) with a tissue-resident memory program, characterized by high cytotoxic potential (CTX+) and ZNF683 expression, within the baseline TME. Pathologic responses after 5 weeks of PD-1 blockade were consistent with activation of preexisting CTX+ZNF683+CD8+ TILs, paralleling loss of viable tumor and associated tumor antigens. Response was associated with high numbers of CD103+PD-1+CD8+ T cells infiltrating pretreatment lesions, whereas revival of nonexhausted persisting clones and clonal replacement were modest. By contrast, nonresponder baseline TME exhibited a relative absence of ZNF683+CTX+ TILs and subsequent accumulation of highly exhausted clones. In HNSCC, revival of preexisting ZNF683+CTX+ TILs is a major mechanism of response in the immediate postneoadjuvant setting.
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Affiliation(s)
- Giacomo Oliveira
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School; Boston, MA, USA
| | - Ann Marie Egloff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School; Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexander B. Afeyan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School; Boston, MA, USA
| | - Jacquelyn O. Wolff
- Center for Immuno-Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Zexiang Zeng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rebecca D. Chernock
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Liye Zhou
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Cameron Messier
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Patrick Lizotte
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Kathleen L Pfaff
- Center for Immuno-Oncology, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Kari Stromhaug
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Livius Penter
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School; Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Hematology, Oncology and Tumor immunology, Campus Virchow Klinikum, Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Laura A. Goguen
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Donald J. Annino
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Vickie Jo
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA, USA
| | - Peter Oppelt
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University School of Medicine; St. Louis, MO, USA
| | - Ryan Jackson
- Department of Otolaryngology, Washington University School of Medicine; St. Louis, MO, USA
| | - Sidharth V. Puram
- Department of Otolaryngology, Washington University School of Medicine; St. Louis, MO, USA
| | - Randal C. Paniello
- Department of Otolaryngology, Washington University School of Medicine; St. Louis, MO, USA
| | - Jason T. Rich
- Department of Otolaryngology, Washington University School of Medicine; St. Louis, MO, USA
| | - Jason Webb
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jose P. Zevallos
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mena Mansour
- Department of Pathology and Immunology, Washington University School of Medicine; St. Louis, MO, USA
| | - Jingxin Fu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gavin P. Dunn
- Department of Neurological Surgery, Massachusetts General Hospital; Boston, MA, USA
| | - Scott J. Rodig
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Pathology, Brigham and Women’s Hospital; Boston, MA, USA
| | - Jessica Ley
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Luc G.T. Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lara Dunn
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cloud P. Paweletz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute; Boston, MA, USA
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University School of Medicine; St. Louis, MO, USA
| | - Jay F. Piccirillo
- Department of Otolaryngology, Washington University School of Medicine; St. Louis, MO, USA
| | - Douglas R. Adkins
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Department of Medicine/Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Catherine J. Wu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School; Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ravindra Uppaluri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School; Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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5
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Haddad RI, Harrington K, Tahara M, Szturz P, Le Tourneau C, Salmio S, Bajars M, Lee NY. Managing cisplatin-ineligible patients with resected, high-risk, locally advanced squamous cell carcinoma of the head and neck: Is there a standard of care? Cancer Treat Rev 2023; 119:102585. [PMID: 37392723 DOI: 10.1016/j.ctrv.2023.102585] [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: 05/05/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 07/03/2023]
Abstract
For the past 2 decades, cisplatin-based adjuvant chemoradiotherapy (CRT) has remained the standard of care for patients with resected, locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) who are at high risk of disease recurrence. However, many patients are deemed ineligible for cisplatin-based CRT because of poor performance status, advanced biological age, poor renal function, or hearing loss. Because outcomes with radiotherapy (RT) alone remain poor, patients at high risk of disease recurrence deemed ineligible to receive cisplatin are a population with a significant unmet medical need, and alternative systemic therapy options in combination with RT are urgently needed. Clinical guidelines and consensus documents have provided definitions for cisplatin ineligibility; however, areas of debate include thresholds for age and renal impairment and criteria for hearing loss. Furthermore, the proportion of patients with resected LA SCCHN who are cisplatin ineligible remains unclear. Because of a scarcity of clinical studies, treatment selection for patients with resected, high-risk LA SCCHN who are deemed ineligible to receive cisplatin is often based on clinical judgment, with few treatment options specified in international guidelines. In this review, we discuss considerations related to cisplatin ineligibility in patients with LA SCCHN, summarize the limited clinical evidence for adjuvant treatment of patients with resected high-risk disease, and highlight ongoing clinical trials that have the potential to provide new treatment options in this setting.
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Affiliation(s)
- Robert I Haddad
- Department of Medical Oncology, Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | | | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Chiba Prefecture, Japan.
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris-Saclay University, Paris, France.
| | | | | | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
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6
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Ye Z, Saraf A, Ravipati Y, Hoebers F, Catalano PJ, Zha Y, Zapaishchykova A, Likitlersuang J, Guthier C, Tishler RB, Schoenfeld JD, Margalit DN, Haddad RI, Mak RH, Naser M, Wahid KA, Sahlsten J, Jaskari J, Kaski K, Mäkitie AA, Fuller CD, Aerts HJWL, Kann BH. Development and Validation of an Automated Image-Based Deep Learning Platform for Sarcopenia Assessment in Head and Neck Cancer. JAMA Netw Open 2023; 6:e2328280. [PMID: 37561460 PMCID: PMC10415962 DOI: 10.1001/jamanetworkopen.2023.28280] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
Importance Sarcopenia is an established prognostic factor in patients with head and neck squamous cell carcinoma (HNSCC); the quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical skeletal muscle segmentation and cross-sectional area. However, manual muscle segmentation is labor intensive, prone to interobserver variability, and impractical for large-scale clinical use. Objective To develop and externally validate a fully automated image-based deep learning platform for cervical vertebral muscle segmentation and SMI calculation and evaluate associations with survival and treatment toxicity outcomes. Design, Setting, and Participants For this prognostic study, a model development data set was curated from publicly available and deidentified data from patients with HNSCC treated at MD Anderson Cancer Center between January 1, 2003, and December 31, 2013. A total of 899 patients undergoing primary radiation for HNSCC with abdominal computed tomography scans and complete clinical information were selected. An external validation data set was retrospectively collected from patients undergoing primary radiation therapy between January 1, 1996, and December 31, 2013, at Brigham and Women's Hospital. The data analysis was performed between May 1, 2022, and March 31, 2023. Exposure C3 vertebral skeletal muscle segmentation during radiation therapy for HNSCC. Main Outcomes and Measures Overall survival and treatment toxicity outcomes of HNSCC. Results The total patient cohort comprised 899 patients with HNSCC (median [range] age, 58 [24-90] years; 140 female [15.6%] and 755 male [84.0%]). Dice similarity coefficients for the validation set (n = 96) and internal test set (n = 48) were 0.90 (95% CI, 0.90-0.91) and 0.90 (95% CI, 0.89-0.91), respectively, with a mean 96.2% acceptable rate between 2 reviewers on external clinical testing (n = 377). Estimated cross-sectional area and SMI values were associated with manually annotated values (Pearson r = 0.99; P < .001) across data sets. On multivariable Cox proportional hazards regression, SMI-derived sarcopenia was associated with worse overall survival (hazard ratio, 2.05; 95% CI, 1.04-4.04; P = .04) and longer feeding tube duration (median [range], 162 [6-1477] vs 134 [15-1255] days; hazard ratio, 0.66; 95% CI, 0.48-0.89; P = .006) than no sarcopenia. Conclusions and Relevance This prognostic study's findings show external validation of a fully automated deep learning pipeline to accurately measure sarcopenia in HNSCC and an association with important disease outcomes. The pipeline could enable the integration of sarcopenia assessment into clinical decision making for individuals with HNSCC.
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Affiliation(s)
- Zezhong Ye
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anurag Saraf
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yashwanth Ravipati
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Hoebers
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paul J. Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Yining Zha
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Zapaishchykova
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Radiology and Nuclear Medicine, CARIM and GROW, Maastricht University, Maastricht, the Netherlands
| | - Jirapat Likitlersuang
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christian Guthier
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Raymond H. Mak
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mohamed Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jaakko Sahlsten
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Joel Jaskari
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Kimmo Kaski
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Antti A. Mäkitie
- Department Otorhinolaryngology–Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hugo J. W. L. Aerts
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Radiology and Nuclear Medicine, CARIM and GROW, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Benjamin H. Kann
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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7
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Tran NA, Palotai M, Hanna GJ, Schoenfeld JD, Bay CP, Rettig EM, Bunch PM, Juliano AF, Kelly HR, Suh CH, Zander DA, Morales Pinzon A, Kann BH, Huang RY, Haddad RI, Guttmann CRG, Guenette JP. Diagnostic performance of computed tomography features in detecting oropharyngeal squamous cell carcinoma extranodal extension. Eur Radiol 2023; 33:3693-3703. [PMID: 36719493 DOI: 10.1007/s00330-023-09407-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 12/06/2022] [Accepted: 12/27/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Accurate pre-treatment imaging determination of extranodal extension (ENE) could facilitate the selection of appropriate initial therapy for HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Small studies have associated 7 CT features with ENE with varied results and agreement. This article seeks to determine the replicable diagnostic performance of these CT features for ENE. METHODS Five expert academic head/neck neuroradiologists from 5 institutions evaluate a single academic cancer center cohort of 75 consecutive HPV + OPSCC patients. In a web-based virtual laboratory for imaging research and education, the experts performed training on 7 published CT features associated with ENE and then independently identified the "single most (if any) suspicious" lymph node and presence/absence of each of the features. Inter-rater agreement was assessed using percentage agreement, Gwet's AC1, and Fleiss' kappa. Sensitivity, specificity, and positive and negative predictive values were calculated for each CT feature based on histologic ENE. RESULTS All 5 raters identified the same node in 52 cases (69%). In 15 cases (20%), at least one rater selected a node and at least one rater did not. In 8 cases (11%), all raters selected a node, but at least one rater selected a different node. Percentage agreement and Gwet's AC1 coefficients were > 0.80 for lesion identification, matted/conglomerated nodes, and central necrosis. Fleiss' kappa was always < 0.6. CT sensitivity for histologically confirmed ENE ranged 0.18-0.94, specificity 0.41-0.88, PPV 0.26-0.36, and NPV 0.78-0.96. CONCLUSIONS Previously described CT features appear to have poor reproducibility among expert head/neck neuroradiologists and poor predictive value for histologic ENE. KEY POINTS • Previously described CT imaging features appear to have poor reproducibility among expert head and neck subspecialized neuroradiologists as well as poor predictive value for histologic ENE. • Although it may still be appropriate to comment on the presence or absence of these CT features in imaging reports, the evidence indicates that caution is warranted when incorporating these features into clinical decision-making regarding the likelihood of ENE.
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Affiliation(s)
- Ngoc-Anh Tran
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Miklos Palotai
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Camden P Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eleni M Rettig
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Paul M Bunch
- Division of Neuroradiology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hillary R Kelly
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - David A Zander
- Division of Neuroradiology, University of Colorado, Aurora, CO, USA
| | - Alfredo Morales Pinzon
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin H Kann
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street Boston, Boston, MA, 02115, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Charles R G Guttmann
- Center for Neurological Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street Boston, Boston, MA, 02115, USA.
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8
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Haddad RI, Harrington K, Tahara M, Ferris RL, Gillison M, Fayette J, Daste A, Koralewski P, Zurawski B, Taberna M, Saba NF, Mak M, Kawecki A, Girotto G, Alvarez Avitia MA, Even C, Toledo JGR, Guminski A, Müller-Richter U, Kiyota N, Roberts M, Khan TA, Miller-Moslin K, Wei L, Argiris A. Nivolumab Plus Ipilimumab Versus EXTREME Regimen as First-Line Treatment for Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: The Final Results of CheckMate 651. J Clin Oncol 2023; 41:2166-2180. [PMID: 36473143 PMCID: PMC10115555 DOI: 10.1200/jco.22.00332] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [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: 02/10/2022] [Revised: 08/17/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE CheckMate 651 (ClinicalTrials.gov identifier: NCT02741570) evaluated first-line nivolumab plus ipilimumab versus EXTREME (cetuximab plus cisplatin/carboplatin plus fluorouracil ≤ six cycles, then cetuximab maintenance) in recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). METHODS Patients without prior systemic therapy for R/M SCCHN were randomly assigned 1:1 to nivolumab plus ipilimumab or EXTREME. Primary end points were overall survival (OS) in the all randomly assigned and programmed death-ligand 1 combined positive score (CPS) ≥ 20 populations. Secondary end points included OS in the programmed death-ligand 1 CPS ≥ 1 population, and progression-free survival, objective response rate, and duration of response in the all randomly assigned and CPS ≥ 20 populations. RESULTS Among 947 patients randomly assigned, 38.3% had CPS ≥ 20. There were no statistically significant differences in OS with nivolumab plus ipilimumab versus EXTREME in the all randomly assigned (median: 13.9 v 13.5 months; hazard ratio [HR], 0.95; 97.9% CI, 0.80 to 1.13; P = .4951) and CPS ≥ 20 (median: 17.6 v 14.6 months; HR, 0.78; 97.51% CI, 0.59 to 1.03; P = .0469) populations. In patients with CPS ≥ 1, the median OS was 15.7 versus 13.2 months (HR, 0.82; 95% CI, 0.69 to 0.97). Among patients with CPS ≥ 20, the median progression-free survival was 5.4 months (nivolumab plus ipilimumab) versus 7.0 months (EXTREME), objective response rate was 34.1% versus 36.0%, and median duration of response was 32.6 versus 7.0 months. Grade 3/4 treatment-related adverse events occurred in 28.2% of patients treated with nivolumab plus ipilimumab versus 70.7% treated with EXTREME. CONCLUSION CheckMate 651 did not meet its primary end points of OS in the all randomly assigned or CPS ≥ 20 populations. Nivolumab plus ipilimumab showed a favorable safety profile compared with EXTREME. There continues to be a need for new therapies in patients with R/M SCCHN.
