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Jhaveri K, Eli LD, Wildiers H, Hurvitz SA, Guerrero-Zotano A, Unni N, Brufsky A, Park H, Waisman J, Yang ES, Spanggaard I, Reid S, Burkard ME, Vinayak S, Prat A, Arnedos M, Bidard FC, Loi S, Crown J, Bhave M, Piha-Paul SA, Suga JM, Chia S, Saura C, Garcia-Saenz JÁ, Gambardella V, de Miguel MJ, Gal-Yam EN, Rapael A, Stemmer SM, Ma C, Hanker AB, Ye D, Goldman JW, Bose R, Peterson L, Bell JSK, Frazier A, DiPrimeo D, Wong A, Arteaga CL, Solit DB. Neratinib + fulvestrant + trastuzumab for HR-positive, HER2-negative, HER2-mutant metastatic breast cancer: outcomes and biomarker analysis from the SUMMIT trial. Ann Oncol 2023; 34:885-898. [PMID: 37597578 DOI: 10.1016/j.annonc.2023.08.003] [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: 05/21/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND HER2 mutations are targetable alterations in patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC). In the SUMMIT basket study, patients with HER2-mutant MBC received neratinib monotherapy, neratinib + fulvestrant, or neratinib + fulvestrant + trastuzumab (N + F + T). We report results from 71 patients with HR+, HER2-mutant MBC, including 21 (seven in each arm) from a randomized substudy of fulvestrant versus fulvestrant + trastuzumab (F + T) versus N + F + T. PATIENTS AND METHODS Patients with HR+ HER2-negative MBC with activating HER2 mutation(s) and prior cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) therapy received N + F + T (oral neratinib 240 mg/day with loperamide prophylaxis, intramuscular fulvestrant 500 mg on days 1, 15, and 29 of cycle 1 then q4w, intravenous trastuzumab 8 mg/kg then 6 mg/kg q3w) or F + T or fulvestrant alone. Those whose disease progressed on F + T or fulvestrant could cross-over to N + F + T. Efficacy endpoints included investigator-assessed objective response rate (ORR), clinical benefit rate (RECIST v1.1), duration of response, and progression-free survival (PFS). Plasma and/or formalin-fixed paraffin-embedded tissue samples were collected at baseline; plasma was collected during and at end of treatment. Extracted DNA was analyzed by next-generation sequencing. RESULTS ORR for 57 N + F + T-treated patients was 39% [95% confidence interval (CI) 26% to 52%); median PFS was 8.3 months (95% CI 6.0-15.1 months). No responses occurred in fulvestrant- or F + T-treated patients; responses in patients crossing over to N + F + T supported the requirement for neratinib in the triplet. Responses were observed in patients with ductal and lobular histology, 1 or ≥1 HER2 mutations, and co-occurring HER3 mutations. Longitudinal circulating tumor DNA sequencing revealed acquisition of additional HER2 alterations, and mutations in genes including PIK3CA, enabling further precision targeting and possible re-response. CONCLUSIONS The benefit of N + F + T for HR+ HER2-mutant MBC after progression on CDK4/6is is clinically meaningful and, based on this study, N + F + T has been included in the National Comprehensive Cancer Network treatment guidelines. SUMMIT has improved our understanding of the translational implications of targeting HER2 mutations with neratinib-based therapy.
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Affiliation(s)
- K Jhaveri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York.
| | - L D Eli
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - H Wildiers
- University Hospitals Leuven, Leuven, Belgium
| | - S A Hurvitz
- David Geffen School of Medicine, UCLA, Los Angeles, Santa Monica, USA
| | - A Guerrero-Zotano
- Medical Oncology Department, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - N Unni
- UT Southwestern Medical Center, Dallas
| | - A Brufsky
- Magee-Womens Hospital of UPMC, Pittsburgh
| | - H Park
- Washington University School of Medicine, St. Louis
| | - J Waisman
- City of Hope Comprehensive Cancer Center, Duarte
| | - E S Yang
- University of Alabama at Birmingham, Birmingham, USA
| | - I Spanggaard
- Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - S Reid
- Division of Hematology/Oncology (Breast Oncology), The Vanderbilt-Ingram Cancer Center, Nashville
| | - M E Burkard
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - S Vinayak
- Seattle Cancer Care Alliance, Seattle, USA
| | - A Prat
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Arnedos
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | - F-C Bidard
- Department of Medical Oncology, UVSQ/Paris-Saclay University, Institut Curie, Saint Cloud, France
| | - S Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne; The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Parkville, Australia
| | - J Crown
- St. Vincent's University Hospital, Dublin, Ireland
| | - M Bhave
- Department of Hematology/Oncology, Emory University, Winship Cancer Institute, Atlanta
| | - S A Piha-Paul
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston
| | - J M Suga
- Kaiser Permanente, Department of Medical Oncology, Vallejo, USA
| | - S Chia
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - C Saura
- Medical Oncology Service, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - J Á Garcia-Saenz
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid
| | - V Gambardella
- Hospital Clínico de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia
| | - M J de Miguel
- START Madrid - Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - E N Gal-Yam
- Institute of Breast Oncology, Sheba Medical Center, Ramat Gan
| | - A Rapael
- Sourasky Medical Center, Tel Aviv
| | - S M Stemmer
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva; Tel Aviv University, Tel Aviv, Israel
| | - C Ma
- Division of Medical Oncology, Department of Medicine and Siteman Cancer Center, Washington University, St. Louis
| | - A B Hanker
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas
| | - D Ye
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas
| | | | - R Bose
- Division of Medical Oncology, Department of Medicine and Siteman Cancer Center, Washington University, St. Louis
| | - L Peterson
- Division of Medical Oncology, Department of Medicine and Siteman Cancer Center, Washington University, St. Louis
| | | | - A Frazier
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - D DiPrimeo
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - A Wong
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - C L Arteaga
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas
| | - D B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
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2
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Zer A, Icht O, Yosef L, Avram D, Jacobi O, Fenig E, Kurman N, Peretz I, Shamai S, Merimsky O, Ben-Ami E, Shapira Frommer R, Schwarzbach AE, Bernstine H, Weitzen R, Vornicova O, Bar-Sela G, Stemmer SM, Lotem M. Phase 2 single arm study of nivolumab and ipilimumab (Nivo/Ipi) in previously treated classical Kaposi Sarcoma (cKS). Ann Oncol 2022; 33:720-727. [PMID: 35339649 DOI: 10.1016/j.annonc.2022.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/22/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Classical Kaposi Sarcoma (cKS) is a rare HHV8-associated sarcoma with limited treatment options. We evaluated the efficacy and safety of nivolumab in combination with ipilimumab (Nivo/Ipi) in patients with previously treated progressive cKS. PATIENTS AND METHODS cKS pts with progressive disease after > 1 lines of systemic therapy and measurable disease by PET/CT and/or physical examination received nivolumab 240mg every two weeks and ipilimumab 1mg/kg every six weeks until progression or toxicity for a maximum of 24 months. The primary endpoint was overall response rate (ORR); secondary endpoints included 6-months progression free survival rate (PFS) and safety. Immune correlates were explored using IHC, DNAseq (596/648 genes) and RNAseq (exome capture transcriptome) of tumor specimens and matched blood. RESULTS Eighteen male patients (median age 76.5) were enrolled between April 2018 and Dec 2020. At a median follow up of 24.4 months, ORR by RECIST v1.1 was 87%. Metabolic complete response as assessed by PET CT was observed in 8 of 13 (62%) evaluable patients. 6/13 achieved pathological CR post treatment. In two patients, palliative limb amputation was prevented. Median PFS was not reached. The 6mo and 12m PFS rate was 76.5% and 58.8%, respectively. Only four patients (22%) experienced grade 3-4 adverse events. The most frequent genomic alteration was biallelic copy number loss of FOX1A gene. The majority of tumors carried a low TMB, were microsatellite stable (MSS), MMR proficient, did not express PD-L1 and displayed only low lymphocytic infiltrates, rendering them immunologically "cold". CONCLUSIONS This prospectively designed phase II study of nivolumab and ipilimumab demonstrates promising activity of this combination in progressive cKS representing a new treatment option in this population.
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Affiliation(s)
- A Zer
- Division of Oncology, Rambam Health Care Campus, Israel.
| | - O Icht
- Davidoff Center, Rabin Medical Center, Israel
| | - L Yosef
- Davidoff Center, Rabin Medical Center, Israel
| | - D Avram
- Davidoff Center, Rabin Medical Center, Israel
| | - O Jacobi
- Davidoff Center, Rabin Medical Center, Israel
| | - E Fenig
- Davidoff Center, Rabin Medical Center, Israel
| | - N Kurman
- Davidoff Center, Rabin Medical Center, Israel
| | - I Peretz
- Davidoff Center, Rabin Medical Center, Israel
| | - S Shamai
- Tel Aviv Sourasky Medical Center
| | | | - E Ben-Ami
- Ella Institute for Immuno-Oncology and melanoma, Sheba medical center, Israel
| | - R Shapira Frommer
- Ella Institute for Immuno-Oncology and melanoma, Sheba medical center, Israel
| | | | - H Bernstine
- Nuclear medicine, Rabin Medical Center, Israel
| | - R Weitzen
- Oncology Institute, Sheba Medical Center, Israel
| | | | | | - S M Stemmer
- Davidoff Center, Rabin Medical Center, Israel
| | - M Lotem
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center
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3
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Deutsch O, Haviv Y, Krief G, Keshet N, Westreich R, Stemmer SM, Zaks B, Navat SP, Yanko R, Lahav O, Aframian DJ, Palmon A. Possible proteomic biomarkers for the detection of pancreatic cancer in oral fluids. Sci Rep 2020; 10:21995. [PMID: 33319845 PMCID: PMC7738525 DOI: 10.1038/s41598-020-78922-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022] Open
Abstract
The 80% mortality rate of pancreatic-cancer (PC) makes early diagnosis a challenge. Oral fluids (OF) may be considered the ultimate body fluid for non-invasive examinations. We have developed techniques to improve visualization of minor OF proteins thereby overcoming major barriers to using OF as a diagnostic fluid. The aim of this study was to establish a short discriminative panel of OF biomarkers for the detection of PC. Unstimulated OF were collected from PC patients and controls (n = 30). High-abundance-proteins were depleted and the remaining proteins were analyzed by two-dimensional-gel-electrophoresis and quantitative dimethylation-liquid-chromatography-tandem mass-spectrometry. Label-free quantitative-mass-spectrometry analysis (qMS) was performed on 20 individual samples (n = 20). More than 100 biomarker candidates were identified in OF samples, and 21 had a highly differential expression profile. qMS analysis yielded a ROC-plot AUC value of 0.91 with 90.0% sensitivity and specificity for a combination of five biomarker candidates. We found a combination of five biomarkers for PC. Most of these proteins are known to be related to PC or other gastric cancers, but have never been detected in OF. This study demonstrates the importance of novel OF depletion methodologies for increased protein visibility and highlights the clinical applicability of OF as a diagnostic fluid.
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Affiliation(s)
- O Deutsch
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Y Haviv
- Salivary Gland Clinic and Saliva Diagnostic Laboratory, Department of Oral Medicine, Sedation and Maxillofacial Radiology, Sjogren's Syndrome Center, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - G Krief
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - N Keshet
- Salivary Gland Clinic and Saliva Diagnostic Laboratory, Department of Oral Medicine, Sedation and Maxillofacial Radiology, Sjogren's Syndrome Center, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - R Westreich
- Department of Internal Medicine B, Soroka Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - S M Stemmer
- Rabin Medical Center, Davidoff Center, Petach Tiqwa, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Zaks
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - S P Navat
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - R Yanko
- Salivary Gland Clinic and Saliva Diagnostic Laboratory, Department of Oral Medicine, Sedation and Maxillofacial Radiology, Sjogren's Syndrome Center, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - O Lahav
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - D J Aframian
- Salivary Gland Clinic and Saliva Diagnostic Laboratory, Department of Oral Medicine, Sedation and Maxillofacial Radiology, Sjogren's Syndrome Center, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - A Palmon
- Institute of Dental Sciences, Faculty of Dental Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Oral Medicine, Sedation and Maxillofacial Imaging, Faculty of Dental Medicine, Hebrew University - Hadassah, Jerusalem, Israel.
