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Fasano GA, Bayard S, Chen Y, Varella L, Cigler T, Bensenhaver J, Simmons R, Swistel A, Marti J, Moore A, Andreopoulou E, Ng J, Brandmaier A, Formenti S, Ali H, Davis M, Newman L. Benefit of adjuvant chemotherapy in node-negative T1a versus T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat 2022; 192:163-173. [PMID: 35022867 DOI: 10.1007/s10549-021-06481-4] [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: 09/22/2021] [Accepted: 12/03/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE National comprehensive cancer network guidelines recommend delivery of adjuvant chemotherapy in node-negative triple-negative breast cancer (TNBC) if the tumor is > 1 cm and consideration of adjuvant chemotherapy for T1b but not T1a disease. These recommendations are based upon sparse data on the role of adjuvant chemotherapy in T1a and T1b node-negative TNBC. Our objective was to clarify the benefits of chemotherapy for patients with T1N0 TNBC, stratified by tumor size. METHODS We performed a retrospective analysis of survival outcomes of TNBC patients at two academic institutions in the United States from 1999 to 2018. Primary tumor size, histology, and nodal status were based upon surgical pathology. The Kaplan-Meier plot and 5-year unadjusted survival probability were evaluated. RESULTS Among 282 T1N0 TNBC cases, the status of adjuvant chemotherapy was known for 258. Mean follow-up was 5.3 years. Adjuvant chemotherapy was delivered to 30.5% of T1a, 64.7% T1b, and 83.9% T1c (p < 0.0001). On multivariable analysis, factors associated with delivery of adjuvant chemotherapy were tumor size and grade 3 disease. Improved overall survival was associated with use of chemotherapy in patients with T1c disease (93.2% vs. 75.2% p = 0.008) but not T1a (100% vs. 100% p = 0.3778) or T1b (100% vs. 95.8% p = 0.2362) disease. CONCLUSION Our data support current guidelines indicating benefit from adjuvant chemotherapy in node-negative TNBC associated with T1c tumors but excellent outcomes were observed in the cases of T1a and T1b disease, regardless of whether adjuvant chemotherapy was delivered.
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Affiliation(s)
- Genevieve A Fasano
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Solange Bayard
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Yalei Chen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Leticia Varella
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Tessa Cigler
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | | | - Rache Simmons
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Alexander Swistel
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Jennifer Marti
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Anne Moore
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Eleni Andreopoulou
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - John Ng
- Department of Radiation Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Silvia Formenti
- Department of Radiation Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Haythem Ali
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Melissa Davis
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Lisa Newman
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA.
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2
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Liu YL, Bager CL, Willumsen N, Ramchandani D, Kornhauser N, Ling L, Cobham M, Andreopoulou E, Cigler T, Moore A, LaPolla D, Fitzpatrick V, Ward M, Warren JD, Fischbach C, Mittal V, Vahdat LT. Tetrathiomolybdate (TM)-associated copper depletion influences collagen remodeling and immune response in the pre-metastatic niche of breast cancer. NPJ Breast Cancer 2021; 7:108. [PMID: 34426581 PMCID: PMC8382701 DOI: 10.1038/s41523-021-00313-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
Tetrathiomolybdate (TM) is a novel, copper-depleting compound associated with promising survival in a phase II study of patients with high-risk and triple-negative breast cancer. We sought to elucidate the mechanism of TM by exploring its effects on collagen processing and immune function in the tumor microenvironment (TME). Using an exploratory cohort, we identified markers of collagen processing (LOXL2, PRO-C3, C6M, and C1M) that differed between those with breast cancer versus controls. We measured these collagen biomarkers in TM-treated patients on the phase II study and detected evidence of decreased collagen cross-linking and increased degradation over formation in those without disease compared to those who experienced disease progression. Preclinical studies revealed decreased collagen deposition, lower levels of myeloid-derived suppressor cells, and higher CD4+ T-cell infiltration in TM-treated mice compared with controls. This study reveals novel mechanisms of TM targeting the TME and immune response with potential applications across cancer types.