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Affiliation(s)
- Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Kevin Harrington
- Royal Marsden Hospital/The Institute of Cancer Research NIHR Biomedical Research Centre, London, United Kingdom
| | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Maura Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Piotr Koralewski
- Wojewodzki Szpital Specjalistyczny im. Ludwika Rydygiera w Krakowie, Krakow, Poland
| | | | - Miren Taberna
- Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nabil F. Saba
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Milena Mak
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Andrzej Kawecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Gustavo Girotto
- Hospital de Base de Sao Jose do Rio Preto, Sao Jose do Rio Preto, Brazil
| | | | | | | | | | - Urs Müller-Richter
- University Hospital Würzburg, Bavarian Cancer Research Center (BZKF), Würzburg, Germany
| | | | | | | | | | - Li Wei
- Bristol Myers Squibb, Princeton, NJ
| | - Athanassios Argiris
- Hygeia Hospital, Marousi, Greece
- Thomas Jefferson University, Philadelphia, PA
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9
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Ye Z, Saraf A, Ravipati Y, Hoebers F, Zha Y, Zapaishchykova A, Likitlersuang J, Tishler RB, Schoenfeld JD, Margalit DN, Haddad RI, Mak RH, Naser M, Wahid KA, Sahlsten J, Jaskari J, Kaski K, Mäkitie AA, Fuller CD, Aerts HJ, Kann BH. Fully-automated sarcopenia assessment in head and neck cancer: development and external validation of a deep learning pipeline. medRxiv 2023:2023.03.01.23286638. [PMID: 36945519 PMCID: PMC10029039 DOI: 10.1101/2023.03.01.23286638] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Purpose Sarcopenia is an established prognostic factor in patients diagnosed with head and neck squamous cell carcinoma (HNSCC). The quantification of sarcopenia assessed by imaging is typically achieved through the skeletal muscle index (SMI), which can be derived from cervical neck skeletal muscle (SM) segmentation and cross-sectional area. However, manual SM segmentation is labor-intensive, prone to inter-observer variability, and impractical for large-scale clinical use. To overcome this challenge, we have developed and externally validated a fully-automated image-based deep learning (DL) platform for cervical vertebral SM segmentation and SMI calculation, and evaluated the relevance of this with survival and toxicity outcomes. Materials and Methods 899 patients diagnosed as having HNSCC with CT scans from multiple institutes were included, with 335 cases utilized for training, 96 for validation, 48 for internal testing and 393 for external testing. Ground truth single-slice segmentations of SM at the C3 vertebra level were manually generated by experienced radiation oncologists. To develop an efficient method of segmenting the SM, a multi-stage DL pipeline was implemented, consisting of a 2D convolutional neural network (CNN) to select the middle slice of C3 section and a 2D U-Net to segment SM areas. The model performance was evaluated using the Dice Similarity Coefficient (DSC) as the primary metric for the internal test set, and for the external test set the quality of automated segmentation was assessed manually by two experienced radiation oncologists. The L3 skeletal muscle area (SMA) and SMI were then calculated from the C3 cross sectional area (CSA) of the auto-segmented SM. Finally, established SMI cut-offs were used to perform further analyses to assess the correlation with survival and toxicity endpoints in the external institution with univariable and multivariable Cox regression. Results DSCs for validation set (n = 96) and internal test set (n = 48) were 0.90 (95% CI: 0.90 - 0.91) and 0.90 (95% CI: 0.89 - 0.91), respectively. The predicted CSA is highly correlated with the ground-truth CSA in both validation (r = 0.99, p < 0.0001) and test sets (r = 0.96, p < 0.0001). In the external test set (n = 377), 96.2% of the SM segmentations were deemed acceptable by consensus expert review. Predicted SMA and SMI values were highly correlated with the ground-truth values, with Pearson r β 0.99 (p < 0.0001) for both the female and male patients in all datasets. Sarcopenia was associated with worse OS (HR 2.05 [95% CI 1.04 - 4.04], p = 0.04) and longer PEG tube duration (median 162 days vs. 134 days, HR 1.51 [95% CI 1.12 - 2.08], p = 0.006 in multivariate analysis. Conclusion We developed and externally validated a fully-automated platform that strongly correlates with imaging-assessed sarcopenia in patients with H&N cancer that correlates with survival and toxicity outcomes. This study constitutes a significant stride towards the integration of sarcopenia assessment into decision-making for individuals diagnosed with HNSCC. SUMMARY STATEMENT In this study, we developed and externally validated a deep learning model to investigate the impact of sarcopenia, defined as the loss of skeletal muscle mass, on patients with head and neck squamous cell carcinoma (HNSCC) undergoing radiotherapy. We demonstrated an efficient, fullyautomated deep learning pipeline that can accurately segment C3 skeletal muscle area, calculate cross-sectional area, and derive a skeletal muscle index to diagnose sarcopenia from a standard of care CT scan. In multi-institutional data, we found that pre-treatment sarcopenia was associated with significantly reduced overall survival and an increased risk of adverse events. Given the increased vulnerability of patients with HNSCC, the assessment of sarcopenia prior to radiotherapy may aid in informed treatment decision-making and serve as a predictive marker for the necessity of early supportive measures.
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Affiliation(s)
- Zezhong Ye
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Anurag Saraf
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Yashwanth Ravipati
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Frank Hoebers
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Yining Zha
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Anna Zapaishchykova
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Jirapat Likitlersuang
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Danielle N. Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Raymond H. Mak
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Mohamed Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kareem A. Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jaakko Sahlsten
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Joel Jaskari
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Kimmo Kaski
- Department of Computer Science, Aalto University School of Science, Espoo, Finland
| | - Antti A. Mäkitie
- Department Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hugo J.W.L. Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
- Department Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Benjamin H. Kann
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, United States
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Klochikhin A, Haddad RI, Meirovitz A, Safina S, Brana I, Le Tourneau C, Uppaluri R, Lee NY, Cohen EE, Chernock R, Westra W, Liu H, Gumuscu B, Benjamin K, Adkins D. KEYNOTE-689: A Phase 3 Study of Neoadjuvant and Adjuvant Pembrolizumab Plus Standard of Care (SOC) in Resectable, Locally Advanced (LA) Head and Neck Squamous Cell Carcinoma (HNSCC). Eur J Surg Oncol 2023. [DOI: 10.1016/j.ejso.2022.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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11
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Pfister DG, Haddad RI, Worden FP, Weiss J, Mehra R, Chow LQM, Liu SV, Kang H, Saba NF, Wirth LJ, Sukari A, Massarelli E, Ayers M, Albright A, Webber AL, Mogg R, Lunceford J, Huang L, Cristescu R, Cheng J, Seiwert TY, Bauml JM. Biomarkers predictive of response to pembrolizumab in head and neck cancer. Cancer Med 2022; 12:6603-6614. [PMID: 36479637 PMCID: PMC10067081 DOI: 10.1002/cam4.5434] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We performed an integrated biomarker evaluation in pembrolizumab-treated patients with R/M HNSCC enrolled in KEYNOTE-012 or KEYNOTE-055. The relationship between biomarkers and HPV status was explored. METHODS We evaluated PD-L1 (combined positive score [CPS]), TMB, T-cell-inflamed gene expression profile (Tcellinf GEP), and HPV status. Associations between biomarkers were evaluated by logistic regression (ORR) and Cox regression (PFS, OS). RESULTS Two hundred and fifty-seven patients (KEYNOTE-012, n = 106; KEYNOTE-055, n = 151) had TMB data available; of these, 254 had PD-L1 and 236 had Tcellinf GEP. TMB, PD-L1, and Tcellinf GEP were each significantly associated with ORR (p < 0.01). Kaplan-Meier curves at prespecified cutoffs generally showed PFS and OS separation in the anticipated direction for these biomarkers, except for OS and TMB. TMB did not correlate with PD-L1 or Tcellinf GEP (Spearman ρ = -0.03 and ρ = -0.13, respectively); PD-L1 and Tcellinf GEP were moderately correlated (Spearman ρ = 0.47). In multivariate models, TMB, PD-L1, and Tcellinf GEP were each independently predictive for ORR (p < 0.001). ORR was higher in patients with high versus low levels of biomarkers when dichotomized using prespecified cutoffs; patients with higher versus lower levels of TMB and PD-L1 or TMB and Tcellinf GEP had the highest ORRs. Within HPV subgroups, higher versus lower distributions of biomarkers (PD-L1, TMB, and Tcellinf GEP) were associated with response. HPV detection by p16-immunohistochemistry and WES showed good concordance (81%); results were generally similar by HPV status, regardless of the detection method. CONCLUSIONS TMB and the inflammatory biomarkers PD-L1 and Tcellinf GEP, assessed alone or together, may be useful for characterizing clinical response to pembrolizumab in R/M HNSCC.
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Affiliation(s)
- David G. Pfister
- Division of Solid Tumor Oncology, Department of Medicine Memorial Sloan Kettering Cancer Center New York New York USA
| | - Robert I. Haddad
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Francis P. Worden
- Division of Medical Oncology University of Michigan Ann Arbor Michigan USA
| | - Jared Weiss
- Department of Medicine University of North Carolina Lineberger Comprehensive Cancer Center Chapel Hill North Carolina USA
| | - Ranee Mehra
- Fox Chase Cancer Center Philadelphia Pennsylvania USA
- University of Maryland Greenebaum Comprehensive Cancer Center Baltimore Maryland USA
| | - Laura Q. M. Chow
- Department of Medicine, Division of Medical Oncology University of Washington Seattle WA USA
- The University of Texas at Austin, Dell Medical School Texas Austin USA
| | - Stephen V. Liu
- Department of Medicine Georgetown University Medical Center Washington DC USA
| | - Hyunseok Kang
- Department of Medical Oncology Johns Hopkins University Baltimore Maryland USA
- University of California San Francisco California USA
| | - Nabil F. Saba
- Department of Hematology and Medical Oncology Winship Cancer Institute, Emory University Atlanta Georgia USA
| | - Lori J. Wirth
- Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Ammar Sukari
- Department of Oncology Karmanos Cancer Institute, Wayne State University Detroit Michigan USA
| | - Erminia Massarelli
- Department of Medical Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mark Ayers
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
| | - Andrew Albright
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
| | - Andrea L. Webber
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
| | - Robin Mogg
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
| | - Jared Lunceford
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
| | - Lingkang Huang
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
| | - Razvan Cristescu
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
| | - Jonathan Cheng
- Department of Medical Oncology, Merck & Co., Inc. Rahway New Jersey USA
- Bristol Myers Squibb Philadelphia Pennsylvania USA
| | - Tanguy Y. Seiwert
- Section of Hematology‐Oncology University of Chicago Department of Medicine Chicago Illinois USA
- Johns Hopkins University Baltimore Maryland USA
| | - Joshua M. Bauml
- Division of Hematology and Oncology, Department of Internal Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Janssen Research and Development Philadelphia Pennsylvania USA
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12
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Rettig EM, Wang AA, Tran NA, Carey E, Dey T, Schoenfeld JD, Sehgal K, Guenette JP, Margalit DN, Sethi R, Uppaluri R, Tishler RB, Annino DJ, Goguen LA, Jo VY, Haddad RI, Hanna GJ. Association of Pretreatment Circulating Tumor Tissue-Modified Viral HPV DNA With Clinicopathologic Factors in HPV-Positive Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:1120-1130. [PMID: 36301568 PMCID: PMC9614675 DOI: 10.1001/jamaoto.2022.3282] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 06/09/2022] [Accepted: 08/31/2022] [Indexed: 01/10/2023]
Abstract
Importance Circulating tumor tissue-modified viral (TTMV) human papillomavirus (HPV) DNA is a dynamic, clinically relevant biomarker for HPV-positive oropharyngeal squamous cell carcinoma. Reasons for its wide pretreatment interpatient variability are not well understood. Objective To characterize clinicopathologic factors associated with TTMV HPV DNA. Design, Setting, and Participants This cross-sectional study included patients evaluated for HPV-positive oropharyngeal squamous cell carcinoma at Dana-Farber Cancer Institute in Boston, Massachusetts, between December 2019 and January 2022 and who were undergoing curative-intent treatment. Exposures Clinicopathologic characteristics including demographic variables, tumor and nodal staging, HPV genotype, and imaging findings. Main Outcomes and Measures Pretreatment circulating TTMV HPV DNA from 5 genotypes (16, 18, 31, 33, and 35) assessed using a commercially available digital droplet polymerase chain reaction-based assay, considered as either detectable/undetectable or a continuous score (fragments/mL). Results Among 110 included patients, 96 were men (87%) and 104 were White (95%), with a mean (SD) age of 62.2 (9.4) years. Circulating TTMV HPV DNA was detected in 98 patients (89%), with a median (IQR) score of 315 (47-2686) fragments/mL (range, 0-60 061 fragments/mL). Most detectable TTMV HPV DNA was genotype 16 (n = 86 [88%]), while 12 patients (12%) harbored other genotypes. Circulating TTMV HPV DNA detection was most strongly associated with clinical N stage. Although few patients had clinical stage N0 disease, only 4 of these 11 patients (36%) had detectable DNA compared with 94 of 99 patients (95%) with clinical stage N1 to N3 disease (proportion difference, 59%; 95% CI, 30%-87%). Among patients with undetectable TTMV HPV DNA, more than half (7 of 12 [58%]) had clinical stage N0 disease. The TTMV HPV DNA prevalence and score increased with progressively higher clinical nodal stage, diameter of largest lymph node, and higher nodal maximum standardized uptake value on positron emission tomography/computed tomography. In multivariable analysis, clinical nodal stage and nodal maximum standardized uptake value were each strongly associated with TTMV HPV DNA score. Among 27 surgically treated patients, more patients with than without lymphovascular invasion had detectable TTMV HPV DNA (12 of 12 [100%] vs 9 of 15 [60%]). Conclusions and Relevance In this cross-sectional study, circulating TTMV HPV DNA was statistically significantly associated with nodal disease at HPV-positive OPSCC diagnosis. The few patients with undetectable levels had predominantly clinical stage N0 disease, suggesting assay sensitivity for diagnostic purposes may be lower among patients without cervical lymphadenopathy. Mechanisms underlying this association, and the use of this biomarker for surveillance of patients with undetectable baseline values, warrant further investigation.
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Affiliation(s)
- Eleni M. Rettig
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Ngoc-Anh Tran
- Harvard Medical School, Boston, Massachusetts
- Division of Neuroradiology, Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Evan Carey
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tanujit Dey
- Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jonathan D. Schoenfeld
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kartik Sehgal
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P. Guenette
- Harvard Medical School, Boston, Massachusetts
- Division of Neuroradiology, Department of Radiology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Danielle N. Margalit
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rosh Sethi
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ravindra Uppaluri
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Roy B. Tishler
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Donald J. Annino
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Laura A. Goguen
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Vickie Y. Jo
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Robert I. Haddad
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Glenn J. Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Nassar AH, Adib E, Abou Alaiwi S, El Zarif T, Groha S, Akl EW, Nuzzo PV, Mouhieddine TH, Perea-Chamblee T, Taraszka K, El-Khoury H, Labban M, Fong C, Arora KS, Labaki C, Xu W, Sonpavde G, Haddad RI, Mouw KW, Giannakis M, Hodi FS, Zaitlen N, Schoenfeld AJ, Schultz N, Berger MF, MacConaill LE, Ananda G, Kwiatkowski DJ, Choueiri TK, Schrag D, Carrot-Zhang J, Gusev A. Ancestry-driven recalibration of tumor mutational burden and disparate clinical outcomes in response to immune checkpoint inhibitors. Cancer Cell 2022; 40:1161-1172.e5. [PMID: 36179682 PMCID: PMC9559771 DOI: 10.1016/j.ccell.2022.08.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 01/28/2023]
Abstract
The immune checkpoint inhibitor (ICI) pembrolizumab is US FDA approved for treatment of solid tumors with high tumor mutational burden (TMB-high; ≥10 variants/Mb). However, the extent to which TMB-high generalizes as an accurate biomarker in diverse patient populations is largely unknown. Using two clinical cohorts, we investigated the interplay between genetic ancestry, TMB, and tumor-only versus tumor-normal paired sequencing in solid tumors. TMB estimates from tumor-only panels substantially overclassified individuals into the clinically important TMB-high group due to germline contamination, and this bias was particularly pronounced in patients with Asian/African ancestry. Among patients with non-small cell lung cancer treated with ICIs, those misclassified as TMB-high from tumor-only panels did not associate with improved outcomes. TMB-high was significantly associated with improved outcomes only in European ancestries and merits validation in non-European ancestry populations. Ancestry-aware tumor-only TMB calibration and ancestry-diverse biomarker studies are critical to ensure that existing disparities are not exacerbated in precision medicine.