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4
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Rijensky NM, Blondheim Shraga NR, Barnea E, Peled N, Rosenbaum E, Popovtzer A, Stemmer SM, Livoff A, Shlapobersky M, Moskovits N, Perry D, Rubin E, Haviv I, Admon A. Identification of Tumor Antigens in the HLA Peptidome of Patient-derived Xenograft Tumors in Mouse. Mol Cell Proteomics 2020; 19:1360-1374. [PMID: 32451349 PMCID: PMC8015002 DOI: 10.1074/mcp.ra119.001876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/20/2020] [Indexed: 12/15/2022] Open
Abstract
Personalized cancer immunotherapy targeting patient-specific cancer/testis antigens (CTA) and neoantigens may benefit from large-scale tumor human leukocyte antigen (HLA) peptidome (immunopeptidome) analysis, which aims to accurately identify antigens presented by tumor cells. Although significant efforts have been invested in analyzing the HLA peptidomes of fresh tumors, it is often impossible to obtain sufficient volumes of tumor tissues for comprehensive HLA peptidome characterization. This work attempted to overcome some of these obstacles by using patient-derived xenograft tumors (PDX) in mice as the tissue sources for HLA peptidome analysis. PDX tumors provide a proxy for the expansion of the patient tumor by re-grafting them through several passages to immune-compromised mice. The HLA peptidomes of human biopsies were compared with those derived from PDX tumors. Larger HLA peptidomes were obtained from the significantly larger PDX tumors as compared with the patient biopsies. The HLA peptidomes of different PDX tumors derived from the same source tumor biopsy were very reproducible, even following subsequent passages to new naïve mice. Many CTA-derived HLA peptides were discovered, as well as several potential neoantigens/variant sequences. Taken together, the use of PDX tumors for HLA peptidome analysis serves as a highly expandable and stable source of reproducible and authentic peptidomes, opening up new opportunities for defining large HLA peptidomes when only small tumor biopsies are available. This approach provides a large source for tumor antigens identification, potentially useful for personalized immunotherapy.
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Affiliation(s)
| | | | - Eilon Barnea
- Department of Biology, Technion-Israel Institute of Technology Haifa, Israel
| | - Nir Peled
- Institute of Oncology, Davidoff Center, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Eli Rosenbaum
- Institute of Oncology, Davidoff Center, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Aron Popovtzer
- Institute of Oncology, Davidoff Center, Rabin Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Solomon M Stemmer
- Davidoff Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Felsentien medical research center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alejandro Livoff
- Institute of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Mark Shlapobersky
- Institute of Pathology, Barzilai University Medical Center, Ashkelon, Israel
| | - Neta Moskovits
- Davidoff Center, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Felsentien medical research center, Petach Tikva, Israel
| | - Dafna Perry
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Eitan Rubin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel; The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Itzhak Haviv
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Arie Admon
- Department of Biology, Technion-Israel Institute of Technology Haifa, Israel.
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5
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Rugo HS, André F, Yamashita T, Cerda H, Toledano I, Stemmer SM, Jurado JC, Juric D, Mayer I, Ciruelos EM, Iwata H, Conte P, Campone M, Wilke C, Mills D, Lteif A, Miller M, Gaudenzi F, Loibl S. Time course and management of key adverse events during the randomized phase III SOLAR-1 study of PI3K inhibitor alpelisib plus fulvestrant in patients with HR-positive advanced breast cancer. Ann Oncol 2020; 31:1001-1010. [PMID: 32416251 DOI: 10.1016/j.annonc.2020.05.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 02/20/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Alpelisib (α-selective phosphatidylinositol 3-kinase inhibitor) plus fulvestrant is approved in multiple countries for men and postmenopausal women with PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer following progression on or after endocrine therapy. A detailed understanding of alpelisib's safety profile should inform adverse event (AE) management and enhance patient care. PATIENTS AND METHODS AEs in the phase III SOLAR-1 trial were assessed in patients with and without PIK3CA mutations. The impact of protocol-specified AE-management recommendations was evaluated, including an amendment to optimize hyperglycemia and rash management. RESULTS Patients were randomly assigned to receive fulvestrant plus alpelisib (n = 284) or placebo (n = 287). The most common grade 3/4 AEs with alpelisib were hyperglycemia (grade 3, 32.7%; grade 4, 3.9%), rash (grade 3, 9.9%), and diarrhea (grade 3, 6.7%). Median time to onset of grade ≥3 toxicity was 15 days (hyperglycemia, based on fasting plasma glucose), 13 days (rash), and 139 days (diarrhea). Metformin alone or in combination with other antidiabetic agents was used by most patients (87.1%) with hyperglycemia. Preventive anti-rash medication resulted in lower incidence (any grade, 26.7% versus 64.1%) and severity of rash (grade 3, 11.6% versus 22.7%) versus no preventative medication. Discontinuations due to grade ≥3 AEs were lower following more-detailed AE management guidelines (7.9% versus 18.1% previously). Patients with PIK3CA mutations had a median alpelisib dose intensity of 248 mg/day. Median progression-free survival with alpelisib was 12.5 and 9.6 months for alpelisib dose intensities of ≥248 mg/day and <248 mg/day, respectively, compared with 5.8 months with placebo. CONCLUSIONS Hyperglycemia and rash occurred early during alpelisib treatment, while diarrhea occurred at a later time point. Early identification, prevention, and intervention, including concomitant medications and alpelisib dose modifications, resulted in less severe toxicities. Reductions in treatment discontinuations and improved progression-free survival at higher alpelisib dose intensities support the need for optimal AE management. CLINICALTRIALS. GOV ID NCT02437318.
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Affiliation(s)
- H S Rugo
- Department of Medicine, Division of Hematology and Oncology, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA.
| | - F André
- Department of Medical Oncology, INSERM U981, Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - T Yamashita
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan
| | - H Cerda
- Clinica RedSalud Vitacura, Santiago, Chile
| | | | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - J C Jurado
- Hospital Universitario Canarias, S/C Tenerife, Islas Canarias, Spain
| | - D Juric
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, USA
| | - I Mayer
- Department of Medicine, Hematology and Oncology, Vanderbilt University, Nashville, USA
| | - E M Ciruelos
- Medical Oncology Department, Breast Cancer Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - H Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - M Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, St Herblain, France
| | - C Wilke
- Novartis Pharma AG, Basel, Switzerland
| | - D Mills
- Novartis Pharma AG, Basel, Switzerland
| | - A Lteif
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - M Miller
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | | | - S Loibl
- Department of Medicine and Research, German Breast Group, Neu-Isenburg; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
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6
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Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, Paluch-Shimon S, Campone M, Petrakova K, Blackwell KL, Winer EP, Janni W, Verma S, Conte P, Arteaga CL, Cameron DA, Mondal S, Su F, Miller M, Elmeliegy M, Germa C, O'Shaughnessy J. Updated results from MONALEESA-2, a phase III trial of first-line ribociclib plus letrozole versus placebo plus letrozole in hormone receptor-positive, HER2-negative advanced breast cancer. Ann Oncol 2019; 30:1842. [PMID: 31407010 PMCID: PMC6927326 DOI: 10.1093/annonc/mdz215] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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7
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Stemmer SM, Chacko AA. 2172 Effect of GNRH Antagonist, Elagolix on Size and Quantity of Endometriotic Lesions Following 2 Months of Therapy. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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8
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Saleev N, Blondheim-Shraga NR, Solomonov E, Shapira S, Haviv I, Stemmer SM, Slor H. Abstract 2297: Anti-labyrinthin monoclonal antibody reduces human adenocarcinoma circulating tumor cells in the blood of patient-derived xenograft models and inhibits the growth of adenocarcinoma cell cultures. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-2297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Labyrinthin is a 255-amino acid protein antigen that is expressed on the cell-surface of most adenocarcinoma tumors and is not expressed on the surface of most normal cells, which makes it an attractive candidate for targeted therapy. Originally, labyrinthin had been deduced to be a product of a large deletion in the gene coding for junctate. We found that the junctate gene in labyrinthin-expressing adenocarcinoma cells does not have any deletion, and we propose that the labyrinthin protein is a splice variant of the junctate gene. This study aimed to determine the effects of an anti-labyrinthin monoclonal antibody, on adenocarcinoma cells in vitro and on patient-derived xenograft (PDX) models in vivo. Lung, breast and colorectal adenocarcinoma cell lines, as well as a primary-cell culture of a colorectal adenocarcinoma patient, were assessed for cell surface expression of labyrinthin. The cells were then incubated in the presence of the anti-labyrinthin antibody and growth rate was monitored by live imaging methods. Untreated primary-cell cultures of the colorectal adenocarcinoma patient were also grafted to immunodeficient mice to produce PDX tumors. When establishment of palpable tumors was observed, the mice were injected with the antibody. Peripheral blood was sampled from the mice and circulating tumor cells (CTCs) were quantified by flow cytometry. A significant reduction of approximately 60% was detected in the number of CTCs in the peripheral blood of the antibody-treated PDX mice compared to untreated control PDX mice. Additionally, a significant reduction was measured in the growth-rate of cultured primary cells and in lung, breast and colorectal adenocarcinoma cell lines in the presence of the antibody. We conclude that the anti-labyrinthin antibody has an inhibitory effect on the formation of adenocarcinoma CTCs in vivo as well as on the growth rate of cultured adenocarcinoma tumor cells.
Citation Format: Natalia Saleev, Netta R. Blondheim-Shraga, Evgeny Solomonov, Shiran Shapira, Izhak Haviv, Solomon M. Stemmer, Hanoch Slor. Anti-labyrinthin monoclonal antibody reduces human adenocarcinoma circulating tumor cells in the blood of patient-derived xenograft models and inhibits the growth of adenocarcinoma cell cultures [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2297.
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Affiliation(s)
- Natalia Saleev
- 1The Azrielyi Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Evgeny Solomonov
- 2Ziv Medical Center and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Shiran Shapira
- 3Integrated Cancer Prevention Center, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Izhak Haviv
- 1The Azrielyi Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Solomon M. Stemmer
- 4Institute of Oncology, Davidoff Centre, Rabin Medical Centre, Petah Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hanoch Slor
- 5Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Stemmer SM, Rizel S, Steiner M, Geffen DB, Soussan-Gutman L, Bareket-Samish A, McCullough D, Svedman C, Nisenbaum B, Ryvo L, Peretz T, Fried G, Rosengarten O, Liebermann N, Ben Baruch N. Abstract P1-07-14: Real-life analysis evaluating >1000 N0/N1mi estrogen receptor (ER)+ breast cancer patients for whom treatment decisions incorporated the 21-gene recurrence score (RS) result: Clinical outcomes with median follow up of > 9 years. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-07-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The 21-gene Recurrence Score (RS) Assay (Oncotype DX®) is a validated prognosticator and predictive of chemotherapy (CT) benefit in patients with hormone receptor (HR)+ human epidermal growth factor receptor 2 (HER2)-negative breast cancer. In Israel, the RS assay has been reimbursed by Clalit Health Services (CHS, the largest HMO in Israel) since 2006, and the assay is widely used in eligible estrogen receptor (ER)+ patients. Notably, ER+ breast cancer patients have a protracted risk of recurrence with approximately half of all distant recurrences occurring after 5 years from diagnosis. The goal of the current ongoing analysis was to investigate early (≤5 years) and late (>5 years) distant recurrence in N0/N1mi ER+ HER2-negative breast cancer patients who were RS-tested through CHS.
Methods: This analysis of the CHS registry included breast cancer patients with ER+ HER2-negative N0/N1mi disease who underwent RS testing from 1/2006 (CHS approval of the assay) through 1/2009. Data sources included CHS claims arms (for patient/tumor characteristics), Teva Pharmaceuticals (for tumor characteristics, RS result), and medical records (for treatment/recurrence/survival). The study was approved by the institutional review boards of the CHS Community Division and was granted a waiver for obtaining patient consent.
Results: The analysis included 1026 patients with median (interquartile range) follow up of 9.3 (8.8-10.2) years. Most patients were females (99%). Median (range) age was 59 (25-84) years; 92% had N0 and 8% had N1mi disease; 14%, 52%, and 16% had grade 1, 2, and 3 tumors, respectively (grade information was not available for 18% of patients); median (range) tumor size was 1.5 (0.3-6.5) cm. The majority of patients (78%) had invasive ductal carcinoma and 12% had invasive lobular carcinoma. Overall, 489 patients (48%) had RS<18, 434 (42%) had RS 18-30, and 103 (10%) had RS≥31. The use of adjuvant CT was consistent with the RS result: 3%, 27%, and 90% of RS<18, RS 18-30, and RS≥31 patients, respectively. Overall, 25 distant recurrences were reported within 5 years of RS testing: 5 (1.0%) in RS<18 patients, 9 (2.1%) in RS 18-30 patients, and 11 (10.6%) in RS≥31 patients. In the first 5 years, breast cancer-specific death was reported in 8 patients including 3 (0.7%) with RS 18-30 and 5 (4.9%) with RS≥31 results. Among N0 patients with RS 11-25 who did not receive adjuvant CT (n = 540), 5 (0.9%) distant recurrences and one (0.2%) breast cancer death were reported within 5 years of RS testing. Analysis of 'late' recurrences and breast cancer-specific death (from 5 to 9.3 years of follow-up) is ongoing.