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Affiliation(s)
- Ying L Liu
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Lu Ling
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | | | | | | | - Anne Moore
- Weill Cornell Medicine, New York, NY, USA
| | | | | | | | | | - Claudia Fischbach
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | | | - Linda T Vahdat
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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3
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Kearney M, Franks L, Lee S, Tiersten A, Makower DF, Cigler T, Mundi P, Chi DC, Goel A, Klein P, Andreopoulou E, Sparano J, Trivedi M, Accordino M, Califano A, Hershman DL, Silva J, Kalinsky K. Phase I/II trial of ruxolitinib in combination with trastuzumab in metastatic HER2 positive breast cancer. Breast Cancer Res Treat 2021; 189:177-185. [PMID: 34169393 PMCID: PMC8487317 DOI: 10.1007/s10549-021-06306-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/18/2021] [Indexed: 01/07/2023]
Abstract
Purpose: Preclinical data demonstrate STAT3 as an important regular in HER2+ tumors, and disruption of the IL6-JAK2-STAT-S100A8/S100A9 signaling cascade reduces HER2+ cell viability. Ruxolitinib is an FDA approved inhibitor of JAK1 and JAK2. We performed a phase I/II trial investigating the safety and efficacy of the combination of trastuzumab and ruxolitinib in patients with trastuzumab-resistant metastatic HER2+ breast cancer. Methods: Patients with metastatic HER2+ breast cancer progressing on at least 2 lines of HER2-directed therapy were eligible. The phase I portion determined the tolerable dose of ruxolitinib in combination with trastuzumab. The primary objective of the phase II was to assess the progression free survival (PFS) of the combination of ruxolitinib plus trastuzumab compared to historical control. Results: Twenty-eight patients were enrolled, with a median number of prior therapies of 4.5. Ruxolitinib 25mg twice daily was the recommended phase II dose with no DLTs. Of 26 evaluable patients in phase II, the median PFS was 8.3 weeks (95% CI: 7.1, 13.9). Among the 14 patients with measurable disease, 1 patient had a partial response and 4 patients had stable disease. Most of the adverse events were hematologic. Conclusion: While well-tolerated with a strong preclinical rationale, the combination of ruxolitinib and trastuzumab did not lead to an improvement in PFS compared to historical control in patients with trastuzumab-resistant metastatic HER2+ breast cancer.
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Affiliation(s)
- Matthew Kearney
- Columbia University Irving Medical Center, 630 W 168th St, New York, NY, 10032, USA
| | - Lauren Franks
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Shing Lee
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Amy Tiersten
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Della F Makower
- Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA
| | - Tessa Cigler
- Weill Cornell Medical, 1300 York Avenue, New York, NY, 10065, USA
| | - Prabhjot Mundi
- Columbia University Irving Medical Center, 630 W 168th St, New York, NY, 10032, USA.,Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Dow-Chung Chi
- Columbia University Irving Medical Center, 630 W 168th St, New York, NY, 10032, USA
| | - Anupama Goel
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA
| | - Pam Klein
- Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | | | - Joseph Sparano
- Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA
| | - Meghna Trivedi
- Columbia University Irving Medical Center, 630 W 168th St, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Melissa Accordino
- Columbia University Irving Medical Center, 630 W 168th St, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Andrea Califano
- Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Dawn L Hershman
- Columbia University Irving Medical Center, 630 W 168th St, New York, NY, 10032, USA.,Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Jose Silva
- Herbert Irving Comprehensive Cancer Center, Columbia University, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Kevin Kalinsky
- Winship Cancer Institute at Emory University, 1365 Clifton Road, Suite B4112, Atlanta, GA, 30322, USA.