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Affiliation(s)
- Amin H Nassar
- Department of Hematology/Oncology, Yale New Haven Hospital, New Haven, CT 06510, USA; Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Elio Adib
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Talal El Zarif
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Stefan Groha
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Elie W Akl
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Pier Vitale Nuzzo
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Tomin Perea-Chamblee
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kodi Taraszka
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Habib El-Khoury
- Center for Prevention of Progression of Blood Cancers, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Muhieddine Labban
- Department of Urologic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Christopher Fong
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kanika S Arora
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Chris Labaki
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Wenxin Xu
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Guru Sonpavde
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - F Stephen Hodi
- Melanoma Center, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Noah Zaitlen
- Department of Computational Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Adam J Schoenfeld
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, 1275 York Avenue, New York, NY 10065, USA
| | - Nikolaus Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Michael F Berger
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Laura E MacConaill
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Guruprasad Ananda
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | | | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Deborah Schrag
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jian Carrot-Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alexander Gusev
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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14
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Haddad RI, Bischoff L, Ball D, Bernet V, Blomain E, Busaidy NL, Campbell M, Dickson P, Duh QY, Ehya H, Goldner WS, Guo T, Haymart M, Holt S, Hunt JP, Iagaru A, Kandeel F, Lamonica DM, Mandel S, Markovina S, McIver B, Raeburn CD, Rezaee R, Ridge JA, Roth MY, Scheri RP, Shah JP, Sipos JA, Sippel R, Sturgeon C, Wang TN, Wirth LJ, Wong RJ, Yeh M, Cassara CJ, Darlow S. Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:925-951. [PMID: 35948029 DOI: 10.6004/jnccn.2022.0040] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Differentiated thyroid carcinomas is associated with an excellent prognosis. The treatment of choice for differentiated thyroid carcinoma is surgery, followed by radioactive iodine ablation (iodine-131) in select patients and thyroxine therapy in most patients. Surgery is also the main treatment for medullary thyroid carcinoma, and kinase inhibitors may be appropriate for select patients with recurrent or persistent disease that is not resectable. Anaplastic thyroid carcinoma is almost uniformly lethal, and iodine-131 imaging and radioactive iodine cannot be used. When systemic therapy is indicated, targeted therapy options are preferred. This article describes NCCN recommendations regarding management of medullary thyroid carcinoma and anaplastic thyroid carcinoma, and surgical management of differentiated thyroid carcinoma (papillary, follicular, Hürthle cell carcinoma).
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Affiliation(s)
| | | | - Douglas Ball
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Paxton Dickson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Quan-Yang Duh
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Shelby Holt
- UT Southwestern Simmons Comprehensive Cancer Center
| | - Jason P Hunt
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | - Susan Mandel
- Abramson Cancer Center at the University of Pennsylvania
| | - Stephanie Markovina
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Rod Rezaee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Mara Y Roth
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Jennifer A Sipos
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Cord Sturgeon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Michael Yeh
- UCLA Jonsson Comprehensive Cancer Center; and
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15
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Hanna GJ, Coleman K, Birch G, Redd RA, Alonso A, Bednarz S, Daley H, Hernandez Rodriguez DE, Shaw KL, Haddad RI, Uppaluri R, Ritz J, Nikiforow S, Soiffer RJ, Romee R. Abstract CT540: A phase 1 trial of cytokine-induced memory-like (CIML) natural killer (NK) cell therapy with IL-15 superagonist in advanced head and neck cancer: Part 1 results. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct540] [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: Outcomes for patients with recurrent, incurable or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) refractory to platinum and immunotherapy are poor. Cellular therapies are emerging treatments with potential utility in epithelial cancers. This proof-of-concept trial investigates an allogeneic cytokine-induced, memory-like (CIML) NK cell infusion with IL-15 superagonist (sa) after lymphodepleting (LD) chemotherapy in advanced SCCHN.
Patients and methods: This phase 1 single-center trial enrolled patients (pts) with R/M SCCHN regardless of human papillomavirus (HPV) status who had prior platinum and immunotherapy. Pts received LD fludarabine (25 mg/m2) and cyclophosphamide (60 mg/m2/kg) on days -6 to -2 prior to haploidentical CIML NK cell infusion on day 0 (5-10 x 106 viable cells/kg=dose level 0) followed by N-803 (IL-15sa, 15 mcg/kg subcutaneously) starting on day +1 every 21-days for 4-doses. Part 1 treated 3 pts at dose level 0; <2 DLTs triggered an additional 3 pts. Part 2 will treat an additional 6 pts with lead-in ipilimumab (day -7). Primary objective: safety, maximum tolerated dose of CIML NK cells. Secondary objectives: objective response rate, progression-free survival (PFS), overall survival (OS), and phenotypic expansion and function of adoptively transferred NK cells.
Results: From 9/8/20 to 9/7/21, 6 pts enrolled to Part 1. One DLT was observed at dose level 0. Among 6 pts, median age: 59; 5/6 (83%) were men; 5/6 (83%) had oropharyngeal primaries (4 HPV+) with a median 6 prior lines of therapy for R/M disease (range: 4-8). R/M disease sites: lung, bone, skin, liver. 5/6 (83%) had offspring donors. Grade (G) 3-4 hematologic adverse events were common (6/6, 100%). One patient died of G5 febrile neutropenia and infection. Median days hospitalized: 14 (range: 9-37). Mild cytokine release syndrome was observed in 5/6 (83%) (median peak ferritin: 2248, CRP: 168); 3/5 required anti-IL6 therapy; no neurotoxicity was noted. There were no dose adjustments or discontinuation of therapy. One (17%) partial response (PR) was observed lasting 6.5 months; 4 (67%) pts had stable disease (SD), and 1 (17%) had progression. Tumor regression was observed in 3/6 (50%) pts at day +30. At a median follow-up of 9.5 months, median PFS: 3.4 months (95%CI 2.6-6.5); median OS: 4.7 months (95%CI 3.4-11.8). CIML NK cells showed large expansion in the peripheral blood (PB) at day +7 in all pts; mean increase: 66% (6-fold; standard deviation [SD] 10.5), to constitute 80% (SD 12.1) of PB lymphocytes. In pts with tumor regression at day +30 compared to those without, the % of PB NK cells remained high at day +28 (mean: 78 vs. 11%). PB NK cells remained >50% at day +42 in the pt with a PR.
Conclusion: Allogeneic CIML NK cells can induce tumor regression associated with persistent CIML NK cell expansion among advanced SCCHN pts. In Part 1 we demonstrate safety and feasibility with the expected risks of LD conditioning. These findings have important implications for the development of cellular therapies in solid tumors.
Citation Format: Glenn J. Hanna, Kimberly Coleman, Grace Birch, Robert A. Redd, Alejandro Alonso, Samantha Bednarz, Heather Daley, Diego E. Hernandez Rodriguez, Kit L. Shaw, Robert I. Haddad, Ravindra Uppaluri, Jerome Ritz, Sarah Nikiforow, Robert J. Soiffer, Rizwan Romee. A phase 1 trial of cytokine-induced memory-like (CIML) natural killer (NK) cell therapy with IL-15 superagonist in advanced head and neck cancer: Part 1 results [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT540.
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16
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Adkins DR, Haddad RI. Clinical trial data of Anti-PD-1/PD-L1 therapy for recurrent or metastatic nasopharyngeal Carcinoma: A review. Cancer Treat Rev 2022; 109:102428. [PMID: 35753157 DOI: 10.1016/j.ctrv.2022.102428] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 11/26/2022]
Abstract
IMPORTANCE Anti-programmed cell death receptor-1 (PD-1) therapy is standard of care for incurable recurrent or metastatic non-nasopharyngeal head and neck cancer. In contrast, there are no regulatory agency-approved anti-PD-1 agents indicated for the treatment of recurrent or metastatic nasopharyngeal carcinomas (RM-NPC) in the Western hemisphere, and no standard treatment option exists beyond first-line chemotherapy for RM-NPC. The pace of development of novel systemic therapy regimens for RM-NPC has been slow compared to many other advanced tumor types, leaving an unmet clinical need for these patients with a poor prognosis. OBSERVATIONS Recent clinical trials have documented the clinical activity of anti-PD-1 therapy in RM-NPC. In particular, randomized clinical trials in the first-line setting have demonstrated significant improvements in progression-free survival (PFS) with the addition of anti-PD-1 therapy to standard chemotherapy. Whether the observed PFS benefits require combination chemoimmunotherapy or can be achieved with chemotherapy followed by crossover to immunotherapy upon progression remains unknown. Ongoing clinical trials are exploring novel anti-PD-1 therapy-based combinations, which may further solidify a role for these agents in RM-NPC. CONCLUSIONS AND RELEVANCE Among patients with RM-NPC, anti-PD-1 therapy added to first-line standard-of-care gemcitabine plus cisplatin provides significantly better efficacy outcomes compared to chemotherapy alone, and anti-PD-1 monotherapy appears to have comparable clinical activity and better tolerability than chemotherapy in previously treated disease. Thus, anti-PD-1 therapy is poised to advance standard of care for the treatment of RM-NPC.
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Affiliation(s)
- Douglas R Adkins
- Division of Medical Oncology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
| | - Robert I Haddad
- Department of Medical Oncology, Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Bakouny Z, Labaki C, Bhalla S, Schmidt AL, Steinharter JA, Cocco J, Tremblay DA, Awad MM, Kessler A, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang H, Anderson-Keightly HM, El Zarif T, Alaiwi SA, Champagne C, Rosenbloom TD, Stewart PS, Johnson BE, Trinh Q, Tolaney SM, Galsky MD, Choueiri TK, Doroshow DB. Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study. Ann Oncol 2022; 33:836-844. [PMID: 35715285 PMCID: PMC9197329 DOI: 10.1016/j.annonc.2022.04.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 03/14/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022] Open
Abstract
Background COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct. Patients and methods This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations. Results The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (−46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from −23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded. Conclusions Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.
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Affiliation(s)
- Z Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - C Labaki
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - S Bhalla
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - A L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J Cocco
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - D A Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - M M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - A Kessler
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - R I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - F Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, USA
| | - C R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - B S Zimmerman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - G Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - T Jun
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - P V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Q Qin
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - L Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - J Feld
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - K M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - D Seidman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - H Huang
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | | | - T El Zarif
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - S Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - C Champagne
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - T D Rosenbloom
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - P S Stewart
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - B E Johnson
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - Q Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, USA
| | - S M Tolaney
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA
| | - M D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - T K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, USA.
| | - D B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, USA.
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18
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Saba NF, Mody MD, Rocco JW, Haddad RI, Yom SS. Head and neck cancer: high-end technology is no guarantee of high-quality care - Authors' reply. Lancet 2022; 399:2102. [PMID: 35658994 DOI: 10.1016/s0140-6736(22)00426-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Nabil F Saba
- Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
| | - Mayur D Mody
- AdventHealth Hematology & Oncology, Calhoun, GA, USA
| | - James W Rocco
- The Ohio State University Wexner Medical Center and Comprehensive Cancer Center, Columbus, OH, USA
| | - Robert I Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Sue S Yom
- University of California San Francisco, San Francisco, CA, USA
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19
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Arbab M, Chen YH, Tishler RB, Gunasti L, Glass J, Fugazzotto JA, Killoran JH, Sethi R, Rettig E, Annino D, Goguen L, Uppaluri R, Hsu C, Burke E, Hanna GJ, Lorch J, Haddad RI, Margalit DN, Schoenfeld JD. Association between radiation dose to organs at risk and acute patient reported outcome during radiation treatment for head and neck cancers. Head Neck 2022; 44:1442-1452. [PMID: 35355358 DOI: 10.1002/hed.27031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Associations between patient-reported outcomes and dose to organs at risk (OARs) may promote management and guide future investigations. METHODS We retrospectively evaluated PROs and OAR dose in head and neck (H&N) cancer. RESULTS In 169 patients, we identified weak associations between: "Difficulty swallowing/chewing" and increased mean RT dose to the oral cavity, larynx, pharyngeal constrictor muscles (PCM) and contralateral parotid; "choking/coughing" and larynx mean dose; "problems with mucus in mouth and throat" and oral cavity, contralateral parotid mean dose and parotid V30, contralateral submandibular gland and PCM mean dose; "difficulty with voice/speech" and oral cavity, contralateral parotid, contralateral submandibular gland and larynx mean dose; and "dry mouth" and ipsilateral submandibular gland, oral cavity and PCM mean dose. CONCLUSION We identified weak associations between PRO and dose to OARs-these data can guide on treatment management, patient counseling, and serve as a baseline for future investigations.
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Affiliation(s)
- Mona Arbab
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiation Oncology, Indiana University, Indianapolis, Indiana, USA
| | - Yu-Hui Chen
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Roy B Tishler
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lauren Gunasti
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Glass
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jo Ann Fugazzotto
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joseph H Killoran
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rosh Sethi
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eleni Rettig
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donald Annino
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura Goguen
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Carolyn Hsu
- Speech Language Pathology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elaine Burke
- Speech Language Pathology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Glenn J Hanna
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jochen Lorch
- Department of Oncology, Northwestern University, Evanston, Illinois, USA
| | - Robert I Haddad
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Danielle N Margalit
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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20
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Adib E, Nassar A, El Zarif T, Kale N, Rakaee M, Mouhieddine TH, Abou Alaiwi S, Freeman D, Labban M, Akl E, Haddad RI, Hodi FS, Sonpavde GP, Giannakis M, Braun DA, Gusev A, Choueiri TK, Overstreet E, Stone E, Kwiatkowski DJ. Dual CDKN2A/MTAP loss compared to CDKN2A loss alone and response to immune-checkpoint inhibitors (ICI) in advanced solid tumors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2622 Background: We previously showed that CDKN2A genomic alterations (GAs) are associated with resistance to ICI (Adib E, Clinical Cancer Research, 2021). The majority of such GAs are homozygous deletions, which commonly (̃50-80%) include MTAP, located 100kb telomeric of CDKN2A. MTAP loss leads to 5′-deoxy-5′-methylthioadenosine (MTA) accumulation and immunosuppressive effects in tumors. We examined combined CDKN2A/MTAP deletion vs. CDKN2A deletion/mutation alone as predictors of poor ICI response. Methods: We curated clinical data for cancer patients (pts) treated with ICI at Dana-Farber Cancer Institute through 6/2021, who had targeted panel sequencing. Inclusion criteria were: ICI in metastatic setting, ≥2 cycles, no concurrent systemic therapy, cancer type with > 50 pts treated. CDKN2A/ MTAP GAs were defined as a deep deletion affecting both genes; CDKN2A only GAs included both homozygous deletions and truncating mutations. Hazard ratios (HR) for overall survival (OS) and time-to-treatment failure (TTF) were derived using multivariable Cox regression, adjusted for prior lines of therapy, treatment type (single vs. combination ICI), tumor mutational burden and ECOG PS. We also used a machine learning approach to quantify the density of tumor-infiltrating lymphocytes (TILs) in digital whole-slide H&E images of 144 melanoma pts with available genomic data. Results: 921 pts with 6 cancer types were studied: non-small cell lung cancer (NSCLC, n = 366), melanoma (mel, n = 228), urothelial carcinoma (UC, n = 120), esophagogastric carcinoma (EGC,n = 90), head and neck squamous cell carcinoma (HNSCC, n = 58), and renal cell carcinoma (RCC, n = 59). UC pts with MTAP/ CDKN2A GAs had shorter OS and TTF than pts without GA in either gene (OS HR = 1.9[1.1-3.4], p = 0.005; TTF HR = 1.8[1.0-3.1], p = 0.0016) after adjusting for covariates. Similar results were seen for melanoma (OS HR = 2.5[1.4-2.6],p = 0.00065; TTF HR = 1.9[1.1-3.2],p = 0.018). There was no significant difference between pts with CDKN2A GA only and those without GA in either gene for OS or TTF in either UC or melanoma. CDKN2A/MTAP status was not associated with significantly shorter survival for NSCLC and EGC; while the analysis was confounded by HPV events for HNSCC, and underpowered for RCC. ML-based analysis of digital slides for melanoma, showed that tumors with CDKN2A GAs only (n = 42) had similar median density of TILs compared to tumors without GAs in either gene (n = 84; 920 vs. 943 TILs/mm2; p = 0.42). In contrast, tumors with co-occurring CDKN2A/ MTAP GAs had lower TIL density (529 TIL/mm2, n = 17 vs. 925 TIL/mm2, n = 126 (pooled); p = 0.018, Wilcoxon rank sum). Conclusions: In this study, we showed that co-occurrence of MTAP/CDKN2A GAs, but not CDKN2A GA only, was associated with worse outcomes in pts with UC and melanoma treated with ICI. Lower TIL density was also seen in melanoma tissue samples with combined MTAP/CDKN2A GA.