Conclusions: These will be the first late recurrence data from over 1000 patients for whom the RS result was used in real-life clinical decision making. Consistent with previous analyses of the CHS registry, CT use was appropriately based on the RS result, and the recurrence/survival outcomes (for the first 5 years) demonstrated the prognostic performance of the RS. Distant recurrence and breast cancer death data beyond 5 years will be presented at the meeting.
Citation Format: Stemmer SM, Rizel S, Steiner M, Geffen DB, Soussan-Gutman L, Bareket-Samish A, McCullough D, Svedman C, Nisenbaum B, Ryvo L, Peretz T, Fried G, Rosengarten O, Liebermann N, Ben Baruch N. Real-life analysis evaluating >1000 N0/N1mi estrogen receptor (ER)+ breast cancer patients for whom treatment decisions incorporated the 21-gene recurrence score (RS) result: Clinical outcomes with median follow up of > 9 years [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-07-14.
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Affiliation(s)
- SM Stemmer
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - S Rizel
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - M Steiner
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - DB Geffen
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - L Soussan-Gutman
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - A Bareket-Samish
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - D McCullough
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - C Svedman
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - B Nisenbaum
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - L Ryvo
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - T Peretz
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - G Fried
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - O Rosengarten
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - N Liebermann
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
| | - N Ben Baruch
- Davidoff Center, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Lin Medical Center, Haifa, Israel; Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Oncotest Division, Teva Pharmaceutical Industries, Ltd, Shoham, Israel; BioInsight Ltd, Zichron Yaakov, Israel; Genomic Health Inc., Redwood City; Meir Medical Center, Kfar Saba, Israel; Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Rambam Health Care Campus, Haifa, Israel; Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel; Community Division, Clalit Health Services, Tel Aviv, Israel; Kaplan Medical Center, Rehovot, Israel
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Perl G, Nordheimer S, Lando S, Benedict C, Brenner B, Perry S, Shmoisman G, Purim O, Amit L, Stemmer SM, Ben-Aharon I. Young patients and gastrointestinal (GI) tract malignancies - are we addressing the unmet needs? BMC Cancer 2016; 16:630. [PMID: 27519697 PMCID: PMC4983017 DOI: 10.1186/s12885-016-2676-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/04/2016] [Indexed: 01/11/2023] Open
Abstract
Background Recent epidemiological studies indicate the rate of gastrointestinal (GI) malignancies among younger patients is increasing, mainly due to colorectal cancer. There is a paucity of data regarding the magnitude of treatment-related symptoms, psychosocial issues and potential unmet needs in this population. We aimed to characterize the needs of this population to evaluate whether unmet needs could be targeted by potential intervention. Methods Female and male patients diagnosed with cancer of the gastrointestinal tract <40y retrospectively completed a questionnaire to evaluate symptoms, daily function and unmet needs at pre-treatment, during and post-treatment. Comparisons were made by gender, disease stage and treatment modality. Multiple linear regression models evaluated effects of demographics, symptoms and needs on multiple domains of health-related-quality-of-life (using Short-Form Health Survey-12 and CARES). Results Fifty patients were enrolled (52 % female) to a pilot study. Median age at diagnosis was 35.5y (range, 21-40y). The symptoms that significantly increased from baseline to during and post-treatment were: diarrhea (37 %), sleeping disorder (32 %) and sexual dysfunction (40 %). Patients also reported significant deterioration in occupational activities and coping with children compared with baseline. Female patients reported significant unmet need for nutritional counseling and psychosocial support compared to male patients (p < 0.05). Patients treated with multimodality-treatment presented higher rates of unmet needs (p = 0.03). Conclusions Young patients with GI cancers represent a group with unique characteristics and needs compared with published evidence on other young-onset malignancies. The distinctive symptoms and areas of treatment-related functional impairments indicate there are unmet needs, especially in the area of psychosocial support and nutritional counseling.
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Affiliation(s)
- G Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - S Nordheimer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - S Lando
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - C Benedict
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B Brenner
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - S Perry
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - G Shmoisman
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - O Purim
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - L Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - I Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Kaplan St, Petah-Tiqva, 49100, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Ben-Aharon I, Abir R, Perl G, Stein J, Gilad G, Toledano H, Elitzur S, Avrahami G, Ben-Haroush A, Oron G, Freud E, Kravarusic D, Ben-Arush M, Herzel G, Yaniv I, Stemmer SM, Fisch B, Ash S. Optimizing the process of fertility preservation in pediatric female cancer patients - a multidisciplinary program. BMC Cancer 2016; 16:620. [PMID: 27506811 PMCID: PMC4979150 DOI: 10.1186/s12885-016-2584-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 07/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background Current evidence indicates sub-optimal incidence of fertility preservation (FP) in eligible patients. We present herein our designated multidisciplinary program for FP in pediatric and adolescent population and present our data on FP in female patients. Methods Pediatric patients (age 0–18) who were candidate for highly gonadotoxic treatments were referred to FP program for a multidisciplinary discussion and gonadal risk-assessment followed by either oocyte cryopreservation or ovarian cryopreservation (OCP) for female patients, and sperm banking for male patients. The OCP protocol consists of aspiration of oocytes from small antral follicles and in-vitro maturation followed by cryopreservation, as well as ovarian tissue cryopreservation. Results The establishment of a designated FP program resulted in a significant increase in referral and subsequent FP procedures of all eligible patients. Sixty-two female patients were referred for FP discussion during a period of 36 months; 41 underwent OCP; 11 underwent oocyte cryopreservation and six were declined due to parental decision. The median age was 13.2y (range 18 months-18y). Thirty-two (51.6 %) were chemotherapy-naïve. Seventeen patients (27 %) had sarcoma, 16 patients (26 %) had acute leukemia. The mean number of mature oocytes that were eventually vitrified was significantly higher in chemotherapy-naïve patients compared with chemotherapy-exposed patients (mean 12 oocytes (1–42) versus 2 (0–7)). Conclusion Multidisciplinary programs that encompass experts of all relevant fields, skilled laboratory resources and a facilitated path appear to maximize the yield. We observed a considerable higher referral rates following launching a designated program and earlier OCP in chemo-naïve patients that culminated in a better fertility preservation procedure.
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Affiliation(s)
- Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - R Abir
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J Stein
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Gilad
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Toledano
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Elitzur
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Avrahami
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Ben-Haroush
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Oron
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Freud
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kravarusic
- Department of Pediatric Surgery, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Ben-Arush
- Division of Pediatric Hematology Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - G Herzel
- Department of Pediatric Hematology Oncology, Ha'Emek Hospital, Afula, Israel
| | - I Yaniv
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Fisch
- IVF and Infertility Unit, Schneider Women Hospital, Rabin Medical Center Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Ash
- Department of Pediatric Oncology, Schneider Children's Hospital, Petah Tikvah and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Abir R, Ben-Aharon I, Garor R, Yaniv I, Ash S, Stemmer SM, Ben-Haroush A, Freud E, Kravarusic D, Sapir O, Fisch B. Cryopreservation of in vitro matured oocytes in addition to ovarian tissue freezing for fertility preservation in paediatric female cancer patients before and after cancer therapy. Hum Reprod 2016; 31:750-62. [PMID: 26848188 DOI: 10.1093/humrep/dew007] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/11/2016] [Indexed: 12/11/2022] Open
Abstract
STUDY QUESTION Is a protocol that combines in vitro maturation of germinal vesicle-stage oocytes and their vitrification with freezing of cortical ovarian tissue feasible for use in fertility preservation for both chemotherapy-naive paediatric patients as well as patients after initiation of cancer therapy? SUMMARY ANSWER Follicle-containing ovarian tissue as well as oocytes that can undergo maturation in vitro can be obtained from paediatric patients (including prepubertal girls) both before and after cancer therapy. WHAT IS KNOWN ALREADY Anticancer therapy reduces the number of follicles/oocytes but this effect is less severe in young patients, particularly the paediatric age group. Autotransplantation of ovarian tissue has yielded to date 60 live births, including one from tissue that was cryostored in adolescence. However, it is assumed that autografting cryopreserved-thawed ovarian cortical tissue poses a risk of reseeding the malignancy. Immature oocytes can be collected from very young girls without hormonal stimulation and then matured in vitro and vitrified. We have previously shown that there is no difference in the number of ovarian cortical follicles between paediatric patients before and after chemotherapy. STUDY DESIGN, SIZE, DURATION A prospective study was conducted in a cohort of 42 paediatric females with cancer (before and after therapy initiation) who underwent fertility preservation procedures in 2007-2014 at a single tertiary medical centre. PARTICIPANTS/MATERIALS, SETTING, METHODS The study group included girls and adolescent females with cancer: 22 before and 20 after chemotherapy. Following partial or complete oophorectomy, immature oocytes were either aspirated manually ex vivo from visible small antral follicles or filtered from spent media. Oocytes were incubated in oocyte maturation medium, and those that matured at 24 or 48 h were vitrified. Ovarian cortical tissue was cut and prepared for slow-gradual cryopreservation. Anti-Mullerian hormone (AMH) levels were measured in serum before and after oophorectomy. MAIN RESULTS AND ROLE OF CHANCE Ovarian tissue was successfully collected from 78.7% of the 42 patients. Oocytes were obtained from 20 patients before chemotherapy and 13 after chemotherapy. The youngest patients from whom oocytes were retrieved were aged 2 years (two atretic follicles) and 3 years. Of the 395 oocytes collected, ∼30% were atretic (29.6% in the pre-chemotherapy group, 37% in the post-chemotherapy group). One hundred twenty-one oocytes (31%) were matured in vitro and vitrified: 67.8% from patients before chemotherapy, the rest after chemotherapy. Mature oocytes suitable for vitrification were obtained from 16/20 patients before chemotherapy and from 12/13 patients after chemotherapy (maturation rate, 32 and 26.4%, respectively). There were significant correlations of the number of vitrified oocytes with patient age (more matured oocytes with older age) (P = 0.001) and with pre-oophorectomy AMH levels (P = 0.038 pre-chemotherapy group, P = 0.029 post-chemotherapy group). Oocytes suitable for vitrification were obtained both by manual aspiration of antral follicles (45%) and from rinse solutions after dissection. There were significantly more matured oocytes in the pre-chemotherapy group from aspiration than in the post-chemotherapy group after both aspiration (P < 0.033) and retrieval from rinsing fluids (P < 0.044). The number of pre-antral follicles per histological section did not differ in the pre- versus post-chemotherapy. AMH levels dropped by approximately 50% after ovarian removal in both groups, with a significant correlation between pre- and post-oophorectomy levels (P = 0.002 pre-chemotherapy group, P = 0.001 post-chemotherapy group). LIMITATIONS, REASONS FOR CAUTION There were no patients between 5 years and 10 years old in the post-chemotherapy group, which might have affected some results and correlations. Oocytes from patients soon after chemotherapy might be damaged, and caution is advised when using them for fertility-restoration purposes. The viability, development capability and fertilization potential of oocytes from paediatric patients, especially prepubertal and after chemotherapy, are unknown, in particular oocytes recovered from the media after the tissue dissection step. WIDER IMPLICATIONS OF THE FINDINGS Although more oocytes were collected and matured from chemotherapy-naïve paediatric patients, ovarian tissue and immature oocytes were also retrieved from young girls in whom cancer therapy has already been initiated. Our centre has established a protocol for potential maximal fertility preservation in paediatric female patients with cancer. Vitrified-in vitro-matured oocytes may serve as an important gamete source in paediatric female patients with cancer because the risk of reseeding the disease is avoided. Further studies are needed on the fertility-restoring potential of oocytes from paediatric and prepubertal patients, especially after exposure to chemotherapy. STUDY FUNDING/COMPETING INTERESTS The study was conducted as part of the routine procedures for fertility preservation at our IVF unit. No funding outside of the IVF laboratory was received. Funding for the AMH measurements was obtained by a research grant from the Israel Science Foundation (to B.-A.I., ISF 13-1873). None of the authors have competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R Abir
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - I Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - R Garor
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - I Yaniv
- Department of Paediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Ash
- Department of Paediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - A Ben-Haroush
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - E Freud
- Department of Paediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kravarusic
- Department of Paediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Sapir
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - B Fisch
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, Petach Tikvah, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
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13
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Brodowicz T, Lang I, Kahan Z, Greil R, Beslija S, Stemmer SM, Kaufman B, Petruzelka L, Eniu A, Anghel R, Koynov K, Vrbanec D, Pienkowski T, Melichar B, Spanik S, Ahlers S, Messinger D, Inbar MJ, Zielinski C. Selecting first-line bevacizumab-containing therapy for advanced breast cancer: TURANDOT risk factor analyses. Br J Cancer 2014; 111:2051-7. [PMID: 25268370 PMCID: PMC4260030 DOI: 10.1038/bjc.2014.504] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/04/2014] [Accepted: 08/18/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The randomised phase III TURANDOT trial compared first-line bevacizumab-paclitaxel (BEV-PAC) vs bevacizumab-capecitabine (BEV-CAP) in HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). The interim analysis revealed no difference in overall survival (OS; primary end point) between treatment arms; however, progression-free survival (PFS) and objective response rate were significantly superior with BEV-PAC. We sought to identify patient populations that may be most appropriately treated with one or other regimen. METHODS Patients with HER2-negative LR/mBC who had received no prior chemotherapy for advanced disease were randomised to either BEV-PAC (bevacizumab 10 mg kg(-1) days 1 and 15 plus paclitaxel 90 mg m(-2) days 1, 8 and 15 q4w) or BEV-CAP (bevacizumab 15 mg kg(-1) day 1 plus capecitabine 1000 mg m(-2) bid days 1-14 q3w). The study population was categorised into three cohorts: triple-negative breast cancer (TNBC), high-risk hormone receptor-positive (HR+) and low-risk HR+. High- and low-risk HR+ were defined, respectively, as having ⩾2 vs ⩽1 of the following four risk factors: disease-free interval ⩽24 months; visceral metastases; prior (neo)adjuvant anthracycline and/or taxane; and metastases in ⩾3 organs. RESULTS The treatment effect on OS differed between cohorts. Non-significant OS trends favoured BEV-PAC in the TNBC cohort and BEV-CAP in the low-risk HR+ cohort. In all three cohorts, there was a non-significant PFS trend favouring BEV-PAC. Grade ⩾3 adverse events were consistently less common with BEV-CAP. CONCLUSIONS A simple risk factor index may help in selecting bevacizumab-containing regimens, balancing outcome, safety profile and patient preference. Final OS results are expected in 2015 (ClinicalTrials.gov NCT00600340).