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Affiliation(s)
- Elio Adib
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | | | | | - Neil Kale
- Worcester Polytechnic Institute, Worcester, MA
| | | | | | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Eli Akl
- Johns Hopkins Medical Institute, Baltimore, MD
| | - Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | | | - David A. Braun
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | | | | | - David J. Kwiatkowski
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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21
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Hanna GJ, Villa A, Mistry N, Jia Y, Quinn CT, Turner MM, Felt KD, Pfaff K, Haddad RI, Uppaluri R, Rodig SJ, Woo SB, Egloff AM, Hodi FS. Correction: Comprehensive Immunoprofiling of High-risk Oral Proliferative and Localized Leukoplakia. Cancer Res Commun 2022; 2:390. [PMID: 36875716 PMCID: PMC9981205 DOI: 10.1158/2767-9764.crc-22-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/16/2022]
Abstract
[This corrects the article DOI: 10.1158/2767-9764.CRC-21-0060.][This corrects the article DOI: 10.1158/2767-9764.CRC-21-0060.].
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22
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Caudell JJ, Gillison ML, Maghami E, Spencer S, Pfister DG, Adkins D, Birkeland AC, Brizel DM, Busse PM, Cmelak AJ, Colevas AD, Eisele DW, Galloway T, Geiger JL, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Mell LK, Mittal BB, Pinto HA, Rocco JW, Rodriguez CP, Savvides PS, Schwartz D, Shah JP, Sher D, St John M, Weber RS, Weinstein G, Worden F, Yang Bruce J, Yom SS, Zhen W, Burns JL, Darlow SD. NCCN Guidelines® Insights: Head and Neck Cancers, Version 1.2022. J Natl Compr Canc Netw 2022; 20:224-234. [PMID: 35276673 DOI: 10.6004/jnccn.2022.0016] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Head and Neck Cancers address tumors arising in the oral cavity (including mucosal lip), pharynx, larynx, and paranasal sinuses. Occult primary cancer, salivary gland cancer, and mucosal melanoma (MM) are also addressed. The specific site of disease, stage, and pathologic findings guide treatment (eg, the appropriate surgical procedure, radiation targets, dose and fractionation of radiation, indications for systemic therapy). The NCCN Head and Neck Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's most recent recommendations regarding management of HPV-positive oropharynx cancer and ongoing research in this area.
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Affiliation(s)
| | | | | | | | | | - Douglas Adkins
- 6Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | - David W Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Jessica L Geiger
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Debra Leizman
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Bharat B Mittal
- 20Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - James W Rocco
- 21The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - David Schwartz
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - David Sher
- 25UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | - Sue S Yom
- 30UCSF Helen Diller Family Comprehensive Cancer Center
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23
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Haddad RI, Seiwert TY, Chow LQM, Gupta S, Weiss J, Gluck I, Eder JP, Burtness B, Tahara M, Keam B, Kang H, Muro K, Albright A, Mogg R, Ayers M, Huang L, Lunceford J, Cristescu R, Cheng J, Mehra R. Influence of tumor mutational burden, inflammatory gene expression profile, and PD-L1 expression on response to pembrolizumab in head and neck squamous cell carcinoma. J Immunother Cancer 2022; 10:jitc-2021-003026. [PMID: 35217573 PMCID: PMC8883256 DOI: 10.1136/jitc-2021-003026] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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] [Accepted: 01/18/2022] [Indexed: 12/13/2022] Open
Abstract
Background To characterize genomic determinants of response to pembrolizumab in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) in the KEYNOTE-012 study. Methods Associations between biomarkers (tumor mutational burden (TMB), neoantigen load (NL), 18-gene T-cell-inflamed gene expression profile (TcellinfGEP), and PD-L1 combined positive score (CPS)) and clinical outcomes with pembrolizumab were assessed in patients with R/M HNSCC (n=192). Tumor human papillomavirus (HPV) status was also evaluated with the use of p16 immunohistochemistry and whole exome sequencing (WES; HPV+, mapping >20 HPV reads) in pretreatment tumor samples (n=106). Results TMB, clonality-weighted TMB, and TcellinfGEP were significantly associated with objective response (p=0.0276, p=0.0201, and p=0.006, respectively), and a positive trend was observed between NL and PD-L1 CPS and clinical response (p=0.0550 and p=0.0682, respectively). No correlation was observed between TMB and TcellinfGEP (Spearman ρ=–0.026) or TMB and PD-L1 (Spearman ρ=0.009); a correlation was observed between TcellinfGEP and PD-L1 (Spearman ρ=0.511). HPV status by WES and p16 immunohistochemistry showed concordance (84% ҡ=0.573) among patients whose HPV results were available using both methods. Conclusions TMB and inflammatory biomarkers (TcellinfGEP and PD-L1) may represent distinct and complementary biomarkers predicting response to anti-programmed death 1 therapies in HNSCC; further study of these relationships in randomized clinical trials is needed. Trial registration number NCT01848834.
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Affiliation(s)
- Robert I Haddad
- Department of Medical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Tanguy Y Seiwert
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois, USA
| | - Laura Q M Chow
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Shilpa Gupta
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Iris Gluck
- Department of Oncology, Sheba Medical Center at Tel HaShomer, Ramat Gan, Israel
| | - Joseph P Eder
- Department of Medicine, Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut, USA
| | - Barbara Burtness
- Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut, USA
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunseok Kang
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland, USA
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - Robin Mogg
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | - Mark Ayers
- Merck & Co., Inc, Kenilworth, New Jersey, USA
| | | | | | | | | | - Ranee Mehra
- Department of Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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24
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Treister NS, Brennan MT, Sollecito TP, Schmidt BL, Patton LL, Mitchell R, Haddad RI, Tishler RB, Shadick R, Hodges JS, Lalla RV, Lalla RV. Exposed bone in patients with head and neck cancer treated with radiation therapy: An analysis of the Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad). Cancer 2022; 128:487-496. [PMID: 34665873 PMCID: PMC8776577 DOI: 10.1002/cncr.33948] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) treated with radiation therapy (RT) are at risk for jaw osteoradionecrosis (ORN), which is largely characterized by the presence of exposed necrotic bone. This report describes the incidence and clinical course of and risk factors for exposed intraoral bone in the multicenter Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad) cohort. METHODS Participants were evaluated before RT and at 6, 12, 18, and 24 months after RT. Exposed bone was characterized by location, sequestrum formation, and other associated features. The radiation dose to the affected area was determined, and the history of treatment for exposed bone was recorded. RESULTS The study enrolled 572 participants; 35 (6.1%) were diagnosed with incident exposed bone at 6 (47% of reports), 12 (24%), 18 (20%), and 24 months (8%), with 60% being sequestrum and with 7 cases (20%) persisting for >6 months. The average maximum RT dose to the affected area of exposed bone was 5456 cGy (SD, 1768 cGy); the most frequent associated primary RT sites were the oropharynx (42.9%) and oral cavity (31.4%), and 76% of episodes occurred in the mandible. The diagnosis of ORN was confirmed in 18 participants for an incidence rate of 3.1% (18 of 572). Risk factors included pre-RT extractions (P = .008), a higher RT dose (P = .039), and tobacco use (P = .048). CONCLUSIONS The 2-year incidence of exposed bone in the OraRad cohort was 6.1%; the incidence of confirmed ORN was 3.1%. Exposed bone after RT for HNC is relatively uncommon and, in most cases, is a short-term complication, not a recurring or persistent one.
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Affiliation(s)
- Nathaniel S. Treister
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, 1620 Tremont Street, 3 Floor, Boston, MA 02120, USA. Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Michael T. Brennan
- Department of Oral Medicine, Atrium Health’s Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC 28203, USA
| | - Thomas P. Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA. Division of Oral Medicine, University of Pennsylvania Health System, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Brian L. Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, New York 10010, USA
| | - Lauren L. Patton
- Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, CB 7450, Chapel Hill, NC, USA
| | - Rebecca Mitchell
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN 55414, USA
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women’s Hospital, 450 Brookline Ave, Boston, MA 02215, United States
| | - Ryann Shadick
- Division of Oral Medicine and Dentistry, Brigham and Women’s Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA 02120, USA
| | - James S. Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN 55414, USA
| | - Rajesh V. Lalla
- Section of Oral Medicine, MC3912, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030-3912, USA
| | - Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut Health, Farmington, Connecticut
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Hanna GJ, O'Neill A, Shin KY, Wong K, Jo VY, Quinn CT, Cutler JM, Flynn M, Lizotte PH, Annino DJ, Goguen LA, Kass JI, Rettig EM, Sethi RKV, Lorch JH, Schoenfeld JD, Margalit DN, Tishler RB, Everett PC, Desai AM, Cavanaugh ME, Paweletz CP, Egloff AM, Uppaluri R, Haddad RI. Neoadjuvant and Adjuvant Nivolumab and Lirilumab in Patients with Recurrent, Resectable Squamous Cell Carcinoma of the Head and Neck. Clin Cancer Res 2022; 28:468-478. [PMID: 34667025 PMCID: PMC9401515 DOI: 10.1158/1078-0432.ccr-21-2635] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/30/2021] [Accepted: 10/13/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Surgery often represents the best chance for disease control in locoregionally recurrent squamous cell carcinoma of the head and neck (SCCHN). We investigated dual immune-checkpoint inhibition [anti-PD-1, nivolumab (N), and anti-KIR, lirilumab (L)] before and after salvage surgery to improve disease-free survival (DFS). PATIENTS AND METHODS In this phase II study, patients received N (240 mg) + L (240 mg) 7 to 21 days before surgery, followed by six cycles of adjuvant N + L. Primary endpoint was 1-year DFS; secondary endpoints were safety, pre-op radiologic response, and overall survival (OS). Correlatives included tumor sequencing, PD-L1 scoring, and immunoprofiling. RESULTS Among 28 patients, the median age was 66, 86% were smokers; primary site: 9 oral cavity, 9 oropharynx, and 10 larynx/hypopharynx; 96% had prior radiation. There were no delays to surgery. Grade 3+ adverse events: 11%. At the time of surgery, 96% had stable disease radiologically, one had progression. Pathologic response to N + L was observed in 43% (12/28): 4/28 (14%) major (tumor viability, TV ≤ 10%) and 8/28 (29%) partial (TV ≤ 50%). PD-L1 combined positive score (CPS) at surgery was similar regardless of pathologic response (P = 0.71). Thirteen (46%) recurred (loco-regional = 10, distant = 3). Five of 28 (18%) had positive margins, 4 later recurred. At median follow-up of 22.8 months, 1-year DFS was 55.2% (95% CI, 34.8-71.7) and 1-year OS was 85.7% (95% CI, 66.3-94.4). Two-year DFS and OS were 64% and 80% among pathologic responders. CONCLUSIONS (Neo)adjuvant N + L was well tolerated, with a 43% pathologic response rate. We observed favorable DFS and excellent 2-year OS among high-risk, previously treated patients exhibiting a pathologic response. Further evaluation of this strategy is warranted.See related commentary by Sacco and Cohen, p. 435.
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Affiliation(s)
- Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Anne O'Neill
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kee-Young Shin
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kristine Wong
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vickie Y Jo
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Charles T Quinn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer M Cutler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Michelle Flynn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patrick H Lizotte
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donald J Annino
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Laura A Goguen
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Eleni M Rettig
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rosh K V Sethi
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jochen H Lorch
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Roy B Tishler
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter C Everett
- Department of Medical Oncology, Boston Medical Center, Boston, Massachusetts
| | - Anupam M Desai
- Department of Hematology/Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Megan E Cavanaugh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cloud P Paweletz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ann Marie Egloff
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Head and Neck Surgical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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26
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Tyan K, Bae JE, Lorch JH, Margalit DN, Tishler RB, Huynh MA, Jo VY, Haddad RI, Chau NG, Hanna GJ, Schoenfeld JD. Oligometastatic adenoid cystic carcinoma: Correlating tumor burden and time to treatment with outcomes. Head Neck 2021; 44:722-734. [DOI: 10.1002/hed.26964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/12/2021] [Accepted: 12/10/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kevin Tyan
- Harvard Medical School Boston Massachusetts USA
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
- Department of Radiation Oncology Dana‐Farber Cancer Institute and Brigham & Women's Hospital Boston Massachusetts USA
| | - Ji Eun Bae
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Jochen H. Lorch
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Danielle N. Margalit
- Department of Radiation Oncology Dana‐Farber Cancer Institute and Brigham & Women's Hospital Boston Massachusetts USA
| | - Roy B. Tishler
- Department of Radiation Oncology Dana‐Farber Cancer Institute and Brigham & Women's Hospital Boston Massachusetts USA
| | - Mai Anh Huynh
- Department of Radiation Oncology Dana‐Farber Cancer Institute and Brigham & Women's Hospital Boston Massachusetts USA
| | - Vickie Y. Jo
- Department of Pathology Brigham & Women's Hospital Boston Massachusetts USA
| | - Robert I. Haddad
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Nicole G. Chau
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
- BC Cancer Vancouver Center Vancouver British Columbia Canada
| | - Glenn J. Hanna
- Department of Medical Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology Dana‐Farber Cancer Institute and Brigham & Women's Hospital Boston Massachusetts USA
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27
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Abstract
Head and neck cancer is the seventh most common type of cancer worldwide and comprise of a diverse group of tumours affecting the upper aerodigestive tract. Although many different histologies exist, the most common is squamous cell carcinoma. Predominant risk factors include tobacco use, alcohol abuse, and oncogenic viruses, including human papillomavirus and Epstein-Barr virus. Head and neck malignancies remain challenging to treat, requiring a multidisciplinary approach, with surgery, radiotherapy, and systemic therapy serving as key components of the treatment of locally advanced disease. Although many treatment principles overlap, treatment is generally site-specific and histology-specific. This Seminar outlines the current understanding of head and neck cancer and focuses on treatment principles, while also discussing future directions to improve the outcomes of patients with these malignancies.
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Affiliation(s)
- Mayur D Mody
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - James W Rocco
- The Ohio State University Comprehensive Cancer Center-James, Columbus, OH, USA
| | - Sue S Yom
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Robert I Haddad
- Harvard Medical School and Dana Farber Cancer Institute, Boston, MA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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28
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Hanna GJ, Villa A, Mistry N, Jia Y, Quinn CT, Turner MM, Felt KD, Pfaff K, Haddad RI, Uppaluri R, Rodig SJ, Woo SB, Egloff AM, Hodi FS. Comprehensive Immunoprofiling of High-Risk Oral Proliferative and Localized Leukoplakia. Cancer Res Commun 2021; 1:30-40. [PMID: 36860910 PMCID: PMC9973379 DOI: 10.1158/2767-9764.crc-21-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
Oral leukoplakia is common and may, in some cases, progress to carcinoma. Proliferative leukoplakia is a progressive, often multifocal subtype with a high rate of malignant transformation compared with the more common localized leukoplakia. We hypothesized that the immune microenvironment and gene expression patterns would be distinct for proliferative leukoplakia compared with localized leukoplakia. We summarize key clinicopathologic features among proliferative leukoplakia and localized leukoplakia and compare cancer-free survival (CFS) between subgroups. We analyze immunologic gene expression profiling in proliferative leukoplakia and localized leukoplakia tissue samples (NanoString PanCancer Immune Oncology Profiling). We integrate immune cell activation and spatial distribution patterns in tissue samples using multiplexed immunofluorescence and digital image capture to further define proliferative leukoplakia and localized leukoplakia. Among N = 58 patients (proliferative leukoplakia, n = 29; localized leukoplakia, n = 29), only the clinical diagnosis of proliferative leukoplakia was associated with significantly decreased CFS (HR, 11.25; P < 0.01; 5-year CFS 46.8% and 83.6% among patients with proliferative leukoplakia and localized leukoplakia, respectively). CD8+ T cells and T regulatory (Treg) were more abundant among proliferative leukoplakia samples (P < 0.01) regardless of degree of epithelial dysplasia, and often colocalized to the dysplasia-stromal interface. Gene set analysis identified granzyme M as the most differentially expressed gene favoring the proliferative leukoplakia subgroup (log2 fold change, 1.93; P adj < 0.001). Programmed death ligand 1 (PD-L1) was comparatively overexpressed among proliferative leukoplakia samples, with higher (>5) PD-L1 scores predicting worse CFS (P adj < 0.01). Proliferative leukoplakia predicts a high rate of malignant transformation within 5 years of diagnosis. A prominent CD8+ T-cell and Treg signature along with relative PD-L1 overexpression compared with localized leukoplakia provides strong rationale for PD-1/PD-L1 axis blockade using preventative immunotherapy. Significance This is the first in-depth profiling effort to immunologically characterize high-risk proliferative leukoplakia as compared with the more common localized leukoplakia. We observed a notable cytotoxic T-cell and Treg signature with relative overexpression of PD-L1 in high-risk proliferative leukoplakia providing a strong preclinical rationale for investigating PD-1/PD-L1 axis blockade in this disease as preventative immunotherapy.
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Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Corresponding Author: Glenn J. Hanna, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Dana Building, Room 2-140, Boston, MA 02215. Phone: 617-632-3090; Fax: 617-632-4448; E-mail:
| | - Alessandro Villa
- Oral Medicine Clinic, University of California San Francisco School of Dentistry, San Francisco, California
| | - Nikhil Mistry
- Division of Oral Medicine and Dentistry, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Yonghui Jia
- Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Charles T. Quinn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Madison M. Turner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kristen D. Felt
- ImmunoProfile, Brigham & Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kathleen Pfaff
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert I. Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ravindra Uppaluri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Scott J. Rodig
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts.,Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Ann Marie Egloff
- Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts
| | - F. Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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29
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Bhalla S, Bakouny Z, Schmidt AL, Labaki C, Steinharter JA, Tremblay DA, Awad MM, Kessler AJ, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang HH, Anderson-Keightly HM, El Zarif T, Abou Alaiwi S, Rosenbloom TD, Stewart PS, Galsky MD, Choueiri TK, Doroshow DB. Care disruptions among patients with lung cancer: A COVID-19 and cancer outcomes study. Lung Cancer 2021; 160:78-83. [PMID: 34461400 PMCID: PMC8284065 DOI: 10.1016/j.lungcan.2021.07.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/07/2021] [Accepted: 07/09/2021] [Indexed: 12/29/2022]
Abstract
Introduction Patients with lung cancer (LC) are susceptible to severe outcomes from COVID-19. This study evaluated disruption to care of patients with LC during the COVID-19 pandemic. Methods The COVID-19 and Cancer Outcomes Study (CCOS) is a prospective cohort study comprised of patients with a current or past history of hematological or solid malignancies with outpatient visits between March 2 and March 6, 2020, at two academic cancer centers in the Northeastern United States (US). Data was collected for the three months prior to the index week (baseline period) and the following three months (pandemic period). Results 313 of 2365 patients had LC, 1578 had other solid tumors, and 474 had hematological malignancies. Patients with LC were not at increased risk of COVID-19 diagnosis compared to patients with other solid or hematological malignancies. When comparing data from the pandemic period to the baseline period, patients with LC were more likely to have a decrease in in-person visits compared to patients with other solid tumors (aOR 1.94; 95% CI, 1.46–2.58), but without an increase in telehealth visits (aOR 1.13; 95% CI 0.85–1.50). Patients with LC were more likely to experience pandemic-related treatment delays than patients with other solid tumors (aOR 1.80; 95% CI 1.13–2.80) and were more likely to experience imaging/diagnostic procedure delays than patients with other solid tumors (aOR 2.59; 95% CI, 1.46–4.47) and hematological malignancies (aOR 2.01; 95% CI, 1.02–3.93). Among patients on systemic therapy, patients with LC were also at increased risk for decreased in-person visits and increased treatment delays compared to those with other solid tumors. Discussion Patients with LC experienced increased cancer care disruption compared to patients with other malignancies during the early phase of the COVID-19 pandemic. Focused efforts to ensure continuity of care for this patient population are warranted.
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Affiliation(s)
- Sheena Bhalla
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Andrew L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Chris Labaki
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - John A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Douglas A Tremblay
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Mark M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Alaina J Kessler
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Michelle Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fiona Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Michael Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Catherine R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Brittney S Zimmerman
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Gabrielle Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tomi Jun
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Pier V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Qian Qin
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Laure Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jonathan Feld
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Kaitlin M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Danielle Seidman
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Hsin-Hui Huang
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Heather M Anderson-Keightly
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Talal El Zarif
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Sarah Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Talia D Rosenbloom
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Penina S Stewart
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Matthew D Galsky
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Deborah B Doroshow
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
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Hanna GJ, O'Neill A, Cutler JM, Flynn M, Vijaykumar T, Clark JR, Wirth LJ, Lorch JH, Park JC, Mito J, Lohr JG, Kaufman J, Zon LI, Haddad RI. Abstract CT165: A phase II trial of all-trans retinoic acid (ATRA) in advanced adenoid cystic carcinoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct165] [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: Recurrent or metastatic adenoid cystic carcinoma (R/M ACC) is a rare cancer often arising from the salivary glands of the head and neck. While effective therapies are lacking, preclinical models have suggested that retinoic acid agonists may inhibit ACC growth by blocking MYB binding at translocated gene enhancers. We conducted a phase II trial evaluating retinoic acid as a potential novel therapy for R/M ACC. Patients and methods: Patients with histologically confirmed R/M ACC of any primary site with measurable disease (RECIST v1.1), clinical or radiographic progression within 12 months prior to enrollment, and any number of prior lines of therapy were eligible. Cohort 1 (CH1) received ATRA 45 mg/m2 split oral daily dosing on days 1-14 of a 28-day cycle; cohort 2 (CH2) received the same dosing continuously; treatment continued until disease progression. The primary endpoint was best overall response: ≥5 patients in CH1 with disease in response (CR+PR) among N=25 (assuming ≥2 of N=14 accrued in first stage of a two-stage design had disease in response) provided 85% power to target a >10% response rate (one-sided 9% binomial test). Secondary endpoints: safety, progression-free survival (PFS), overall survival. Exploratory analyses: ATRA impact on MYB expression, define resistance mechanisms, and monitor circulating tumor DNA. All had targeted tumor sequencing prior to enrollment. Results: Between 8/2019 and 2/2020, N=14 enrolled in stage 1 CH1. Primary endpoint of response to continue accrual into stage 2 in CH1 was not met; by 5/2020, N=4 enrolled in CH2 when the trial closed to accrual (budget constraints). Among 18 patients, median age: 58, 61% (11/18) women; each patient had a median of 3 organs (range, 1-4) with metastatic disease. 39% had 2+ prior lines of therapy. Best overall response: CR+PR 0%; SD 61% (11/18); PD 28% (5/18); unevaluable 11% (2/18). Median duration of stability 3.5 months (range, 1-12.3+). One patient (CH1) remains on drug with SD >1 year. Half of those who received prior VEGFR therapy achieved SD (4/8). At a median follow-up of 7.9 months, median PFS was 3.2 months (95% CI, 1.8-3.9). N=1 required dose adjustment; N=1 came off drug for toxicity. There were no grade 3-4 adverse events (headache, dry skin were common); no deaths due to treatment. Median tumor mutational burden was 0 (range, 0-5). NOTCH1 was the most frequent alteration (4, 22%) with 2 evaluable NOTCH1-mutant patients exhibiting SD. Mutations in the PI3K pathway, TP53, and TERT promoter were common. Low MYB protein expression was associated with longer duration of stability (p<0.01). Conclusion: While the trial did not meet its prespecified overall response endpoint, SD was observed among R/M ACC patients with disease progression 12 months prior to enrollment. This combined with limited toxicity makes ATRA a treatment option for long-term growth stabilization alone, or worth exploring in combination with other agents for R/M ACC.
Citation Format: Glenn J. Hanna, Anne O'Neill, Jennifer M. Cutler, Michelle Flynn, Tushara Vijaykumar, John R. Clark, Lori J. Wirth, Jochen H. Lorch, Jong C. Park, Jeffrey Mito, Jens G. Lohr, Jeffrey Kaufman, Leonard I. Zon, Robert I. Haddad. A phase II trial of all-trans retinoic acid (ATRA) in advanced adenoid cystic carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT165.
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31
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Hanna GJ, ONeill A, Cutler JM, Flynn M, Vijaykumar T, Clark JR, Wirth LJ, Lorch JH, Park JC, Mito JK, Lohr JG, Kaufman J, Burr NS, Zon LI, Haddad RI. A phase II trial of all-trans retinoic acid (ATRA) in advanced adenoid cystic carcinoma. Oral Oncol 2021; 119:105366. [PMID: 34091189 DOI: 10.1016/j.oraloncology.2021.105366] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 04/19/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Effective therapies are lacking for recurrent, metastatic adenoid cystic carcinoma (R/M ACC) and preclinical models suggest retinoic acid agonists inhibit ACC growth. This phase II trial evaluated all-trans retinoic acid (ATRA) as a novel therapy for ACC. METHODS Patients with R/M ACC (any site) with clinical and/or radiographic progression ≤12 months prior to study entry were eligible. Cohort 1 (CH1) received ATRA 45 mg/m2 split oral daily dosing on days 1-14 of a 28-day cycle; Cohort 2 (CH2) received the same dosing continuously. Primary endpoint was best overall response rate (CR + PR) (RECIST v1.1). Secondary endpoints: safety and progression-free survival (PFS). Exploratory analyses: ATRA impact on MYB expression and genomic predictors of response. RESULTS Eighteen patients enrolled. There were no responses, but 61% (11/18) had stable disease (SD) and 28% (5/18) progression as best response; 11% (2/18) unevaluable. Median duration of stability: 3.7 months (95%CI, 1.9-3.9). One patient (CH1) remains on drug with SD approaching 1 year. Half of those who received prior VEGFR therapy achieved SD (4/8). At median follow up of 7.9 months, median PFS was 3.2 months (95%CI, 1.8-3.9). N = 1 required dose adjustment; N = 1 came off drug for toxicity. There were no grade 3-4 adverse events. NOTCH1 and PI3K pathway alterations were most frequent. Low MYB protein expression was associated with longer duration of stability on ATRA (P < 0.01). CONCLUSION(S) While the trial did not meet its prespecified response endpoint, ATRA alone or in combination may be a low toxicity treatment for disease growth stabilization in R/M ACC.
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Affiliation(s)
- Glenn J Hanna
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA.
| | - Anne ONeill
- Department of Data Science, Dana-Farber Cancer Institute, Boston, USA
| | - Jennifer M Cutler
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Michelle Flynn
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Tushara Vijaykumar
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - John R Clark
- Center for Head and Neck Cancers, Massachusetts General Hospital, Boston, USA
| | - Lori J Wirth
- Center for Head and Neck Cancers, Massachusetts General Hospital, Boston, USA
| | - Jochen H Lorch
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
| | - Jong C Park
- Center for Head and Neck Cancers, Massachusetts General Hospital, Boston, USA
| | - Jeffrey K Mito
- Department of Pathology, Brigham & Women's Hospital, Boston, USA
| | - Jens G Lohr
- Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | | | | | - Leonard I Zon
- Department of Stem Cell and Regenerative Biology, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Robert I Haddad
- Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA
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Adib E, Nassar AH, Akl EW, Abou Alaiwi S, Nuzzo PV, Mouhieddine TH, Sonpavde G, Haddad RI, Mouw KW, Giannakis M, Hodi FS, Shukla SA, Gusev A, Braun DA, Choueiri TK, Kwiatkowski DJ. CDKN2A Alterations and Response to Immunotherapy in Solid Tumors. Clin Cancer Res 2021; 27:4025-4035. [PMID: 34074656 DOI: 10.1158/1078-0432.ccr-21-0575] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/24/2021] [Accepted: 05/07/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Immune checkpoint inhibitors (ICI) have shown clinical benefit in many types of metastatic cancers with only a few predictive biomarkers identified so far. CDKN2A is commonly altered in human cancers, but prior studies have provided conflicting evidence regarding the association between CDKN2A genomic alterations (GA) and response to ICIs. Herein, we examined the impact of loss-of-function CDKN2A alterations on response and survival in patients treated with ICIs. EXPERIMENTAL DESIGN We studied the association between loss-of-function CDKN2A alterations and the response to ICIs in two independent cohorts of six different cancer types. Seven hundred and eighty-nine patients treated at Dana-Farber Cancer Institute (DFCI; Boston, MA) and 1,250 patients treated at Memorial Sloan Kettering Cancer Center (MSKCC; New York, NY) were included in the final analysis. Patients' tumors were sequenced using Oncopanel or MSK-IMPACT. RNA sequencing data from The Cancer Genome Atlas and IMvigor210 were used to investigate differences in the tumor microenvironment. RESULTS In the DFCI cohort, CDKN2A GAs were associated with poor response and survival in patients with urothelial carcinoma treated with ICIs, but not those treated with platinum-based therapy. Similarly, CDKN2A GAs were associated with worse outcomes in the MSKCC urothelial carcinoma cohort treated with ICIs. There was no association of CDKN2A status with ICI treatment outcome in five other cancers: esophagogastric, head and neck, non-small cell lung, renal cell carcinoma, and melanoma. Immuno-inflammatory pathways were significantly reduced in expression in CDKN2A-altered tumors. CONCLUSIONS Our data show that CDKN2A GAs were associated with reduced benefit from ICI therapy in urothelial carcinoma as well as changes in the tumor-immune microenvironment.