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Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology and Department of Medicine I, Medical University of Vienna and CECOG, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - I Lang
- Ráth György u. 7-9, National Institute of Oncology, H-1122 Budapest, Hungary
| | - Z Kahan
- Department of Oncotherapy, University of Szeged, H-6720 Szeged, Korányi fasor 12, H-6720 Szeged, Hungary
| | - R Greil
- IIIrd Medical Department, Paracelsus Medical University Hospital Salzburg and AGMT, Salzburg, Austria
| | - S Beslija
- Institute of Oncology, Clinical Center, University of Sarajevo, Bolnicka 27, 71000 Sarajevo, Bosnia and Herzegovina
| | - S M Stemmer
- Davidoff Center, Rabin Medical Center, Kaplan Street, Petah Tiqwa 49100, Israel
| | - B Kaufman
- Breast Oncology Institute, Sheba Medical Center, 52621 Tel Hashomer, Ramat-Gan, Israel
| | - L Petruzelka
- Department of Oncology, First Faculty of Medicine and General Teaching Hospital, Charles University Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - A Eniu
- Department of Breast Tumors, Cancer Institute Ion Chiricuţă, Republicii 34–36, 400015 Cluj-Napoca, Romania
| | - R Anghel
- University of Medicine and Pharmacy Bucharest, Soseaua Fundeni, Nr 252, Sector 2, Bucharest 022328, Romania
| | - K Koynov
- Department of Medical Oncology, Hospital Serdika, 6 Damyan Gruev street, 1303 Sofia, Bulgaria
| | - D Vrbanec
- Department of Medical Oncology, University Hospital Zagreb-Rebro, Medical University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - T Pienkowski
- Oncology Department, European Health Centre Otwock, ul. Borowa 14/18, 04-500 Otwock, Poland
| | - B Melichar
- Department of Oncology, Palacký University Medical School, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
| | - S Spanik
- St Elisabeth Cancer Institute, Heydukova 10, 812 50 Bratislava, Slovak Republic
| | - S Ahlers
- Biometrics, IST GmbH, Soldnerstrasse 1, 68219 Mannheim, Germany
| | - D Messinger
- Biometrics, IST GmbH, Soldnerstrasse 1, 68219 Mannheim, Germany
| | - M J Inbar
- Oncology Division, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
| | - C Zielinski
- Clinical Division of Oncology and Department of Medicine I, Medical University of Vienna and CECOG, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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14
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Gordon N, Stemmer SM. Anti-Cancer Treatments in Elderly (≥75 Years Old) Patients: A Retrospective Analysis. Value Health 2014; 17:A663. [PMID: 27202416 DOI: 10.1016/j.jval.2014.08.2437] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- N Gordon
- Davidoff Center, Rabin Medical Center, Petach-Tikva, Israel
| | - S M Stemmer
- Davidoff Center, Rabin Medical Center, Petach-Tikva, Israel
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15
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Goldstein LJ, Oliveria CT, Heinrich B, Stemmer SM, Mala C, Selder S, Bevan P, Harbeck N. Abstract P5-20-01: A randomized double-blind phase II study of the combination of oral WX-671 plus capecitabine vs. capecitabine monotherapy in first-line HER2− negative metastatic breast cancer (MBC). Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p5-20-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: uPA and its inhibitor PAI-1 play a key role in tumor invasion, metastasis and tumor growth. High levels of uPA and PAI-1 in breast tumors are statistically significant prognostic factors of disease-free (DFS) and overall survival (OS), which were validated at the highest level of evidence, as well as predictors for benefit of adjuvant chemotherapy. WX-UK1 is an active site competitive inhibitor of uPA with an inhibition constant in the submicromolar range. WX-671 (upamostat) is an oral prodrug of WX-UK1. In preclinical animal tumor models, both WX-UK1 and WX-671 have been shown to reduce the growth rate of implanted tumors, to inhibit invasion, and reduce metastases. This current proof of concept study is designed to substantiate the anti-metastatic properties of upamostat for patients appropriate for first line therapy for MBC.
Methods: Female patients aged >18, with HER2 negative MBC appropriate for first line monotherapy with capecitabine, with adequate performance status, organ function, bone marrow reserve without brain metastases were eligible. Patients were randomized in a double-blind fashion to receive upamostat (200mg orally daily for 21 days) plus capecitabine (1000 mg/m2 orally twice daily for 14 days) vs. capecitabine (1000 mg/m2 orally twice daily for 14 days) in 3 week treatment cycles until progressive disease or unacceptable toxicity. The primary endpoint is to evaluate the efficacy of the combination of upamostat plus capecitabine compared to monotherapy as assessed by comparison of progression free survival. The secondary objectives are OS, objective response rates, safety and tolerability, and to assess the pharmacokinetics (PK) of upamostat and capecitabine when combined.
Results: Between August 2008 and April 2011,132 patients were enrolled. 17 patients are still receiving treatment. 26% of the patients are characterized as triple negative, 13% as only Estrogen Receptor (ER) positive and 4% as only Progesteron Receptor (PR) positive. 57 % of the patients are ER and PR positive.
Conclusions: Progression free survival, response rates and safety will be reported. This abstract is being submitted as a placeholder. A completed abstract will be submitted when the analyses are completed.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-20-01.
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Affiliation(s)
- LJ Goldstein
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
| | - CT Oliveria
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
| | - B Heinrich
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
| | - SM Stemmer
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
| | - C Mala
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
| | - S Selder
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
| | - P Bevan
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
| | - N Harbeck
- Fox Chase Cancer Center, Philadelphia, PA; Instituto Brasilerio Controle Cancer, Sao Paulo, Brazil; Hamatologisch-Onkologische-Praxis Augsburg, Augsburg, Germany; Rabin Medical Center, Petah Tikva, Israel; Wilex, Munich, Germany; Univeristy of Munich, Munich, Germany
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16
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Lang I, Inbar MJ, Kahán Z, Greil R, Beslija S, Stemmer SM, Kaufman B, Zvirbule Z, Steger GG, Messinger D, Brodowicz T, Zielinski C. Safety results from a phase III study (TURANDOT trial by CECOG) of first-line bevacizumab in combination with capecitabine or paclitaxel for HER-2-negative locally recurrent or metastatic breast cancer. Eur J Cancer 2012; 48:3140-9. [PMID: 22640829 DOI: 10.1016/j.ejca.2012.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/30/2012] [Accepted: 04/28/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND We report safety data from a randomised, phase III study (CECOG/BC.1.3.005) evaluating first-line bevacizumab plus paclitaxel or capecitabine for locally recurrent or metastatic breast cancer. PATIENTS AND METHODS Patients aged ≥18 years with human epidermal growth factor receptor-2-negative breast adenocarcinoma were randomised to Arm A: bevacizumab 10 mg/kg days 1 and 15; paclitaxel 90 mg/m(2) days 1, 8, and 15, every 4 weeks; or Arm B: bevacizumab 15 mg/kg day 1; capecitabine 1000 mg/m(2) b.i.d., days 1-14, every 3 weeks, until disease progression, unacceptable toxicity or consent withdrawal. RESULTS A post hoc interim safety analysis included 561 patients (Arm A: 284, Arm B: 277). The regimens demonstrated similar frequencies of all-grade and serious adverse events (SAEs), but different safety profiles. Treatment-related events occurred in 85.2% (Arm A) and 78.0% (Arm B) of patients. Fatigue was most common in Arm A (30.6% versus 23.5% Arm B), and hand-foot syndrome (HFS) most common in Arm B (49.5% versus 2.5% Arm A). Diarrhoea (Arm A: 0.4%, Arm B: 1.4%) and pulmonary embolism (Arm A: 0.7%, Arm B: 1.1%) were the most frequently reported SAEs. CONCLUSION These findings are in-line with safety data for bevacizumab plus paclitaxel or capecitabine, reported in previous phase III trials.
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Affiliation(s)
- I Lang
- National Institute of Oncology, Oncology Department, Budapest, Hungary.
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17
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Saad F, Brown JE, Van Poznak C, Ibrahim T, Stemmer SM, Stopeck AT, Diel IJ, Takahashi S, Shore N, Henry DH, Barrios CH, Facon T, Senecal F, Fizazi K, Zhou L, Daniels A, Carrière P, Dansey R. Incidence, risk factors, and outcomes of osteonecrosis of the jaw: integrated analysis from three blinded active-controlled phase III trials in cancer patients with bone metastases. Ann Oncol 2012; 23:1341-1347. [PMID: 21986094 DOI: 10.1093/annonc/mdr435] [Citation(s) in RCA: 477] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Osteonecrosis of the jaw (ONJ) has been reported in patients receiving bisphosphonates for metastatic bone disease. ONJ incidence, risk factors, and outcomes were evaluated in a combined analysis of three phase III trials in patients with metastatic bone disease receiving antiresorptive therapies. PATIENTS AND METHODS Patients with bone metastases secondary to solid tumors or myeloma were randomly assigned to receive either s.c. denosumab (120 mg) or i.v. zoledronic acid (4 mg) every 4 weeks. On-study oral examinations were conducted by investigators at baseline and every 6 months. Oral adverse events were adjudicated by an independent blinded committee of dental experts. RESULTS Of 5723 patients enrolled, 89 (1.6%) patients were determined to have ONJ: 37 (1.3%) received zoledronic acid and 52 (1.8%) received denosumab (P = 0.13). Tooth extraction was reported for 61.8% of patients with ONJ. ONJ treatment was conservative in >95% of patients. As of October 2010, ONJ resolved in 36.0% of patients (29.7% for zoledronic acid and 40.4% for denosumab). CONCLUSIONS In this combined analysis of three prospective trials, ONJ was infrequent, management was mostly conservative, and healing occurred in over one-third of the patients. Educating physicians about oral health before and during bone-targeted therapy may help reduce ONJ incidence and improve outcomes.