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Affiliation(s)
- Elio Adib
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amin H Nassar
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elie W Akl
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Pier Vitale Nuzzo
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Tarek H Mouhieddine
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York
| | - Guru Sonpavde
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Robert I Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kent W Mouw
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - F Stephen Hodi
- Melanoma Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sachet A Shukla
- Translational Immunogenomics Laboratory, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alexander Gusev
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A Braun
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David J Kwiatkowski
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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Nassar A, Adib E, Abou Alaiwi S, Akl E, El Zarif T, Nuzzo PV, Mouhieddine TH, El-Khoury H, Groha S, Sonpavde GP, Haddad RI, Mouw KW, Giannakis M, Ananda G, Freedman ML, Kwiatkowski DJ, MacConaill LE, Choueiri TK, Gusev A. Genetic ancestry and clinical outcomes to immune checkpoint inhibitors among seven common cancers. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10536 Background: Prior studies and clinical trials report associations between self-reported race and clinical outcomes to Immune Checkpoint Inhibitors (ICIs). However, comprehensive studies of ancestry-associated differences in clinical outcomes have not been performed. We derived genetic ancestry scores and assessed clinical outcomes in 1341 patients with cancer treated with ICIs. Methods: Patients at the Dana-Farber Cancer Institute treated with ICIs only and with relevant cancer types and targeted exome sequencing data (Oncopanel) were included. Relevant cancer types included colorectal adenocarcinoma (CRC), esophagogastric adenocarcinoma (EGC), head and neck squamous cell carcinoma (HNSCC), melanoma, non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), and urothelial carcinoma (UC). We developed a bioinformatics pipeline to infer fine-scale genetic ancestry for each patient (n=1341) directly from tumor sequencing data by leveraging off and on-target sequenced reads and external ancestry reference panels. Three ancestry scores were determined (African, East Asian, European). Overall survival (OS) and time-to-treatment failure (TTF) were compared by Cox logistic regression between ancestral populations. Hazard ratio (HR) was derived using multivariable analysis, adjusted for single versus combination therapy, prior lines of therapy, and tumor mutational burden (TMB, as percentiles). Results: Median follow-up was 37.8 months (m; interquartile range: 35.7-39.5m). Common cancer types included CRC (n=52), EGC (n=114), HNSCC (n=88), melanoma (n=274), NSCLC (n=571), RCC (n=99), and UC (n=143). A higher East Asian ancestry (EAS) was significantly associated with worse OS ( p=0.03) and TTF ( p=0.002) in patients with RCC, independent of the histologic subtype (Table). There was no significant association between any of the three ancestral populations and clinical outcomes in the other 6 cancer types. Conclusions: We described clinical outcomes to ICIs across three global populations in 7 cancers. As the medical field re-evaluates the use of self-reported race in clinical decision-making, we utilize a novel ancestry pipeline that can be readily applied to tumor-only sequencing panels and better characterize non-white populations. We find no ancestry differences in clinical outcomes except in patients with RCC treated with ICIs which will require future validation. We plan to analyze genomic correlates of response by ancestry in each of the cancer types to better understand these diverge clinical behaviors.[Table: see text]
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Affiliation(s)
| | - Elio Adib
- The Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Elie Akl
- Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | - Guru P. Sonpavde
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | | | - Matthew L. Freedman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Laura E MacConaill
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - Toni K. Choueiri
- Dana-Farber Cancer Institute, The Lank Center for Genitourinary Oncology, Boston, MA
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Uppaluri R, Chernock R, Mansour M, Jackson R, Rich J, Pipkorn P, Paniello RC, Puram S, Zevallos JP, Annino DJ, Goguen LA, Morris L, Haddad RI, Hanna GJ, Oppelt PJ, Dunn L, Ley JC, Kallogjeri D, Egloff AM, Adkins D. Enhanced pathologic tumor response with two cycles of neoadjuvant pembrolizumab in surgically resectable, locally advanced HPV-negative head and neck squamous cell carcinoma (HNSCC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6008 Background: We reported that one cycle of neoadjuvant pembrolizumab induced pathologic tumor response in >10% (pTR-any) and in >50% (pTR-2) of the resection bed in 44% and 22% of patients (pts) with surgically resectable HPV-negative, Stage III/IV HNSCC ( Clin Cancer Res 2020). We hypothesized that two cycles of neoadjuvant pembrolizumab would induce pTR-2 in 50% of pts. Increasing the pathologic response rate may favorably impact clinical outcomes. Methods: Multi-institutional phase 2 trial where pts with locally advanced, HPV-negative HNSCC received two cycles of pembrolizumab (200 mg), given 42 and 21 days prior to surgery. Resected tumor was analyzed by two independent pathologists for pTR (tumor necrosis and/or giant cell/histiocytic reaction to keratinous debris) in the resection bed (primary tumor and/or lymph nodes). Additional definitions: pTR-1 (>10-49%) and major pathologic response ( > 90%). The primary endpoint was pTR-2. A sample size of 26 pts was needed to detect a significantly higher pTR-2 rate of 50%, with 80% power using a one-sided alpha level of 0.05. Pts were followed for serious adverse events (AEs) for 30 days after surgery and for AEs of clinical interest for 90 days following the last dose of pembrolizumab. Pts underwent baseline blood collection and tumor biopsies to match with blood and surgical specimens obtained post-pembrolizumab. Planned correlatives included PD-L1 expression, immune function, and molecular signatures of activation in the pre- and post-treatment blood and tumor tissue. Results: Characteristics of 29 enrolled and treated pts were median age 62 (30-82) yrs, smoking history 62% (18 pts); clinical stage T2 (n = 6), T3 (n = 5), T4 (n = 18) and N0/1 (n = 17), N2 (n = 12). All treated patients received two cycles of neoadjuvant pembrolizumab, which was tolerated well with only one (3%) grade 3 AE (rash) and no grade 4 AEs. The primary endpoint was evaluable in 25 pts, and not evaluable in 4 pts (one pt withdrew before surgery and in three pts, pTR review was pending). pTR-2 occurred in 44% (11 of 25 pts), and 4 (16%) of these pts had a major pathologic response including 1 (4%) pathologic CR at the primary site. Conclusions: Two (vs one) cycles of neoadjuvant pembrolizumab resulted in a two-fold increase in the frequency of pTR-2 (44% vs 22%). These data imply that the frequency of pTR to neoadjuvant pembrolizumab can be improved by increasing the number of cycles and the treatment interval. Clinical trial information: NCT02296684.
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Affiliation(s)
- Ravindra Uppaluri
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
| | | | - Mena Mansour
- Washington University in St. Louis, St. Louis, MO
| | - Ryan Jackson
- Washington University School of Medicine, St. Louis, MO
| | - Jason Rich
- Washington University Medical Center, St. Louis, MO
| | | | | | | | | | | | | | - Luc Morris
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | - Lara Dunn
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica C. Ley
- Division of Medical Oncology and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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Hanna GJ, O'Neill AM, Jo VY, Wong K, Lizotte PH, Annino DJ, Goguen LA, Kass JI, Rettig EM, Sethi RK, Lorch JH, Schoenfeld JD, Margalit DN, Tishler RB, Everett PC, Desai AM, Paweletz CP, Egloff AM, Uppaluri R, Haddad RI. Neoadjuvant and adjuvant nivolumab and lirilumab in patients with recurrent, resectable squamous cell carcinoma of the head and neck. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6053 Background: Locoregional recurrence (LRR) is a major cause of death for patients (pts) with squamous cell carcinoma of the head and neck (SCCHN). With therapy options limited by prior treatment, surgery often represents the best chance for disease control. Emerging data suggests a role for neoadjuvant immunotherapy in upfront resectable SCCHN and the importance of NK cells in the tumor microenvironment. We hypothesized that dual immune checkpoint inhibition (anti-PD-1, nivolumab [N] and anti-KIR, lirilumab [L]) before and after salvage surgery would improve 1-year disease-free survival (DFS). Methods: Pts with operable LRR of SCCHN (any HPV or smoking status) with a disease-free interval of > 8 weeks after curative intent therapy were eligible for this phase II trial. Pts received a single dose of pre-op N (240 mg) + L (240 mg) 7-21 days before surgery, followed by 6-cycles of adjuvant N+L on days 1, 15 (N alone) of a 28-day cycle (C) for C1-3; and on day 1 for C4-6. Primary endpoint was 1-year DFS; 37 DFS events among N = 54 pts provided 81% power to detect improvement in 1-year DFS from 57% to 67.5% (one-sided 10% Wald’s test). Secondary endpoints: safety, radiologic response (RECIST v1.1) to pre-op N+L, and overall survival (OS). Correlatives included tumor sequencing, PD-L1 status, and immunoprofiling. Results: Between 3/15/18 and 5/29/20, N = 29 enrolled (stopped due to expiration of drug supply). Among 28 treated pts, median age: 66, 18% (5/28) women, 83% smokers; primary site: 10 oral cavity, 8 oropharynx (5/8 HPV+), and 10 larynx/hypopharynx. 96% (27/28) had prior HN radiation; 71% (20/28) prior chemotherapy. There were no delays to surgery. Grade 3+ adverse events: 11% (3/28); no deaths from treatment. At time of surgery, 96% (27/28) had stable disease radiologically with 3 showing regression, 4% (1/28) had disease progression. Pathologic response to N+L was observed in 43% (12/28): 4/28 (14%) major (tumor viability, TV ≤10%); 8/28 (29%) partial (TV ≤50%). PD-L1 CPS at surgery was similar regardless of pathologic response (p = 0.63). 68% (19/28) completed all 6-cycles of adjuvant N+L; N = 1 came off for toxicity. Ten pts (36%) recurred (local = 8, distant = 2). 5/28 (18%) had positive margins, of which 4 (80%) recurred; 4/28 (14%) declined to start adjuvant N+L, of which 3 (75%) later recurred. At median follow-up of 20.2 months, 1-year DFS70% (95%CI, 48-84%) and 1-year OS: 85% (95%CI, 65-94%). Median tumor mutational burden was 4 (range, 1-11). TP53 was the most frequent alteration (78%, 21/27). CD39 expression by TILs and CD38 expression by circulating CD4/8+ T cells increased after N+L exposure (p < 0.05). Conclusions: Neoadjuvant and adjuvant N+L was safe and well tolerated. We observed a 43% pathologic response rate prior to salvage surgery, with a favorable 1-year DFS of 70% and 1-year OS > 80% among previously irradiated pts. Further evaluation of this strategy is warranted (NCT03341936).
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Affiliation(s)
| | | | | | | | - Patrick H. Lizotte
- Belfer Center for Applied Cancer Science and Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | | | | | - Peter C. Everett
- Boston Medical Center, Boston University School of Medicine, Boston, MA
| | | | - Cloud P. Paweletz
- Belfer Center for Applied Cancer Science and Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Haddad RI, Adkins D, Licitra LF, Bruce JY, Gillison ML, Ahn MJ, Hsieh CY, Wang HM, Psyrri A, Machiels JPH, Balsara B, Leoni M, Harrington KJ, Saba NF, Ho AL. The AIM-HN Study: A pivotal study evaluating the efficacy of tipifarnib in patients with recurrent or metastatic head and neck squamous cell carcinoma with HRAS mutations. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps6087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS6087 Background: Head and neck squamous cell carcinoma (HNSCC) accounts for more than 830,000 new cancer cases each year worldwide. The prognosis for recurrent and/or metastatic (R/M) HNSCC patients remains poor with an estimated median overall survival (mOS) of 7-15 months in the first line setting and 5-8 months in the second line setting and beyond. Approximately 4-8% of HNSCC tumors are driven by gain-of-function mutations in the HRAS (m HRAS) proto-oncogene. Tipifarnib is a potent and selective farnesyltransferase inhibitor that disrupts HRAS function by blocking required protein membrane localization, and subsequent cellular growth and survival. Data from a prior phase 2 study (RUN-HN; NCT02383927) of tipifarnib in R/M m HRAS HNSCC patients in the second line plus setting demonstrated encouraging efficacy, with an objective response rate (ORR) of 55% and mOS of 15.4 months for patients with mHRAS variant allele frequency (VAF) ≥ 20%, providing support for pursuing a pivotal trial in this patient population. Methods: AIM-HN (NCT03719690) is a global, open-label single-arm pivotal study evaluating the efficacy and tolerability of tipifarnib in second line plus R/M m HRAS HNSCC patients. The primary objective is to determine the ORR in patients with a m HRAS VAF ≥ 20% (High VAF population), as assessed using RECIST v1.1 by Independent Review Facility. Key secondary objectives include the ORR for patients of all VAF levels, and the duration of responses for both VAF≥ 20% and all VAF levels. Key inclusion criteria include: histologically confirmed head and neck cancer of squamous histology not amenable to local therapy with curative intent; known tumor missense HRAS mutation (with VAF determined and available) detected by Next Generation Sequencing; ECOG performance status of 0-1; measurable disease by RECIST v1.1; and adequate organ function. Key exclusion criteria include: salivary gland, thyroid, (primary) cutaneous squamous or non-squamous histologies; intolerable Grade 2 or ≥ Grade 3 neuropathy or unstable neurological symptoms within 4 weeks of Cycle 1 Day 1; or active, uncontrolled infections requiring systemic therapy. Tipifarnib is administered at a dose of 600 mg, orally with a meal twice a day for 7 days in alternating weeks (Days 1-7 and 15-21) of 28-day cycles until discontinuation criteria are met. All patients are being followed for safety through the End of Treatment visit, roughly 30 days after treatment discontinuation or immediately before the administration of another anticancer treatment, whichever occurs first. Upon therapy discontinuation, all patients are being followed approximately every 12 weeks for survival status, and the use of subsequent therapy. The IDMB last reviewed data in October 2020 and recommended the trial continue as planned. AIM-HN is continuing to enroll patients globally. Ho et al, JCO, accepted. Clinical trial information: NCT03719690.
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Affiliation(s)
- Robert I. Haddad
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - Lisa F. Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | | | | | | | | | | | - Amanda Psyrri
- National Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | | | | | - Kevin Joseph Harrington
- The Royal Marsden//The Institute of Cancer Research NIHR Biomedical Research Centre, London, United Kingdom
| | - Nabil F. Saba
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Alan Loh Ho
- Memorial Sloan Kettering Cancer Center, New York, NY
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Lee NY, Ferris RL, Psyrri A, Haddad RI, Tahara M, Bourhis J, Harrington K, Chang PMH, Lin JC, Razaq MA, Teixeira MM, Lövey J, Chamois J, Rueda A, Hu C, Dunn LA, Dvorkin MV, De Beukelaer S, Pavlov D, Thurm H, Cohen E. Avelumab plus standard-of-care chemoradiotherapy versus chemoradiotherapy alone in patients with locally advanced squamous cell carcinoma of the head and neck: a randomised, double-blind, placebo-controlled, multicentre, phase 3 trial. Lancet Oncol 2021; 22:450-462. [PMID: 33794205 DOI: 10.1016/s1470-2045(20)30737-3] [Citation(s) in RCA: 253] [Impact Index Per Article: 84.3] [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: 08/11/2020] [Revised: 11/02/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Chemoradiotherapy is the standard of care for unresected locally advanced squamous cell carcinoma of the head and neck. We aimed to assess if addition of avelumab (anti-PD-L1) to chemoradiotherapy could improve treatment outcomes for this patient population. METHODS In this randomised, double-blind, placebo-controlled, phase 3 study, patients were recruited from 196 hospitals and cancer treatment centres in 22 countries. Patients aged 18 years or older, with histologically confirmed, previously untreated, locally advanced squamous cell carcinoma of the oropharynx, hypopharynx, larynx, or oral cavity (unselected for PD-L1 status), an Eastern Cooperative Oncology Group performance status score of 0 or 1, and who could receive chemoradiotherapy were eligible. Patients were randomly assigned (1:1) centrally by means of stratified block randomisation with block size four (stratified by human papillomavirus status, tumour stage, and nodal stage, and done by an interactive response technology system) to receive 10 mg/kg avelumab intravenously every 2 weeks plus chemoradiotherapy (100 mg/m2 cisplatin every 3 weeks plus intensity-modulated radiotherapy with standard fractionation of 70 Gy [35 fractions during 7 weeks]; avelumab group) or placebo plus chemoradiotherapy (placebo group). This was preceded by a single 10 mg/kg avelumab or placebo lead-in dose given 7 days previously and followed by 10 mg/kg avelumab or placebo every 2 weeks maintenance therapy for up to 12 months. The primary endpoint was progression-free survival by investigator assessment per modified Response Evaluation Criteria in Solid Tumors, version 1.1, in all randomly assigned patients. Adverse events were assessed in patients who received at least one dose of avelumab or placebo. This trial is registered with ClinicalTrials.gov, NCT02952586. Enrolment is no longer ongoing, and the trial has been discontinued. FINDINGS Between Dec 12, 2016, and Jan 29, 2019, from 907 patients screened, 697 patients were randomly assigned to the avelumab group (n=350) or the placebo group (n=347). Median follow-up for progression-free survival was 14·6 months (IQR 8·5-19·6) in the avelumab group and 14·8 months (11·6-18·8) in the placebo group. Median progression-free survival was not reached (95% CI 16·9 months-not estimable) in the avelumab group and not reached (23·0 months-not estimable) in the placebo group (stratified hazard ratio 1·21 [95% CI 0·93-1·57] favouring the placebo group; one-sided p=0·92). The most common grade 3 or worse treatment-related adverse events were neutropenia (57 [16%] of 348 patients in the avelumab group vs 52 [15%] of 344 patients in the placebo group), mucosal inflammation (50 [14%] vs 45 [13%]), dysphagia (49 [14%] vs 47 [14%]), and anaemia (41 [12%] vs 44 [13%]). Serious treatment-related adverse events occurred in 124 (36%) patients in the avelumab group and in 109 (32%) patients in the placebo group. Treatment-related deaths occurred in two (1%) patients in the avelumab group (due to general disorders and site conditions, and vascular rupture) and one (<1%) in the placebo group (due to acute respiratory failure). INTERPRETATION The primary objective of prolonging progression-free survival with avelumab plus chemoradiotherapy followed by avelumab maintenance in patients with locally advanced squamous cell carcinoma of the head and neck was not met. These findings may help inform the design of future trials investigating the combination of immune checkpoint inhibitors plus CRT. FUNDING Pfizer and Merck KGaA, Darmstadt, Germany.
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Affiliation(s)
- Nancy Y Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | | | - Amanda Psyrri
- Attikon University Hospital, National Kapodistrian University of Athens, Athens, Greece
| | | | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Jean Bourhis
- Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Kevin Harrington
- The Royal Marsden Hospital-The Institute of Cancer Research National Institute for Health Research Biomedical Research Centre, London, UK
| | - Peter Mu-Hsin Chang
- Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
| | - Jin-Ching Lin
- Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | | | | | - József Lövey
- Országos Onkológiai Intézet, Sugárterápiás Osztály Semmelweis Egyetem, Onkológiai Tanszék, Budapest, Hungary
| | - Jerome Chamois
- Centre Hospitalier Prive Saint Gregoire, Saint Gregoire, France
| | - Antonio Rueda
- Medical Oncology, Costa del Sol Sanitary Agency and Regional University Hospital, IBIMA, Málaga, Spain
| | - Chaosu Hu
- Fudan University Cancer Hospital, Xuhui, Shanghai, China
| | - Lara A Dunn
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Ezra Cohen
- Moores Cancer Center, UC San Diego Health, La Jolla, CA, USA
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Bhalla S, Bakouny Z, Schmidt AL, Steinharter JA, Tremblay DA, Awad MM, Kessler AJ, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang HH, Labaki C, Anderson-Keightly HM, Alaiwi SA, Rosenbloom TD, Stewart PS, Galsky MD, Choueiri TK, Doroshow DB. Abstract S06-02: Disruption to care of patients with thoracic malignancies: A COVID-19 and cancer outcomes study. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Patients with thoracic malignancies are susceptible to severe outcomes from coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the disruption to care of patients with thoracic malignancies during the COVID-19 pandemic. Methods: The COVID-19 and Cancer Outcomes Study (CCOS) is a multicenter prospective cohort study comprised of adult patients with a current or past history of hematological malignancy or invasive solid tumor who had an outpatient medical oncology visit on the index week between March 2 and March 6, 2020 at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, NY (MSSM) or the Dana-Farber Cancer Institute in Boston, MA (DFCI). An electronic data capture platform was used to collect patient-, cancer-, and treatment-related variables during the three months prior to the index week (the baseline period) and the following three months (the pandemic period). Two-by-three contingency tables with Fisher’s exact tests were computed. All tests were two-tailed and considered statistically significant for p<0.05. All analyses were done in the R statistical environment (v3.6.1). Results: The overall cohort included 2365 patients, of which 313 had thoracic malignancies, 1578 had other solid tumors, and 474 had hematological malignancies. At a median follow-up of 84 days (95% confidence interval, 82-84), 13 patients with thoracic malignancies (4.1%) had developed COVID-19 (vs. other solid: 63 [4.0%] and hematological: 52 [11.0%]; p<0.001). When comparing data from the pandemic period to the baseline period, patients with thoracic malignancies had a decrease in the number of in-person outpatient visits (thoracic: 209 [66.8%] vs. other solid: 749 [47.5%] vs. hematological: 260 [54.9%]; p<0.001) and an increase in the number of telehealth visits (thoracic: 126 [40.3%] vs. other solid: 465 [29.5%] vs. hematological: 168 [35.4%]; p<0.001). During the pandemic period, 33 (10.5%) patients with thoracic malignancies experienced treatment delays due to the pandemic (vs. other solid: 127 [8.0%] and hematological: 79 [16.7%]; p<0.001), and 26 (8.3%) patients with thoracic malignancies experienced delays in cancer imaging or diagnostic procedures (vs. other solid: 63 [4.0%] and hematological: 26 [5.5%]; p=0.003). Discussion: In this prospective cohort study, patients with thoracic malignancies were not at increased risk of developing COVID-19 compared to patients with other cancers, but experienced significant cancer care disruption during the COVID-19 pandemic with a higher likelihood of decreased in-person visits and increased telehealth visits compared to patients with other malignancies. Focused efforts to ensure continuity of care for this vulnerable patient population are warranted.
Citation Format: Sheena Bhalla, Ziad Bakouny, Andrew L. Schmidt, John A. Steinharter, Douglas A. Tremblay, Mark M. Awad, Alaina J. Kessler, Robert I. Haddad, Michelle Evans, Fiona Busser, Michael Wotman, Catherine R. Curran, Brittney S. Zimmerman, Gabrielle Bouchard, Tomi Jun, Pier V. Nuzzo, Qian Qin, Laure Hirsch, Jonathan Feld, Kaitlin M Kelleher, Danielle Seidman, Hsin-Hui Huang, Chris Labaki, Heather M. Anderson-Keightly, Sarah Abou Alaiwi, Talia D. Rosenbloom, Penina S. Stewart, Matthew D. Galsky, Toni K. Choueiri, Deborah B. Doroshow. Disruption to care of patients with thoracic malignancies: A COVID-19 and cancer outcomes study [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S06-02.
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Affiliation(s)
- Sheena Bhalla
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tomi Jun
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
| | | | - Qian Qin
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
| | | | - Jonathan Feld
- 1Icahn School of Medicine at Mount Sinai, New York, NY,
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Nassar A, Adib E, Akl EW, Abou Alaiwi S, Nuzzo PV, Mouhieddine TH, Sonpavde G, Haddad RI, Giannakis M, Hodi FS, Choueiri TK, Kwiatkowski DJ. CDKN2A alterations as markers of immune checkpoint blockade (ICB) resistance in urothelial carcinoma (UC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.475] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
475 Background: ICB has shown clinical benefit across several metastatic carcinomas; however, predictive biomarkers are still lacking. CDKN2A is one of the most commonly altered genes across human cancers. With prior studies giving conflicting evidence regarding the association between CDKN2A alterations and ICBs, we examined the impact of CDKN2A alterations on clinical outcomes in UC patients treated with ICBs. Methods: Of 809 patients at the Dana Farber Cancer institute (DFCI) treated with ICBs only and with relevant cancer types and targeted exome sequencing data (Oncopanel), 235 (29%) had loss-of-function (LOF) mutations or homozygous deletions in CDKN2A. Overall survival (OS) was compared by Cox logistic regression between CDKN2A altered and CDKN2A wild type (WT) patients. Hazard ratio (HR) was derived using multivariable analysis (MVA), adjusted for prior lines of therapy and tumor mutational burden (TMB). A validation cohort from Memorial Sloan Kettering Cancer Center (MSKCC) (Samstein et al., Nature Genetics, 2019) of 811 cancer patients treated with ICBs was analyzed in a similar manner, adjusted for TMB. As a control, the association between CDKN2A alterations and OS was examined in a cohort of platinum-treated UC patients (N = 56) to determine whether CDKN2A alterations were predictive of response to ICIs. Results: For the DFCI and MSKCC cohorts, median follow-up was 26.9 and 24 months (m), respectively. In the DFCI and MSKCC cohorts, CDKN2A alterations were found in 32/90 (35%) and 22/104 (21.2%) of UC, respectively; 4/55 (7.3%) and 3/131 (2.3%) of renal cell carcinoma, respectively; 73/178 (41%) and 45/194 (23.2%) of melanoma tumors, respectively; 86/370 (23.2%) and 26/260 (10%) of non-small cell lung cancer (NSCLC) tumors, respectively; 18/66 (27.2%) and 4/53 (7.5%) of esophagogastric tumors, respectively; and 22/50 (44%) and 11/69 (15.9%) of head and neck, respectively. CDKN2A alterations were significantly associated with shorter OS and TTF in the DFCI UC and melanoma cohorts by MVA, and showed a trend towards significance in the MSKCC UC cohort (Table). There was no significant association between CDKN2A alterations and OS for the other cancer types in both cohorts; and no association with OS or TTF was seen in the DFCI cisplatin-treated UC cohort. Conclusions: CDKN2A alteration status may serve as a predictive biomarker in patients with UC treated with ICBs. Further studies are needed to examine the mechanism of this clinical effect. [Table: see text]
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Affiliation(s)
| | - Elio Adib
- Dana Farber Cancer Institute, Boston, MA
| | | | - Sarah Abou Alaiwi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Guru Sonpavde
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Robert I. Haddad
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
| | | | | | - Toni K. Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Schoenfeld JD, Hanna GJ, Jo VY, Rawal B, Chen YH, Catalano PS, Lako A, Ciantra Z, Weirather JL, Criscitiello S, Luoma A, Chau N, Lorch J, Kass JI, Annino D, Goguen L, Desai A, Ross B, Shah HJ, Jacene HA, Margalit DN, Tishler RB, Wucherpfennig KW, Rodig SJ, Uppaluri R, Haddad RI. Neoadjuvant Nivolumab or Nivolumab Plus Ipilimumab in Untreated Oral Cavity Squamous Cell Carcinoma: A Phase 2 Open-Label Randomized Clinical Trial. JAMA Oncol 2021; 6:1563-1570. [PMID: 32852531 DOI: 10.1001/jamaoncol.2020.2955] [Citation(s) in RCA: 175] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Novel approaches are needed to improve outcomes in patients with squamous cell carcinoma of the oral cavity. Neoadjuvant immunotherapy given prior to surgery and combining programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) immune checkpoint inhibitors are 2 strategies to enhance antitumor immune responses that could be of benefit. Design, Setting, and Participants In this randomized phase 2 clinical trial conducted at 1 academic center, 29 patients with untreated squamous cell carcinoma of the oral cavity (≥T2, or clinically node positive) were enrolled between 2016 to 2019. Interventions Treatment was administered with nivolumab, 3 mg/kg, weeks 1 and 3, or nivolumab and ipilimumab (ipilimumab, 1 mg/kg, given week 1 only). Patients had surgery 3 to 7 days following cycle 2. Main Outcomes and Measures Safety and volumetric response determined using bidirectional measurements. Secondary end points included pathologic and objective response, progression-free survival (PFS), and overall survival. Multiplex immunofluorescence was used to evaluate primary tumor immune markers. Results Fourteen patients were randomized to nivolumab (N) and 15 patients to nivolumab/ipilimumab (N+I) (mean [SD] age, 62 [12] years; 18 men [62%] and 11 women [38%]). The most common subsite was oral tongue (n = 16). Baseline clinical staging included patients with T2 (n = 20) or greater (n = 9) T stage and 17 patients (59%) with node-positive disease. Median time from cycle 1 to surgery was 19 days (range, 7-21 days); there were no surgical delays. There were toxic effects at least possibly related to study treatment in 21 patients, including grade 3 to 4 events in 2 (N), and 5 (N+I) patients. One patient died of conditions thought unrelated to study treatment (postoperative flap failure, stroke). There was evidence of response in both the N and N+I arms (volumetric response 50%, 53%; pathologic downstaging 53%, 69%; RECIST response 13%, 38%; and pathologic response 54%, 73%, respectively). Four patients had major/complete pathologic response greater than 90% (N, n = 1; N+I, n = 3). With 14.2 months median follow-up, 1-year progression-free survival was 85% and overall survival was 89%. Conclusions and Relevance Treatment with N and N+I was feasible prior to surgical resection. We observed promising rates of response in both arms, supporting further neoadjuvant studies with these agents. Trial Registration ClinicalTrials.gov Identifier: NCT02919683.
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Affiliation(s)
- Jonathan D Schoenfeld
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Glenn J Hanna
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Vickie Y Jo
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Bhupendra Rawal
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,PRA Health Sciences, Boston, Massachusetts
| | - Yu-Hui Chen
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Paul S Catalano
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Ana Lako
- Brigham and Women's Hospital, Boston, Massachusetts.,Bristol-Myers Squibb, Boston, Massachusetts
| | - Zoe Ciantra
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jason L Weirather
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Shana Criscitiello
- Brigham and Women's Hospital, Boston, Massachusetts.,Beth-Israel Deaconess Medical Center, Boston, Massachusetts
| | - Adrienne Luoma
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Nicole Chau
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,British Columbia Cancer, Vancouver, Canada
| | - Jochen Lorch
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Jason I Kass
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Donald Annino
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Laura Goguen
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Anupam Desai
- Beth-Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brendan Ross
- Brigham and Women's Hospital, Boston, Massachusetts.,McGill Medical School, Montreal, Canada
| | - Hina J Shah
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Heather A Jacene
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Danielle N Margalit
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Roy B Tishler
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Kai W Wucherpfennig
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Scott J Rodig
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Ravindra Uppaluri
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Robert I Haddad
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Jonathan D Schoenfeld
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Ravindra Uppaluri
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Robert I Haddad
- Brigham and Women's Hospital, Boston, Massachusetts.,Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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Schmidt AL, Bakouny Z, Bhalla S, Steinharter JA, Tremblay DA, Awad MM, Kessler AJ, Haddad RI, Evans M, Busser F, Wotman M, Curran CR, Zimmerman BS, Bouchard G, Jun T, Nuzzo PV, Qin Q, Hirsch L, Feld J, Kelleher KM, Seidman D, Huang HH, Anderson-Keightly HM, Abou Alaiwi S, Rosenbloom TD, Stewart PS, Galsky MD, Choueiri TK, Doroshow DB. Cancer Care Disparities during the COVID-19 Pandemic: COVID-19 and Cancer Outcomes Study. Cancer Cell 2020; 38:769-770. [PMID: 33176161 PMCID: PMC7609043 DOI: 10.1016/j.ccell.2020.10.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Andrew L Schmidt
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Ziad Bakouny
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Sheena Bhalla
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - John A Steinharter
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Douglas A Tremblay
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Mark M Awad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Alaina J Kessler
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Robert I Haddad
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Michelle Evans
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Fiona Busser
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Michael Wotman
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA
| | - Catherine R Curran
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Brittney S Zimmerman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Gabrielle Bouchard
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Tomi Jun
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Pier V Nuzzo
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Qian Qin
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Laure Hirsch
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Jonathan Feld
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Kaitlin M Kelleher
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Danielle Seidman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Hsin-Hui Huang
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | | | - Sarah Abou Alaiwi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Talia D Rosenbloom
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Penina S Stewart
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA
| | - Toni K Choueiri
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Deborah B Doroshow
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA.
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Schoenfeld JD, Fell G, Haddad RI, Trippa L. Reply to "Keynote 48: Is it really for everyone?". Oral Oncol 2020; 115:105108. [PMID: 33277202 DOI: 10.1016/j.oraloncology.2020.105108] [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: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan D Schoenfeld
- Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States.
| | - Geoffrey Fell
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States
| | - Robert I Haddad
- Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States
| | - Lorenzo Trippa
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States
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Hanna GJ, Rettig EM, Park JC, Varvares MA, Lorch JH, Margalit DN, Schoenfeld JD, Tishler RB, Goguen LA, Annino DJ, Haddad RI, Uppaluri R. Hospitalization rates and 30-day all-cause mortality among head and neck cancer patients and survivors with COVID-19. Oral Oncol 2020; 112:105087. [PMID: 33190021 PMCID: PMC7833708 DOI: 10.1016/j.oraloncology.2020.105087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
We note high 30-day all-cause mortality for HNC patients admitted with COVID-19. ICU admission and residing in a LTC facility predicted poor outcomes. Most deaths were in HNC survivors and not in those on active cancer therapy.