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Affiliation(s)
- F Saad
- Department of Urology, University of Montreal Montreal, Canada.
| | - J E Brown
- Cancer Research UK Clinical Centre, University of Leeds, Leeds, UK
| | - C Van Poznak
- Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
| | - T Ibrahim
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - S M Stemmer
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, Israel
| | - A T Stopeck
- Department of Medicine, University of Arizona, Arizona Cancer Center, Tucson, USA
| | - I J Diel
- Institute for Gynecologic Oncology, Center for Comprehensive Gynecology, Mannheim, Germany
| | - S Takahashi
- The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - N Shore
- Carolina Urologic Research Center, Myrtle Beach
| | - D H Henry
- Joan Karnell Cancer Center, Pennsylvania Hospital, Philadelphia, USA
| | - C H Barrios
- Internal Medicine Department, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Rio Grande do Sul, Brazil
| | - T Facon
- Department of Blood Diseases, Hôpital Claude Huriez, Lille, France
| | - F Senecal
- Northwest Medical Specialties Tacoma, USA
| | - K Fizazi
- Department of Medicine, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
| | - L Zhou
- Global Biostatistical Sciences
| | | | | | - R Dansey
- Clinical Development, Amgen Inc., Thousand Oaks, USA
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18
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Hamama-Raz Y, Perry S, Pat-Horenczyk R, Bar-Levav R, Stemmer SM. Factors affecting participation in group intervention in patients after adjuvant treatment for early-study breast cancer. Acta Oncol 2012; 51:208-14. [PMID: 22263971 DOI: 10.3109/0284186x.2011.648339] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE According to studies of patients with cancer, support groups can help in three areas: 1) improve mood; 2) introduce new, adaptive ways of handling potentially difficult situations; and 3) impart strategies for managing stress. Nevertheless, the decrease in the quality of life of cancer patients or survivors does not always translate into their utilization of available psychosocial services. The aim of the current study was to explore the factors affecting the decision of patients with breast cancer to participate in group intervention based on an enhancing-resilience approach. METHODS One hundred eighty-nine patients who were diagnosed with early-stage breast cancer at a tertiary hospital and had completed adjuvant therapy at least three months previously were asked to enroll in the study with or without group intervention. One hundred and one (53.4%) completed the battery of psychological questionnaires, of whom 56 agreed to participate in the intervention. Sociodemographic and medical data were collected for all 189 subjects from the medical files. RESULTS No significant differences in sociodemographic or medical data were found between intervention-group participants (N = 56) and non-participants (N = 133). Group participants reported significantly higher levels of psychological pathology. Subjects who completed the questionnaires but did not participate in the intervention reported significantly higher levels of positive cognitive emotion regulation and flexibility than participants. CONCLUSION Low participation in group interventions may be more strongly associated with psychological characteristics than sociodemographic and medical factors. It seems that patients know to perceive whether their personal resources are inadequate for facing a life-threatening illness. Like individual therapy, group interventions should be more sensitive to perceived individual needs and to the art of tailoring suitable contents according individual needs.
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Affiliation(s)
- Yaira Hamama-Raz
- School of Social Work, Ariel University Center of Samaria, Israel.
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19
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Beslija S, Brodowicz T, Greil R, Inbar MJ, Kahán Z, Kaufman B, Lang I, Steger GG, Stemmer SM, Zielinski C, Zvirbule Z. OT2-01-02: First-Line Bevacizumab in Combination with Capecitabine or Paclitaxel for HER2−Negative Locally Recurrent or Metastatic Breast Cancer (LR/MBC): A Randomized Phase III Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot2-01-02] [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
Background
A number of phase III studies have shown significant progression-free survival (PFS) benefits with the combination of bevacizumab (Bev) and either first-line capecitabine (X) or taxane therapy in LR/MBC. The ongoing open-label, randomized, phase III CECOG-sponsored TURANDOT study (CECOG/BC.1.3.005) is investigating the efficacy and safety of first-line Bev plus paclitaxel (P) versus Bev plus X in this setting.
Materials and methods: Eligible patients (pts) are aged ≥18 years with HER2−negative, chemonaïve LR/MBC, an ECOG performance status of 0–2 and a life expectancy >12 weeks. Prior chemotherapy and concomitant hormonal therapy for LR/MBC are not permitted, but prior (neo)adjuvant chemotherapy is allowed if completed ≥6 months before randomization or ≥12 months if taxane based. Pts are randomized to receive Bev 10mg/kg days 1, 15 plus P 90mg/m2 days 1, 8, 15, q28d (Arm A) or Bev 15mg/kg day 1 plus X 1,000mg/m2 bid days 1–14, q21d (Arm B) until disease progression, unacceptable toxicity or withdrawal of consent. The primary objective is to demonstrate non-inferiority in overall survival (OS) with Bev plus P versus Bev plus X (upper limit ≤1.33 for the two-sided confidence interval for hazard ratio [HR]). Secondary objectives are: comparison of overall response rate (RECIST criteria); PFS; time to response; duration of response; time to treatment failure; safety (CTCAE version 3); and quality of life (EORTC QLQ-30). The recruitment target is 560 pts. A sample size of 490 pts in the per-protocol population will be required to provide 80% power to reject the null hypothesis of inferiority at a one-sided significance level of 0.025, assuming a 24-month median OS with Bev plus P and an alternative hypothesis of HR=1. Data cut-off for adverse event reports was 12 Apr 2010. Interim and final efficacy analyses will be triggered after 175 and 389 events, respectively.
Results: Recruitment to the study began in Sep 2008 and was completed in Aug 2010, with 561 pts randomized. Follow-up is ongoing.
Conclusions: TURANDOT is the first study to examine the efficacy and safety of Bev plus P versus Bev plus X as first-line treatment for pts with LR/MBC.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-01-02.
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Affiliation(s)
- S Beslija
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - T Brodowicz
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - R Greil
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - MJ Inbar
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Z Kahán
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - B Kaufman
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - I Lang
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - GG Steger
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - SM Stemmer
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - C Zielinski
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Z Zvirbule
- 1The CECOG TURANDOT Trialists. Institute of Oncology, Sarajevo, Bosnia and Herzegovina; Medical University of Vienna, Vienna, Austria; University Hospital Salzburg, Salzburg, Austria; Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; University of Szeged, Szeged, Hungary; Sheba Medical Center, Tel Hashomer, Israel; National Institute of Oncology, Budapest, Hungary; Rabin Medical Center, Petah Tikva, Israel; Riga Eastern Clinical University Hospital, Riga, Latvia
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Cohen S, Stemmer SM, Zozulya G, Ochaion A, Patoka R, Barer F, Bar-Yehuda S, Rath-Wolfson L, Jacobson KA, Fishman P. CF102 an A3 adenosine receptor agonist mediates anti-tumor and anti-inflammatory effects in the liver. J Cell Physiol 2011; 226:2438-47. [PMID: 21660967 DOI: 10.1002/jcp.22593] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The Gi protein-associated A(3) adenosine receptor (A(3) AR) is a member of the adenosine receptor family. Selective agonists at the A(3) AR, such as CF101 and CF102 were found to induce anti-inflammatory and anti-cancer effects. In this study, we examined the differential effect of CF102 in pathological conditions of the liver. The anti-inflammatory protective effect of CF101 was tested in a model of liver inflammation induced by Concanavalin A (Con. A) and the anti-cancer effect of CF102 was examined in vitro and in a xenograft animal model utilizing Hep-3B hepatocellular carcinoma (HCC) cells. The mechanism of action was explored by following the expression levels of key signaling proteins in the inflamed and tumor liver tissues, utilizing Western blot (WB) analysis. In the liver inflammation model, CF102 (100 µg/kg) markedly reduced the secretion of serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase in comparison to the vehicle-treated group. Mechanistically, CF102 treatment decreased the expression level of phosphorylated glycogen synthase kinase-3β, NF-κB, and TNF-α and prevented apoptosis in the liver. This was demonstrated by decreased expression levels of Fas receptor (FasR) and of the pro-apoptotic proteins Bax and Bad in liver tissues. In addition, CF102-induced apoptosis of Hep-3B cells both in vitro and in vivo via de-regulation of the PI3K-NF-κB signaling pathway, resulting in up-regulation of pro-apoptotic proteins. Taken together, CF102 acts as a protective agent in liver inflammation and inhibits HCC tumor growth. These results suggest that CF102 through its differential effect is a potential drug candidate to treat various pathological liver conditions.
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Affiliation(s)
- S Cohen
- Can-Fite BioPharma Ltd., Kiryat-Matalon, Petach-Tikva, Israel
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Yerushalmi R, Kramer MR, Rizel S, Sulkes A, Gelmon K, Granot T, Neiman V, Stemmer SM. Decline in pulmonary function in patients with breast cancer receiving dose-dense chemotherapy: a prospective study. Ann Oncol 2009; 20:437-40. [PMID: 19139179 DOI: 10.1093/annonc/mdn652] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prompted by complaints of dyspnea in breast cancer patients receiving adjuvant dose-dense chemotherapy (DDC), we sought to evaluate the possible association of DDC with pulmonary dysfunction. PATIENTS AND METHODS A total of 34 consecutive patients receiving adjuvant DDC were enrolled. The chemotherapy regimen consisted of i.v. doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) (AC) every 14 days x4 with growth factor support followed by weekly i.v. paclitaxel 80 mg/m(2) x12. The following parameters were prospectively measured before and after the AC protocol (P1, P2) and at completion of paclitaxel treatment (P3): presence of dyspnea, blood pressure, pulse rate, hemoglobin, erythrocyte sedimentation rate, C-reactive protein level, cardiac ejection fraction, and pulmonary function. Repeated measures analysis was used to evaluate differences among the time points, and paired t-test was used to evaluate differences between consecutive time points. RESULTS Although only five patients (15%) complained of dyspnea, there was a significant decrease in mean carbon monoxide diffusing capacity (DLCO), in all patients from P1 (22.09 ml/min/mmHg) to P3 (15 ml/min/mmHg) and in 29 of 32 patients (90.6%) from P1 to P2 (15.96 ml/min/mmHg) (P<0.001). CONCLUSIONS DDC is associated with a statistical significant reduction in DLCO. Awareness of this potential toxicity may be important in women with preexisting lung disease.
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Affiliation(s)
- R Yerushalmi
- Institute of Oncology, Davidoff Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Bar-Yehuda S, Stemmer SM, Madi L, Castel D, Ochaion A, Cohen S, Barer F, Zabutti A, Perez-Liz G, Del Valle L, Fishman P. The A3 adenosine receptor agonist CF102 induces apoptosis of hepatocellular carcinoma via de-regulation of the Wnt and NF-kappaB signal transduction pathways. Int J Oncol 2008; 33:287-295. [PMID: 18636149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The A3 adenosine receptor (A(3)AR) is highly expressed in tumors and was suggested as a target for cancer treatment. In this study, we show that A(3)AR is highly expressed in tumor tissues and in peripheral blood mononuclear cells (PBMCs) derived from patients with HCC, as well as from HCC tumor-bearing rats. The high expression level of the receptor was directly correlated to overexpression of NF-kappaB, known as a transcription factor of A(3)AR. CF102, a synthetic highly selective agonist to A(3)AR induced a marked dose response inhibition of tumor growth in N1S1 HCC tumor rats, via de-regulation of the NF-kappaB and the Wnt signal transduction pathways, resulting in apoptosis of tumor cells. Taken together, A(3)AR is highly expressed in tumors and PBMCs of HCC patients and tumor-bearing rats. CF102 induced apoptosis and tumor growth inhibition. These data suggest A(3)AR as a novel targeted therapy to treat HCC.
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Affiliation(s)
- S Bar-Yehuda
- Can-Fite BioPharma Ltd., Kiryat-Matalon, Petach-Tikva 49170, Israel
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Grossman A, Gafter-Gvili A, Green H, Ben Aharon I, Stemmer SM, Molad Y, Krause I. Severe digital ischemia–a presenting symptom of malignancy–associated antiphospholipid syndrome. Lupus 2008; 17:206-9. [DOI: 10.1177/0961203307086235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The association of the antiphospholipid syndrome with malignancy has been extensively reported. Raynaud’s phenomenon has also been reported to be associated with various malignancies. In this report, we describe two patients who presented with severe digital ischemia mimicking Raynaud’s phenomenon. The patients were found to have antiphospholipid syndrome, and upon extensive evaluation, a diagnosis of a malignancy was made. This report highlights the importance of malignancy workup in patients with severe digital ischemia associated with antiphospholipid syndrome.