Background The impact of COVID-19 on patients with cancer is emerging, but data are urgently needed for head and neck cancer (HNC) patients or survivors who are inherently high-risk for severe illness and mortality with SARS-CoV-2 infection. Methods This multi-institution, academic cohort study collected comprehensive data on clinical risk factors, COVID-19 symptoms and viral testing patterns, information about hospitalization rates, and predictors of survival among HNC patients with active disease or in remission. The primary endpoint was 30-day all-cause mortality from the date of confirmed COVID-19. We performed multivariate analysis to understand the prognostic value of clinical and laboratory parameters on outcomes. Results Thirty-two patients with COVID-19 and HNC were included. Median age was 70 (range: 38–91) with 38% aged 75+, and 34% resided in long-term care facilities (LTCF). Thirteen (41%) had active cancer, with 6 (19%) on cancer therapy within 4 weeks of COVID-19 diagnosis. New or worsening cough and fatigue were the most commonly reported presenting symptoms. More than 30% required >1 SARS-CoV-2 test before confirming a positive result. Twenty (63%) required hospitalization. At data cutoff, 7 (22%) had died (1 on active cancer treatment), with a 30-day all-cause mortality of 18.9% (95%CI: 11.4–33.6) among all patients, and 71.5% (95%CI: 38.2–92.3) among those requiring intensive care unit (ICU) admission. ICU admission and residing in a LTCF predicted worse outcomes (p < 0.01), while age, gender, and recent treatment did not. Conclusions We observed high 30-day all-cause mortality among HNC patients with COVID-19, but most were not on active cancer therapy.
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Affiliation(s)
- Glenn J Hanna
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA.
| | - Eleni M Rettig
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
| | - Jong C Park
- Massachusetts General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Mark A Varvares
- Massachusetts General Cancer Center, Massachusetts General Hospital, Boston, MA; Massachusetts Eye & Ear Infirmary, Boston, MA
| | - Jochen H Lorch
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA
| | - Danielle N Margalit
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Radiation Oncology, Brigham & Women's Hospital, Boston, MA
| | - Jonathan D Schoenfeld
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Radiation Oncology, Brigham & Women's Hospital, Boston, MA
| | - Roy B Tishler
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Radiation Oncology, Brigham & Women's Hospital, Boston, MA
| | - Laura A Goguen
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
| | - Donald J Annino
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
| | - Robert I Haddad
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA
| | - Ravindra Uppaluri
- Dana-Farber Cancer Institute, Center for Head & Neck Oncology, Boston, MA; Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, Brigham & Women's Hospital, Boston, MA
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Arbab M, Chen YH, Criscitiello S, Glass J, Fugazzotto JA, Killoran JH, Hanna G, Lorch J, Haddad RI, Margalit DN, Tishler RB, Schoenfeld JD. Patient reported outcomes in patients with head and neck cancer treated with concurrent chemoradiation with weekly versus bolus cisplatin. Head Neck 2020; 42:3670-3677. [PMID: 32815253 DOI: 10.1002/hed.26432] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/30/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patient Reported Outcome (PRO) data comparing bolus (B-CP) with weekly (W-CP) cisplatin concurrent with radiation are lacking. METHODS We performed a retrospective study comparing PRO among 99 patients with head and neck radiation, 26% who received concurrent B-CP and 73% treated with W-CP. RESULTS W-CP patients had a higher Charlson comorbidity index (CCI) (P = .004). There were no differences in median cisplatin dose, PROs, percutaneous endoscopic gastrostomy (PEG) dependence or hospitalization between arms. Patients with a greater decline in their self-reported dysphagia score were more often PEG dependent at the end of radiation therapy (P = .03). There was also a trend toward PEG dependence with a higher maximum dysphagia score and greater change in aspiration score (P = .06). The maximum decline in white cell count and absolute neutrophil count were greater in the W-CP group (P = .04, P = .01). CONCLUSION Both B-CP and W-CP are well tolerated. PROs do not suggest a benefit to W-CP.
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Affiliation(s)
- Mona Arbab
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiation Oncology, Indiana University, Indianapolis, Indiana, USA
| | - Yu-Hui Chen
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shana Criscitiello
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Glass
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - Glenn Hanna
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jochen Lorch
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Robert I Haddad
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Danielle N Margalit
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Roy B Tishler
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Lee NY, Uppaluri R, Westra W, Cohen EE, Haddad RI, Temam S, Le Tourneau C, Chernock R, Safina S, Klochikhin A, Meirovitz A, Brana I, Ge JY, Swaby RF, Pinheiro C, Adkins D. Abstract CT285: KEYNOTE-689: A phase 3 study of neoadjuvant and adjuvant pembrolizumab plus standard of care (SOC) in locally advanced (LA) head and neck squamous cell carcinoma (HNSCC). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct285] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Background: In phase 2 studies (NCT02296684 and NCT02641093), neoadjuvant and adjuvant pembrolizumab demonstrated a pathological response (PR) and acceptable safety in patients with high-risk, resectable, LA HNSCC. KEYNOTE-689 (NCT03765918) is a randomized, open-label, phase 3 trial that will evaluate efficacy and safety of neoadjuvant pembrolizumab and adjuvant pembrolizumab in combination with SOC in patients with previously untreated LA HNSCC. Methods: Key eligibility criteria include histologically confirmed, newly diagnosed, resectable, nonmetastatic SCC (stage III oropharyngeal p16-positive disease [T4 (N0-N2), M0]; stage III/IVA oropharyngeal p16 negative; or stage III/IVA larynx or hypopharynx or oral cavity, independent of p16 status), evaluable tumor burden (measurable and/or nonmeasurable tumor lesions), newly obtained core or excisional biopsy, and ECOG performance status 0 or 1. Patients will be randomly assigned 1:1 to arms A and B. Randomization will be stratified by primary tumor site (oropharynx/oral cavity vs larynx vs hypopharynx), tumor stage (III vs IVA), and PD-L1 status defined by tumor proportion score 50% (TPS ≥50% vs TPS <50%). In arm A, patients will receive 200 mg Q3W neoadjuvant pembrolizumab for 2 cycles, followed by surgical resection, then 200 mg Q3W adjuvant pembrolizumab for 15 cycles in combination with SOC. In arm B, patients will undergo surgical resection followed by adjuvant SOC without pembrolizumab. SOC is radiotherapy alone (patients at low risk) or radiotherapy plus concurrent 100 mg/m2 Q3W cisplatin for 3 cycles (patients at high risk). Radiotherapy is standard fractionation at 2 Gy/fraction for 30, 33, or 35 fractions (60 Gy, 66 Gy, or 70 Gy) for patients at low risk or high risk or with gross residual disease, respectively. Treatment will continue until disease progression that is radiographically documented and verified by blinded independent central review, unacceptable toxicity, or investigator or patient decision to withdraw. Co-primary end points are major PR (≤10% invasive SCC within resected primary tumor and sampled regional lymph nodes per blinded central pathology) and event-free survival per RECIST 1.1 to include a maximum of 10 target lesions and a maximum of 5 target lesions per organ. Secondary end points include overall survival, pathological complete response, health-related quality of life, and safety. All end points except safety will be evaluated in patients whose tumors express PD-L1 combined positive score ≥1 and in all patients regardless of tumor PD-L1 status. The first radiologic imaging in arm A will occur after 2 cycles of pembrolizumab and before surgery. Postoperative imaging will occur in both arms 12 weeks after SOC, then every 3 months until year 3 and every 6 months thereafter. Recruitment is ongoing; planned enrollment is ~704 patients.
Citation Format: Nancy Y. Lee, Ravindra Uppaluri, William Westra, Ezra E. Cohen, Robert I. Haddad, Stephane Temam, Christophe Le Tourneau, Rebecca Chernock, Sufia Safina, Arkadiy Klochikhin, Amichay Meirovitz, Irene Brana, Joy Yang Ge, Ramona F. Swaby, Cecilia Pinheiro, Douglas Adkins. KEYNOTE-689: A phase 3 study of neoadjuvant and adjuvant pembrolizumab plus standard of care (SOC) in locally advanced (LA) head and neck squamous cell carcinoma (HNSCC) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT285.
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Affiliation(s)
| | - Ravindra Uppaluri
- 2Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | | | | | - Sufia Safina
- 8Republican Dispensary of Tatarstan MoH, Kazan, Russian Federation
| | - Arkadiy Klochikhin
- 9Yaroslavl Regional Clinical Oncology, Ulitsa Chkalov, Yaroslavl, Russian Federation
| | | | | | | | | | | | - Douglas Adkins
- 7Washington University School of Medicine, St. Louis, MO
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Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, Bruce JY, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Galloway T, Gillison ML, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco JW, Rodriguez CP, Shah JP, Weber RS, Weinstein G, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:873-898. [DOI: 10.6004/jnccn.2020.0031] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.
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Affiliation(s)
| | | | - David Adelstein
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Douglas Adkins
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Yoshimi Anzai
- 5Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - David W. Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Moon Fenton
- 13The University of Tennessee Health Science Center
| | | | | | | | | | | | | | | | - Debra Leizman
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bharat B. Mittal
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - James W. Rocco
- 23The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Sue S. Yom
- 27UCSF Helen Diller Family Comprehensive Cancer Center
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Haddad RI. Optimizing Treatment for Head and Neck Cancers: Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma. J Natl Compr Canc Netw 2020. [DOI: 10.6004/jnccn.2020.5009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immunotherapy has changed the game in the treatment of head and neck cancer (HNC). Practice-changing results from the phase III KEYNOTE-048 trial led to the approval of pembrolizumab immunotherapy alone or in combination with chemotherapy for the treatment of recurrent/metastatic HNC in the first-line setting. Testing for combined positive score (CPS) is now part of routine practice, because patients with CPS ≥1 can be started on single-agent immunotherapy in the first-line. Pembrolizumab replaces the “old” standard of care established by the EXTREME study, as trials looking at targets besides immunotherapy have proved “disappointing.” Additionally, nivolumab and pembrolizumab are both approved for use in the second-line.
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Hanna GJ, Bae JE, Lorch JH, Haddad RI, Jo VY, Schoenfeld JD, Margalit DN, Tishler RB, Goguen LA, Annino DJ, Chau NG. The Benefits of Adjuvant Trastuzumab for HER-2-Positive Salivary Gland Cancers. Oncologist 2020; 25:598-608. [PMID: 32310325 PMCID: PMC7356716 DOI: 10.1634/theoncologist.2019-0841] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 11/05/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although high-grade salivary gland cancers (SGCs) often express androgen receptor (AR) and/or HER-2/neu, therapeutically targeting these receptors in SGC remains investigational. We investigated the prevalence of receptor expression and the benefit of adjuvant HER-2 directed therapy in the high-risk postoperative setting and explored the clinical utility of sequentially targeting these receptors in the setting of advanced disease. MATERIALS AND METHODS We clinically annotated 95 patients with SGC (excluding adenoid cystic carcinoma) treated at our institution from 2002 to 2019 and recorded AR, HER-2/neu status, and tumor genomic profiling results when available. Clinicopathologic information was then integrated with outcomes. RESULTS Of 95 patients, most had high-risk histologies, with salivary duct carcinoma (SDC) as the most frequent diagnosis (43, 45%). Thirty-five (37%) experienced recurrence (51% SDC). HER-2/neu was positive (1-3+) by immunostaining in 34 of 52 (65%) evaluable cases. There was no difference in survival based on HER-2/neu or AR expression. Nine of 17 (53%) patients with HER-2+ SDC received adjuvant chemoradiation with trastuzumab. Median disease-free survival (DFS) and overall survival (OS) were longer among patients with HER-2/neu 3+ staining tumors who received adjuvant trastuzumab versus those who did not (DFS, 117 vs. 9 months; p = .02; OS, 74 vs. 43 months; p = .02), with no difference among other HER-2/neu subgroups (0-2+). Two of nine (22%) patients treated with adjuvant trastuzumab demonstrated recurrence, both with low HER-2/neu staining intensity (1+). Longer time to recurrence (hazard ratio, 0.94; p = .01) predicted improved outcomes. Both androgen deprivation and HER-2-directed therapies had clinical benefit beyond the first-line metastatic setting, with partial response observed beyond second-line use. CONCLUSION Although prospective data are lacking, the use of adjuvant trastuzumab in high-risk patients with SGC appears beneficial, particularly among patients with tumors exhibiting HER-2/neu 3+ immunostaining. IMPLICATIONS FOR PRACTICE Results of this study showed an improved disease-free and overall survival in patients treated with adjuvant trastuzumab for high-risk salivary gland cancers with strong HER-2/neu staining intensity. Following recurrence or metastatic spread, sequential HER-2, and androgen-directed therapies may benefit certain patients with salivary gland cancer.
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Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Ji Eun Bae
- Department of Medical Oncology, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Jochen H. Lorch
- Department of Medical Oncology, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Robert I. Haddad
- Department of Medical Oncology, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Vickie Y. Jo
- Department of Pathology, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana‐Farber Cancer Institute, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Danielle N. Margalit
- Department of Radiation Oncology, Dana‐Farber Cancer Institute, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Roy B. Tishler
- Department of Radiation Oncology, Dana‐Farber Cancer Institute, Brigham and Women's HospitalBostonMassachusettsUSA
| | - Laura A. Goguen
- Head and Neck Surgical Oncology, Dana‐Farber Cancer Institute, Division of Otolaryngology‐Head and Neck Surgery, Brigham & Women's HospitalBostonMassachusettsUSA
| | - Donald J. Annino
- Head and Neck Surgical Oncology, Dana‐Farber Cancer Institute, Division of Otolaryngology‐Head and Neck Surgery, Brigham & Women's HospitalBostonMassachusettsUSA
| | - Nicole G. Chau
- Department of Medical Oncology, Dana‐Farber Cancer InstituteBostonMassachusettsUSA
- BC Cancer, Vancouver CentreVancouverBritish ColumbiaCanada
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Lorch JH, Barletta JA, Nehs M, Uppaluri R, Alexander EK, Haddad RI, Hanna GJ, Margalit DN, Tishler RB, Schoenfeld JD, Goguen LA, Jabiev A, Sorensen MJ, Ahmadi S, Marqusee E, Kim MI, Stanizzi D, Harris E, Kacew A, Barbie DA. A phase II study of nivolumab (N) plus ipilimumab (I) in radioidine refractory differentiated thyroid cancer (RAIR DTC) with exploratory cohorts in anaplastic (ATC) and medullary thyroid cancer (MTC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6513] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6513 Background: Treatment options for aggressive TC are limited. Pre-clinical data suggests efficacy of CTLA-4 plus PD-1 blockade in aggressive RAIR TC. Methods: This investigator initiated phase II study tested N (3mg/kg every 2 weeks) plus I (1mg/kg every 6 weeks) until disease progression or completion of 24 mo of treatment in RAIR differentiated TC including poorly differentiated TC (PDTC) with exploratory cohorts in anaplastic (ATC) and medullary TC (MTC). Radiographic response rate by RECIST v1.1 (CR+PR) was primary endpoint. At least 6 pts with disease response among n=32 DTC provided 84% power to distinguish between a 10% and a 25% RR (one-sided 9% binomial test). Results: Accrual is complete with n=32 patients with DTC, 10 with ATC and 7 with MTC enrolled between October 2017 and May 2019. Thirty-two DTC included: n=17 papillary, n=7 Hurthle, n=4 follicular TC, n=4 PDTC. Among n=49, median (range) age was 65 (30-88), 51% (25/49) were female. To date, in DTC, 3/32 achieved a PR (n=2 Hurthle and n=1 PDTC), 9.4% RR (.95CI:2%-25%). One near complete response has been observed. Among pts w ATC, 3/ 10 profound PR by RECIST occurred (30% RR, .95CI: 7%-65%). Among them, two remain without clear evidence of disease at 26 and 13 mo after treatment start. No PR's were observed in MTC. Most frequent grade 3-4 TRAEs were as expected and included increased lipase (n=8), increased serum amylase (n=4). There was an unexpected number of treatment related adrenal insufficiency (AI) (n=4) which was associated with long PFS (range 10.1—16.4+mo). Conclusions: N+I appears to have considerable activity in ATC. In unselected RAIR DTC, activity was low but responses were seen in PDTC and Hurthle cell TC. Exceptional responses with prolonged remissions were observed. Clinical trial information: NCT03246958 .
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Affiliation(s)
| | | | | | - Ravindra Uppaluri
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
| | | | - Robert I. Haddad
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, MA
| | | | - Danielle Nina Margalit
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Roy B. Tishler
- Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | | | | | | | | | | | | | | | | | - Alec Kacew
- Dana-Farber Cancer Instutute, Boston, MA
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