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Affiliation(s)
- A Grossman
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - A Gafter-Gvili
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - H Green
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - I Ben Aharon
- Davidoff Comprehensive Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Faculty of Medicine School, Tel Aviv University, Tel Aviv, Israel
| | - SM Stemmer
- Davidoff Comprehensive Cancer Center, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Faculty of Medicine School, Tel Aviv University, Tel Aviv, Israel
| | - Y Molad
- Unit of Rheumatology, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - I Krause
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tikva Israel. Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Schmilovitz-Weiss H, Stemmer SM, Liberzon E, Avigad S, Sulkes J, Belinki A, Kazatsker A, Ben-Ari Z. Quantitation of alpha-fetoprotein messenger RNA for early detection of recurrent hepatocellular carcinoma: A prospective pilot study. ACTA ACUST UNITED AC 2006; 30:204-9. [PMID: 16638626 DOI: 10.1016/j.cdp.2005.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/14/2005] [Accepted: 12/09/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Alpha-fetoprotein (AFP) messenger RNA (mRNA) may be a potential marker of the dissemination of hepatocellular carcinoma (HCC) cells into the circulation. The aim of this prospective pilot study was to assess the prognostic value of quantitative levels of AFP mRNA in patients undergoing ablative treatment for HCC. METHODS Peripheral blood samples were taken from seven patients before and after treatment for measurement of AFP mRNA levels by reverse-transcriptase polymerase chain reaction (RT-PCR). Patients were treated with percutaneous radiofrequency thermal ablation (n=3) or transarterial chemoembolization (n=4). The level of AFP mRNA in blood was serially determined, and the time course was related to the clinical course and disease outcome. The median duration of follow-up was 14 months (range, 9-16 months). RESULTS HCC recurred locally in four patients, and lung metastases developed in two of them. Patients were divided into three groups on the basis of the pre- and post-treatment AFP mRNA status. Group 1 included four patients with consistently high serum AFP and AFP mRNA levels (pre- and post-treatment). These patients developed distant and local recurrence. Group 2 included a patient with serum-negative AFP mRNA and normal AFP levels at entry. Although serum AFP remained within normal range, mean AFP mRNA increased from 10 to 95 copies/microg RNA. This patient had no distant metastases, but his tumor markedly increased in size. In Group 3, AFP mRNA and serum AFP remained within normal range before and after treatment. These two patients did not develop either local or distant metastases during the follow-up period. CONCLUSIONS Although this is a small sample size pilot study these findings imply that quantitative measurement of AFP-expressing cells in peripheral blood may serve as a marker of HCC recurrence.
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Affiliation(s)
- H Schmilovitz-Weiss
- Tel Aviv University, Rabin Medical Center, Sackler School of Medicine, Gastroenterology Unit, Hasharon-Golda Campus, Petah Tiqwa, Tel Aviv 49372, Israel.
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Stemmer SM, Hardan I, Raz H, Adamou AK, Inbar M, Gottfried M, Merrick Y, Cohen Y, Sulkes A, Ben-Baruch N, Pfeffer RP, Brenner HJ, Rizel S. Adjuvant treatment of high-risk stage II breast cancer with doxorubicin followed by high-dose chemotherapy and autologous stem-cell transplantation: a single-institution experience with 132 consecutive patients. Bone Marrow Transplant 2003; 31:655-61. [PMID: 12692605 DOI: 10.1038/sj.bmt.1703856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several studies have shown conflicting results with the use of intensive consolidation chemotherapy for breast cancer. The aim of the present study was to investigate the efficacy, feasibility and toxicity of high-dose chemotherapy with stem cell support in patients with high-risk stage II breast cancer. From February 1994 to November 1998, 132 consecutive patients with multinode positive breast cancer were entered to the study. In total, 86 patients had >or=10 positive axillary lymph nodes, and 46 had 4-9 positive axillary lymph nodes with at least two additional predetermined risk factors at diagnosis. All patients were offered adjuvant chemotherapy (doxorubicin, 75 mg/m(2) x 4) followed by high-dose chemotherapy (cyclophosphamide 6000 mg/m(2), carboplatin 800 mg/m(2) and thio-tepa 500 mg/m(2)) and autologous stem cell support with growth factor. In all, 131 patients also received local radiation therapy and tamoxifen based on receptor status. After a median follow-up of 51 months (range 27-87), the disease-free and overall survival rates were 72 and 81%, respectively. There was no difference in the outcome for high-risk patients with > or < than 10 positive axillary lymph nodes. On Cox regression analysis only progesterone receptor status was predictive of disease-free, but not overall survival. There were no treatment-related deaths; grades III-IV toxicity was relatively low. This combined approach of doxorubicin followed by high-dose chemotherapy and stem-cell support, followed by locoregional radiotherapy, was safe and seems to be effective in patients with multinode positive stage II breast cancer. In previous trials of adjuvant high-dose therapy in this patient population, treatment-related morbidity and mortality markedly influenced the outcome. For this high-risk patient population, further testing of intensive chemotherapy regimens with a lower toxicity profile is warranted.
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Affiliation(s)
- S M Stemmer
- Department of Oncology and Radiotherapy, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Stemmer SM, Pfeffer MR, Rizel S, Hardan I, Goffman J, Gezin A, Neumann A, Kitsios P, Alezra D, Brenner HJ. Feasibility and low toxicity of early radiotherapy after high-dose chemotherapy and autologous stem cell transplantation for patients with high-risk stage II-III and locally advanced breast carcinoma. Cancer 2001; 91:1983-91. [PMID: 11391576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND This prospective trial examined the feasibility, toxicity, and effectiveness of early locoregional radiotherapy after high-dose chemotherapy and autologous stem cell transplantation in patients with high-risk American Joint Committee on Cancer (AJCC) Stage II-III and locally advanced breast carcinoma. METHODS One hundred forty-seven consecutive patients with high-risk and locally advanced breast carcinoma were included in the current study. All patients received induction chemotherapy with a doxorubicin-based therapy, which was consolidated with high-dose cyclophosphamide, carboplatin, and thiotepa followed by autologous stem cell support. Within 50 days of the transplant, the patients were treated with locoregional radiotherapy that included the chest wall or breast, the axilla and supraclavicular area, and the internal mammary chain. The volume of lung included in the treatment volume was kept to a minimum. The central lung distance of the tangential fields ranged from 0.6-2.0 cm (mean, 1.1 cm). Tamoxifen was given based on receptor status. RESULTS One hundred forty-six of 147 patients received the planned treatment. Only six patients had a delay in the initiation of radiotherapy, and another 16 patients had delays during radiotherapy. Leukocyte and platelet toxicities during radiotherapy were not life-threatening and blood counts thereafter returned to normal. Grade 2 (according to National Cancer Institute Common Toxicity Criteria) skin toxicity occurred in 22% of patients and Grade 3 skin toxicity occurred in 6% of patients. Radiation pneumonitis was reported to occur in 5 patients (< 4%). After a median follow-up of 36 months from diagnosis (range, 6-64 months), there were no long-term organ toxicity and no secondary malignancy reported. No treatment-related deaths were reported. Three patients (< 3%) developed locoregional recurrence. CONCLUSIONS Locoregional radiotherapy after high-dose chemotherapy and autologous stem cell transplantation appears to be feasible and can be delivered safely within 10 weeks of transplantation. The short-term and long-term toxicity are reported to be low, with good local control.
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Affiliation(s)
- S M Stemmer
- Bone Marrow Transplant Service, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Stemmer SM. Current progress in early pregnancy investigation. Early Pregnancy (Cherry Hill) 2001; 5:149-52. [PMID: 11753528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Stemmer SM. Current progress in early pregnancy investigation. Early Pregnancy (Cherry Hill) 2001; 5:4-8. [PMID: 11743627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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30
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Stemmer SM. Current progress in early pregnancy investigation. Early Pregnancy (Cherry Hill) 2000; 4:214-8. [PMID: 11727014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Feigin R, Greenberg A, Ras H, Hardan Y, Rizel S, Ben Efraim T, Stemmer SM. The psychosocial experience of women treated for breast cancer by high-dose chemotherapy supported by autologous stem cell transplant: a qualitative analysis of support groups. Psychooncology 2000; 9:57-68. [PMID: 10668060 DOI: 10.1002/(sici)1099-1611(200001/02)9:1<57::aid-pon434>3.0.co;2-c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Autologous bone marrow transplantation (AuBMT) is probably among the most aggressive of physical treatments endured by cancer patients. High-risk breast cancer patients who choose this therapy face prolonged, agonizing and life-threatening interventions that are no less arduous than confronting the malignant disease itself. The study, which aimed to broadening our understanding of the psychosocial impact and the implications of AuBMT, presents a protocol analysis of group support intervention in 45 recipients (eight to ten women in five groups). The sessions were held at the Transplant Department at the Chaim Sheba Medical Center. The contribution of group support to the healing process was examined. The findings show that recovery was affected by a wide range of psychosocial factors, specifically highlighting the impact of transplantation and survival on five domains, viz. physical, psychological/emotional, vocational, social and family/spousal intimacy. Illness and treatment management is also discussed. The support generated by the group, both individually and collectively, was found to contribute significantly to the spectrum of resources available to the participants.
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Affiliation(s)
- R Feigin
- Bob Shapell School of Social Work, Tel Aviv University, Ramat-Aviv, Tel Aviv, Israel.
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Stemmer SM. Current clinical progress in early pregnancy investigation. Early Pregnancy (Cherry Hill) 2000; 4:74-81. [PMID: 11719824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Johnson DW, Cagnoni PJ, Schossau TM, Stemmer SM, Grayeb DE, Baron AE, Shpall EJ, Bearman SI, McDermitt J, Jones RB. Optic disc and retinal microvasculopathy after high-dose chemotherapy and autologous hematopoietic progenitor cell support. Bone Marrow Transplant 1999; 24:785-92. [PMID: 10516683 DOI: 10.1038/sj.bmt.1701913] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to prospectively evaluate the retinal and optic nerve changes in patients undergoing high-dose chemotherapy (HDC) followed by autologous hematopoietic progenitor cell support (AHPCS). One hundred and forty patients undergoing HDC and AHPCS underwent extensive pre- and post-transplant ophthalmologic evaluations for development of retinal microvascular complications. One hundred and ten patients received high-dose cyclophosphamide, cisplatin and BCNU; thirty received identical doses of cyclophosphamide and cisplatin, but received paclitaxel instead of BCNU. Thirty-four patients (24%) had retinal findings of either cotton wool spots (CWS) (n = 20) or retinal hemorrhages (n = 18) during follow-up, which ranged from 1 to 12 months. Ten (7%) of these patients, all of whom received BCNU, showed ocular toxicity characterized by CWS 1 to 4 months post transplant (n = 10); optic disc edema (n = 3); and variable vision loss associated with the onset of BCNU-induced pulmonary toxicity. Retinal and optic disc microvascular complications may occur after high-dose chemotherapy followed by AHPCS. The association of ischemic retinal lesions and/or optic disc edema with BCNU-induced pulmonary toxicity and the lack of ocular toxicity in patients that did not receive BCNU may suggest that BCNU is the etiologic agent.
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Affiliation(s)
- D W Johnson
- Department of Ophthalmology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA
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Brown MS, Stemmer SM, Simon JH, Stears JC, Jones RB, Cagnoni PJ, Sheeder JL. White matter disease induced by high-dose chemotherapy: longitudinal study with MR imaging and proton spectroscopy. AJNR Am J Neuroradiol 1998; 19:217-21. [PMID: 9504468 PMCID: PMC8338197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to determine the time course for development of white matter changes induced by high-dose chemotherapy. METHODS Eight patients with advanced breast cancer were entered into a prospective, longitudinal trial that included examination by MR imaging and proton MR spectroscopy before chemotherapy and through 12 months after treatment with carmustine, cyclophosphamide, and cisplatin, combined with autologous hematopoietic progenitor cell support (AHPCS). RESULTS Six patients completed induction chemotherapy, at which time all MR imaging studies appeared normal. At 3 months after the conclusion of high-dose chemotherapy and beyond, three of the four patients remaining in the study showed an increasing volume of white matter changes, which appeared to stabilize during the period from 6 months to 1 year. Maximal volumes of abnormal white matter ranged from 73 to 166 cm3. MR spectroscopy showed little or no change in metabolic ratios through the period of observation, although there was a suggestion of small transient treatment-related decreases in the ratio of N-acetyl aspartate (NAA) to creatine. CONCLUSION White matter changes are common sequelae of treatment with high-dose chemotherapy combined with AHPCS, occurring early in the period following high-dose chemotherapy, with a rapid and progressive accumulation to about 6 months, but not accompanied by persistent neurologic symptoms. The MR spectroscopic analyses suggest a minimal disturbance of the neuronal marker NAA, a finding that may in part explain the good neurologic outcome.
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Affiliation(s)
- M S Brown
- Department of Radiology, University of Colorado Health Sciences Center, Denver 80262, USA
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Stemmer SM, Cagnoni PJ, Shpall EJ, Bearman SI, Matthes S, Dufton C, Day T, Taffs S, Hami L, Martinez C, Purdy MH, Arron J, Jones RB. High-dose paclitaxel, cyclophosphamide, and cisplatin with autologous hematopoietic progenitor-cell support: a phase I trial. J Clin Oncol 1996; 14:1463-72. [PMID: 8622060 DOI: 10.1200/jco.1996.14.5.1463] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To determine the maximal-tolerated dose (MTD) of paclitaxel in combination with high-dose cyclophosphamide (CPA) and cisplatin (cDDP) followed by autologous hematopoietic progenitor-cell support (AHPCS). PATIENTS AND METHODS Forty-nine patients with poor-prognosis breast cancer, non-Hodgkin's lymphoma (NHL), or ovarian cancer were treated with escalating doses of paclitaxel infused over 24 hours, followed by CPA (5,625 mg/m2 intravenously over 1 hour in three divided doses) and cDDP (165 mg/m2 intravenously as a continuous infusion over 72 hours) and AHPCS. Pharmacokinetic measurements for each drug were performed. RESULTS Dose-limiting toxicities were encountered in two patients at 825 mg/m2 of paclitaxel; one patient died of multiorgan failure that involved the lung, CNS, and kidneys, and the other developed grade 3 respiratory, CNS, and renal toxicity, which resolved. The MTD of this combination was determined to be paclitaxel 775 mg/m2, CPA 5,625 mg/m2, and cDDP 165 mg/m2 followed by AHPCS. Sensory polyneuropathy and mucositis were prominent toxicities, but both were reversible and tolerable. The pharmacokinetics of paclitaxel correlated significantly with the severity of mucositis (P < .001) and peripheral neuropathy (P < .00004). Eighteen of 33 patients (54%) with measurable, heavily pretreated metastatic breast cancer achieved a partial response (PR). Responses were also observed in patients with NHL (four of five patients) and ovarian cancer (two of two). CONCLUSION It is possible to escalate the dose of paclitaxel to 775 mg/m2 in combination with 5,625 mg/m2 of CPA, 165 mg/m2 of cDDP, and AHPCS. An encouraging response rate in poor-prognosis patients with breast cancer, NHL, and ovarian cancer warrants further study.
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Affiliation(s)
- S M Stemmer
- University of Colorado Bone Marrow Transplant Program, University of Colorado Cancer Center, Denver, USA
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36
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Abraham BB, Hardan I, Segal E, Stemmer SM, Perel A. Respiratory failure and intensive care treatment in bone marrow-transplanted patients. Intensive Care Med 1996; 22:269-70. [PMID: 8727445 DOI: 10.1007/bf01712250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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37
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Schrier DM, Stemmer SM, Johnson T, Kasliwal R, Lear J, Matthes S, Taffs S, Dufton C, Glenn SD, Butchko G. High-dose 90Y Mx-diethylenetriaminepentaacetic acid (DTPA)-BrE-3 and autologous hematopoietic stem cell support (AHSCS) for the treatment of advanced breast cancer: a phase I trial. Cancer Res 1995; 55:5921s-5924s. [PMID: 7493371] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This Phase I trial explores the use of high-dose 90Y conjugated to the antibreast cancer monoclonal antibody BrE-3 and autologous hematologic cell support in the treatment of women with stage four breast cancer. Nine women with heavily pretreated disease were enrolled. All of the patients had BrE-3-positive tumors by immunostaining and were treated with increasing doses of 90Y (15 mCi/m2, 3 patients), 20 mCi/M2 (six patients), and a fixed (50 mg) dose of BrE-3. 111In-labeled BrE-3 (5 mCi) was given simultaneously for scanning purposes. The only toxicity noted was hematological. Grade 4 platelet toxicity requiring transfusion support occurred in four patients. Grade 4 WBC toxicity was seen in two patients that resolved in 3-9 days. All hematological nadirs occurred approximately 25 days after treatment. Objective partial responses were noted in 4 of 8 (50%) patients with measurable tumors. Dose escalation is ongoing.
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Affiliation(s)
- D M Schrier
- Bone Marrow Transplant Program, University of Colorado Health Sciences Center, Denver 80262, USA
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38
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Brown MS, Simon JH, Stemmer SM, Stears JC, Scherzinger A, Cagnoni PJ, Jones RB. MR and proton spectroscopy of white matter disease induced by high-dose chemotherapy with bone marrow transplant in advanced breast carcinoma. AJNR Am J Neuroradiol 1995; 16:2013-20. [PMID: 8585489 PMCID: PMC8337223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine whether the MR-detectable white matter changes associated with high-dose chemotherapy and bone marrow transplant in patients with advanced breast carcinoma are accompanied by neurochemical disturbances detectable by proton MR spectroscopy. METHODS MR studies were obtained in 13 patients, and single-voxel proton MR spectra were acquired in vivo in 12 of these 13 for comparison with 13 age- and sex-matched control subjects. RESULTS Considerable white matter change determined with MR was found in 10 of 13 patients with volume white matter change ranging from 1 to 153 cm3 (mean, 49 cm3; SD, 50 cm3). Single-voxel spectra successfully acquired in 12 patients revealed no significant difference in patients compared with control subjects for the spectral ratios N-acetyl aspartate to creatine or N-acetyl aspartate to choline at either short or long echo times (30 and 136 milliseconds). CONCLUSION Extensive, late-stage white matter change induced by high-dose chemotherapy is not accompanied by measurable disturbances in the putative neuronal marker N-acetyl aspartate, suggesting that chemotherapy-induced white matter disease is predominantly a water space and possibly an extraneuronal process rather than a primary neuronal (axonal) disease. The MR spectroscopic examination, accomplished at the time of the MR imaging examination, complements the MR imaging study by increasing the specificity of the MR-based clinical evaluation.
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Affiliation(s)
- M S Brown
- Department of Radiology, University of Colorado Health Sciences Center, Denver 80262, USA
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39
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Stemmer SM, Stears JC, Burton BS, Jones RB, Simon JH. White matter changes in patients with breast cancer treated with high-dose chemotherapy and autologous bone marrow support. AJNR Am J Neuroradiol 1994; 15:1267-73. [PMID: 7976937 PMCID: PMC8332441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To study MR changes in the white matter of the brain in patients with breast cancer treated with a widely used protocol of high-dose chemotherapy and autologous bone marrow support. METHODS Thirteen patients with high-risk stage II or stage IV breast cancer treated with high-dose cyclophosphamide, cisplatin, carmustine, and bone marrow support underwent posttransplant MR examination of the brain. Serial posttransplant MR examinations were performed in 5 of the 13 patients and single MR examinations in 8. The severity of the white matter change was evaluated by two neuroradiologists and rated mild, moderate, or severe. RESULTS In 9 of the 13 patients, central and peripheral cerebral white matter changes were observed. Four patients had severe changes, extending from the ependyma of the lateral ventricles to the gyri. An additional 4 patients had moderate white matter change at the last observation. One had mild change, and 4 had no white matter change. In all patients, there was sparing of inferior frontal, posterior inferior occipital, and anterior temporal lobes, and of the centrosylvian brain. CONCLUSIONS White matter change occurred in patients treated with a high-dose chemotherapy and bone marrow support protocol. Most of the changes, and the more severe ones, occurred 5 or more months after the transplants. There was no apparent relationship between these changes and central nervous system function. Because of the increased longevity with this treatment, it is important to appreciate these white matter changes, recognizing however that their expression may be subclinical.
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Affiliation(s)
- S M Stemmer
- Department of Radiology, University of Colorado School of Medicine, Denver 80262
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40
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Bitter MA, Fiorito D, Corkill ME, Huffer WE, Stemmer SM, Shpall EJ, Archer PG, Franklin WA. Bone marrow involvement by lobular carcinoma of the breast cannot be identified reliably by routine histological examination alone. Hum Pathol 1994; 25:781-8. [PMID: 7520018 DOI: 10.1016/0046-8177(94)90247-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aims of this study were twofold: (1) to evaluate the ability of pathologists to recognize infiltration of bone marrow core biopsy specimens by breast carcinoma, particularly lobular carcinoma, using routine hematoxylin-eosin (HE) sections; and (2) if indicated, to determine the reasons for difficulties in diagnosis. Thirty-six bone cores obtained before bone marrow harvest were involved by breast carcinoma and were confirmed by pancytokeratin immunostains. Thirty of the 36 were ductal carcinomas and six were lobular carcinomas. Fourteen negative bone core biopsy specimens (from patients with breast cancer or lymphoma) were included as controls. These 50 bone cores were reviewed by three surgical pathologists. Lobular carcinoma was correctly identified in only 39% of positive specimens as compared with 88% for ductal carcinoma. After instruction, sensitivity for the detection of lobular carcinoma improved to 61% but at the expense of an unacceptably high rate of false-positive diagnoses (18%). None of the three pathologists was able to achieve both high sensitivity and high specificity in recognizing lobular carcinoma in the bone marrow. Lobular carcinoma was difficult to detect because of tumor cell size similar to hematopoietic cells, infiltration as single cells, presence of bland cytological features, and paucity of tissue reaction to the tumor. Although the number of cases of bone marrow involved by lobular carcinoma is small, these findings suggest that pancytokeratin stains should be performed routinely in the evaluation of bone core biopsy specimens from patients with lobular carcinoma, and probably from patients with ductal carcinoma whose HE-stained bone core biopsy specimens are considered negative for tumor.
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Affiliation(s)
- M A Bitter
- Department of Pathology, University of Colorado Health Sciences Center, Denver 80262
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41
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Shpall EJ, Stemmer SM, Hami L, Franklin WA, Shaw L, Bonner HS, Bearman SI, Peters WP, Bast RC, McCulloch W. Amifostine (WR-2721) shortens the engraftment period of 4-hydroperoxycyclophosphamide-purged bone marrow in breast cancer patients receiving high-dose chemotherapy with autologous bone marrow support. Blood 1994; 83:3132-7. [PMID: 8193351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
4-Hydroperoxycyclophosphamide (4-HC), a commonly used marrow-purging agent, is active against many tumors, but is also toxic to normal marrow progenitors. Amifostine (WR-2721) is a sulfhydryl compound with chemoprotectant activity. Preclinical studies using suspensions of bone marrow and breast cancer cells demonstrated that ex vivo treatment with amifostine followed by 4-HC resulted in protection of marrow progenitors, with no compromise in the antitumor effect of 4-HC. This fact stimulated the development of a clinical trial. Bone marrow was harvested from 15 poor-prognosis breast cancer patients and randomly assigned to ex vivo treatment with amifostine followed by 4-HC (amifostine + 4-HC), or treatment with 4-HC alone. High-dose chemotherapy was then administered followed by infusion of the purged autologous bone marrow support (ABMS). Leukocyte engraftment, defined as a white blood cell count > or = 1 x 10(9)/L, was achieved in an average of 26 days for patients whose marrow was purged with amifostine + 4-HC versus 36 days for patients whose marrow was purged with 4-HC alone (P = .032). The average number of platelet transfusions (12 v 29; P = .017) and days of antibiotic therapy (28 v 40; P = .012) were significantly less for patients whose marrow was exposed to amifostine + 4-HC, compared with 4-HC alone. Unpurged backup marrow fractions were infused into three patients whose marrow was purged with 4-HC alone, because of inadequate marrow recovery. None of the patients who received amifostine + 4-HC-purged marrow required a backup marrow fraction. Complete remissions were achieved in 83% of patients with measurable disease, with no difference between the two cohorts. Forty-three percent of patients remained alive and progression-free at a mean of 13 months posttransplant. There was no significant difference in the rate or pattern of relapse for patients whose marrow was purged with amifostine + 4-HC compared with those whose marrow was purged with 4-HC alone. Ex vivo treatment of marrow with amifostine significantly shortens the time to marrow recovery, thereby reducing the risk of myelosuppressive complications in breast cancer patients receiving high-dose chemotherapy and 4-HC-purged ABMS. Since supportive care requirements are also significantly decreased, amifostine may reduce the cost of such therapy.
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Affiliation(s)
- E J Shpall
- Bone Marrow Transplant Program, University of Colorado, Denver, CO 80262
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42
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Shpall EJ, Jones RB, Bearman SI, Franklin WA, Archer PG, Curiel T, Bitter M, Claman HN, Stemmer SM, Purdy M. Transplantation of enriched CD34-positive autologous marrow into breast cancer patients following high-dose chemotherapy: influence of CD34-positive peripheral-blood progenitors and growth factors on engraftment. J Clin Oncol 1994; 12:28-36. [PMID: 7505806 DOI: 10.1200/jco.1994.12.1.28] [Citation(s) in RCA: 281] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To evaluate the capacity of enriched CD34-positive (CD34+) progenitor cells to reconstitute hematopoiesis in poor-prognosis breast cancer patients following administration of a high-dose alkylating agent chemotherapy regimen. PATIENTS AND METHODS Forty-four breast cancer patients received high-dose chemotherapy followed by autologous bone marrow support (ABMS) with CD34+ hematopoietic progenitor cells in five sequentially treated cohorts. Following infusion of CD34+ marrow, cohort no. 1 received no growth factor, cohort no. 2 received granulocyte colony-stimulating factor (G-CSF), and cohort no. 3 received granulocyte-macrophage colony-stimulating factor (GM-CSF). Cohort no. 4 received the CD34+ fractions of both marrow and peripheral-blood progenitor cells (PBPCs) plus G-CSF. Cohort no. 5 received only the CD34+ PBPCs plus G-CSF. Immunohistochemical staining for breast cancer was performed on all hematopoietic cell products before and after the positive selection procedure, to assess quantitatively the level of tumor-cell contamination. RESULTS Cohorts no. 1, 2, 3, 4, and 5 achieved a granulocyte count > or = 500 x 10(9)/L in a median of 23, 10, 16, 11, and 11 days, with a platelet count greater than 20,000 x 10(9)/L documented in a median of 22, 23, 32, 12, and 10 days, respectively. The time to granulocyte reconstitution was significantly shorter for patients who received CD34+ PBPCs alone (cohort no. 5), or in combination with CD34+ marrow (cohort no. 4), when compared with those who received only the CD34+ marrow fraction (P < .01). From 1 to greater than 4 logs of breast cancer cell depletion were documented after CD34-selection, for patients in whom tumor was initially detected. CONCLUSION CD34+ marrow and/or PBPCs provide reliable and timely hematopoietic reconstitution in breast cancer patients receiving high-dose chemotherapy. Contamination of both marrow and PBPCs with breast cancer cells was reduced using this positive selection technique.
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Affiliation(s)
- E J Shpall
- Department of Pathologu, University of Colorado, Denver
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43
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Shpall EJ, Jones RB, Bearman SI, Stemmer SM, Purdy MH, Heimfeld S, Berenson RJ. Positive selection of CD34+ hematopoietic progenitor cells for transplantation. Stem Cells 1993; 11 Suppl 3:48-9. [PMID: 7507756 DOI: 10.1002/stem.5530110913] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- E J Shpall
- Bone Marrow Transplant Program, University of Colorado, Denver
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44
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Shpall EJ, Stemmer SM, Bearman SI, Jones RB. Role of autotransplantation in treatment of other solid tumors. Hematol Oncol Clin North Am 1993; 7:663-86. [PMID: 8344885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This article reviews the use of high-dose chemotherapy with autologous bone marrow support for a variety of solid tumors. A major feature of the vast majority of studies examined is the high response rates achieved with intensive therapy when compared with those reported with standard chemotherapy. If these rates can be obtained in patients with diseases refractory to standard therapy, then applying the same treatment earlier in the disease course may produce more durable antitumor effects.
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Affiliation(s)
- E J Shpall
- Division of Oncology, University of Colorado, Denver
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45
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Jones RB, Matthes S, Shpall EJ, Fisher JH, Stemmer SM, Dufton C, Stephens JK, Bearman SI. Acute lung injury following treatment with high-dose cyclophosphamide, cisplatin, and carmustine: pharmacodynamic evaluation of carmustine. J Natl Cancer Inst 1993; 85:640-7. [PMID: 8468721 DOI: 10.1093/jnci/85.8.640] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Therapy with high-dose cyclophosphamide, cisplatin, and carmustine (BCNU) plus autologous bone marrow transplantation has been extensively studied as treatment for patients with stage II or III breast cancer who have a 70% or greater risk of developing metastatic disease. This therapy is being used in a cooperative intergroup phase III clinical trial. In the cyclophosphamide-cisplatin-BCNU regimen, cyclophosphamide and BCNU, but not cisplatin, have been reported to cause acute lung injury, suggesting that either cyclophosphamide or BCNU may contribute to this injury. PURPOSE The purpose of this study was to analyze clinical and pharmacokinetic data from our ongoing phase II trials and to determine whether there is an association between BCNU pharmacokinetics and acute lung injury following cyclophosphamide-cisplatin-BCNU therapy. METHODS We performed a retrospective study of 38 patients treated following induction therapy or relapse, 29 with stage II-IV breast cancer and nine with intermediate and high-grade stage III-IV non-Hodgkin's lymphoma. These patients received therapy with cyclophosphamide at a dose of 1875 mg/m2 daily as a 1-hour intravenous infusion for 3 days, cisplatin at 55 mg/m2 per day as a 72-hour continuous intravenous infusion, and BCNU at 600 mg/m2 as a 2-hour infusion immediately following completion of the cisplatin infusion. Data from analysis of blood samples were used to calculate pharmacokinetic parameters for BCNU, and acute lung injury was determined on the basis of pulmonary function test results and histologic examination of lung biopsy specimens. RESULTS Our analysis showed that 20 (53%) of the 38 patients developed pulmonary injury following treatment. Twelve (60%) of the 20 had values for area under the curve (AUC) for BCNU concentration x time that exceeded 600 (micrograms/mL) x minute, whereas only two (11%) of the 18 without pulmonary injury had values above this level (P < .03). Thus, 12 (86%) of 14 patients with BCNU AUC greater than 600 (micrograms/mL) x minute developed lung injury. CONCLUSIONS These results suggest that BCNU exposure greater than 600 (micrograms/mL) x minute is associated with increased risk of acute lung injury after cyclophosphamide-cisplatin-BCNU therapy and may be a major cause of pulmonary drug injury following this regimen. IMPLICATIONS Strategies aimed at more uniform drug exposure or selective neutralization of chlorethylisocyanate, one of the two major hydrolysis products of BCNU, might reduce the incidence of acute lung injury following this regimen without major compromise of antitumor effect.
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Affiliation(s)
- R B Jones
- Division of Hematology/Oncology, University of Colorado Health Sciences Center, Denver 80262
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46
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Stemmer SM, Kinsman K, Tellschow S, Jones RB. Fatal noncutaneous visceral infection with varicella-zoster virus in a patient with lymphoma after autologous bone marrow transplantation. Clin Infect Dis 1993; 16:497-9. [PMID: 8513054 DOI: 10.1093/clind/16.4.497] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
After undergoing high-dose chemotherapy and autologous bone marrow transplantation, a patient developed fatal disseminated infection due to varicella-zoster virus (VZV) with no coincident skin lesions. This article describes this unusual case and briefly reviews the English-language literature on the abdominal presentation of VZV infection as well as that on VZV infection after bone marrow transplantation. In the severely immunocompromised host, visceral infection with VZV may uncommonly occur in the absence of skin lesions. The possibility of such infection should be considered when immunocompromised patients develop unusual symptoms or other evidence of visceral disease (e.g., cholecystitis).
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Affiliation(s)
- S M Stemmer
- Bone Marrow Transplant Program, University of Colorado Health Sciences Center, Denver 80262
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47
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Jones RB, Matthes S, Dufton C, Bearman SI, Stemmer SM, Meyers S, Shpall EJ. Pharmacokinetic/pharmacodynamic interactions of intensive cyclophosphamide, cisplatin, and BCNU in patients with breast cancer. Breast Cancer Res Treat 1993; 26 Suppl:S11-7. [PMID: 8400329 DOI: 10.1007/bf00668355] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Combinations of alkylating agents in intensive doses with autologous hematopoietic cell support (AHCS) are commonly used to treat advanced, solid tumors. Relatively little is known about the pharmacokinetic or pharmacodynamic aspects of their use. The cyclophosphamide, cisplatin, and BCNU (CPA/cDDP/BCNU) regimen is often used in patients with breast cancer. In these individuals, the blood levels of BCNU vary by more than tenfold. In rats given BCNU, the blood level variability is associated with cisplatin pretreatment, and mean levels are much higher than those that occur when cisplatin pretreatment is omitted. These observations suggest that a major elimination pathway for BCNU is metabolic and is subject to cisplatin disruption. Between 30-50% of patients receiving the CPA/cDDP/BCNU regimen experience a steroid-responsive pulmonary injury that can be fatal if untreated. Blood levels of BCNU are positively correlated with the risk of pulmonary injury in these patients. Others have demonstrated that blood levels of CPA can be inversely correlated with the likelihood of cardiac toxicity and 2-year, relapse-free survival in patients with breast cancer. Emerging data suggest that circulating drug levels, rather than the calculated dose, best explain the variability of outcome in patients treated with combination alkylating agents and AHCS.
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Affiliation(s)
- R B Jones
- University of Colorado Health Sciences Center, Bone Marrow Transplant Program, Denver 80262
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48
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Shpall EJ, Stemmer SM, Bearman SI, Myers S, Purdy M, Jones RB. New strategies in marrow purging for breast cancer patients receiving high-dose chemotherapy with autologous bone marrow transplantation. Breast Cancer Res Treat 1993; 26 Suppl:S19-23. [PMID: 7691269 DOI: 10.1007/bf00668356] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
High-dose chemotherapy and autologous bone marrow transplantation (ABMT) are commonly used to treat selected patients with high-risk breast cancer. A limitation of ABMT is that clonogenic cancer cells could be collected with the bone marrow and produce a relapse of diseases when reinfused into patients. Purging the marrow ex vivo may eliminate the tumor cells, but it can also delay engraftment. We employed two different purging methods whereby breast cancer cells were depleted without delaying engraftment. The addition of WR-2721 (amifostine) to 4-hydroperoxycyclophosphamide (4-HC) reduced the time to engraftment by 10 days compared with marrow purged with 4-HC alone (26 versus 37 days, respectively). The positive selection of CD34+ hematopoietic progenitors produced engraftment within 21 days. The use of granulocyte colony-stimulating factor (G-CSF) accelerated the engraftment time of CD34+ hematopoietic progenitors to 11 days.
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Affiliation(s)
- E J Shpall
- University of Colorado Bone Marrow Transplant Program, University of Colorado Health Sciences Center, Denver 80262
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49
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Affiliation(s)
- A Shushan
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University Hadassah Medical School, Jerusalem, Israel
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50
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Shpall EJ, Stemmer SM, Johnston CF, Hami L, Bearman SI, Berenson R, Jones RB. Purging of Autologous Bone Marrow for Transplantation: The Protection and Selection of the Hematopoietic Progenitor Cell. ACTA ACUST UNITED AC 1992; 1:45-54. [PMID: 1365017 DOI: 10.1089/scd.1.1992.1.45] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Autologous bone marrow transplantation (ABMT) is the treatment of choice for selected patients with acute myelogenous leukemia, non-Hodgkin's lymphoma, and poor prognosis breast cancer. A possible limitation of this approach is that clonogenic tumor cells could be collected and infused back into the patient along with the normal bone marrow. The major emphasis in our laboratory has been the development of marrow purging regimens for breast cancer patients. This paper describes two investigative approaches hematopoietic progenitor cell protection and selection. We describe how the use of G-CSF in the patients who receive positively selected marrow shortens the rate of engraftment.
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Affiliation(s)
- E J Shpall
- University of Colorado Bone Marrow Transplant Program and Cancer Center, Denver, CO
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