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4
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Ivanidze J, Subramanian K, Youn T, Cigler T, Osborne JR, Magge RS, Balogun OD, Knisely JPS, Ramakrishna R. Utility of [18F]-fluoroestradiol (FES) PET/CT with dedicated brain acquisition in differentiating brain metastases from posttreatment change in estrogen receptor-positive breast cancer. Neurooncol Adv 2021; 3:vdab178. [PMID: 34988456 PMCID: PMC8713741 DOI: 10.1093/noajnl/vdab178] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jana Ivanidze
- Division of Molecular Imaging and Therapeutics, Department of Radiology, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Kritika Subramanian
- Division of Molecular Imaging and Therapeutics, Department of Radiology, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Trisha Youn
- Division of Molecular Imaging and Therapeutics, Department of Radiology, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Tessa Cigler
- Department of Breast Oncology, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Joseph R Osborne
- Division of Molecular Imaging and Therapeutics, Department of Radiology, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Rajiv S Magge
- Department of Neurology, Weill Cornell Brain Tumor Center, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Onyinye D Balogun
- Department of Radiation Oncology, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Jonathan P S Knisely
- Department of Radiation Oncology, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, NewYork-Presbyterian Hospital—Weill Cornell Campus, New York, New York, USA
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5
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Chan N, Willis A, Kornhauser N, Ward MM, Lee SB, Nackos E, Seo BR, Chuang E, Cigler T, Moore A, Donovan D, Cobham MV, Fitzpatrick V, Schneider S, Wiener A, Guillaume-Abraham J, Aljom E, Zelkowitz R, Warren JD, Lane ME, Fischbach C, Mittal V, Vahdat L. Correction: Influencing the Tumor Microenvironment: A Phase II Study of Copper Depletion Using Tetrathiomolybdate in Patients with Breast Cancer at High Risk for Recurrence and in Preclinical Models of Lung Metastases. Clin Cancer Res 2020; 26:5051. [DOI: 10.1158/1078-0432.ccr-20-3177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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6
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Shah MA, Emlen MF, Shore T, Mayer S, Leonard JP, Rossi A, Martin P, Ritchie E, Niesvizky R, Pastore R, Cigler T, De Sancho M, Scheff R, Van Besien K, Roboz G, Nanus D, Goldstein P, Scrimenti L, Hidalgo M. Hematology and oncology clinical care during the coronavirus disease 2019 pandemic. CA Cancer J Clin 2020; 70:349-354. [PMID: 32662880 PMCID: PMC7404745 DOI: 10.3322/caac.21627] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 12/30/2022] Open
Abstract
New York City has been at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic that has already infected over a million people and resulted in more than 70,000 deaths as of early May 2020 in the United States alone. This rapid and enormous influx of patients into the health care system has had profound effects on all aspects of health care, including the care of patients with cancer. In this report, the authors highlight the transformation they underwent within the Division of Hematology and Medical Oncology as they prepared for the COVID-19 crisis in New York City. Under stressful and uncertain conditions, some of the many changes they enacted within their division included developing a regular line of communication among division leaders to ensure the development and implementation of a restructuring strategy, completely reconfiguring the inpatient and outpatient units, rapidly developing the ability to perform telemedicine video visits, and creating new COVID-rule-out and COVID-positive clinics for their patients. These changes allowed them to manage the storm while minimizing the disruption of important continuity of care to their patients with cancer. The authors hope that their experiences will be helpful to other oncology practices about to experience their own individual COVID-19 crises.
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Affiliation(s)
- Manish A. Shah
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - M. Frances Emlen
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Tsiporah Shore
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Sebastian Mayer
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - John P. Leonard
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Adriana Rossi
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Peter Martin
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Ellen Ritchie
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Raymond Pastore
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Tessa Cigler
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Maria De Sancho
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Ronald Scheff
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Koen Van Besien
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Gail Roboz
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - David Nanus
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Paula Goldstein
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Lara Scrimenti
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
| | - Manuel Hidalgo
- Department of Medicine, Division of Hematology and Medical OncologyWeill Cornell MedicineNew YorkNew York
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7
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Oktay KH, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Increased chemotherapy-induced ovarian reserve loss in women with germline BRCA mutations due to oocyte deoxyribonucleic acid double strand break repair deficiency. Fertil Steril 2020; 113:1251-1260.e1. [PMID: 32331767 DOI: 10.1016/j.fertnstert.2020.01.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether woman who have BRCA mutations (WBM) experience more declines in ovarian reserve after chemotherapy treatment, as it induces oocyte death by deoxyribonucleic acid (DNA) damage, and BRCA mutations result in DNA damage repair deficiency. DESIGN Longitudinal cohort study. SETTING Academic centers. PATIENT(S) The 108 evaluable women with breast cancer were stratified into those never tested (negative family history; n = 35) and those negative (n = 59) or positive (n = 14) for a pathogenic BRCA mutation. INTERVENTION(S) Sera were longitudinally obtained before and 12-24 months after chemotherapy treatment, assayed for antimüllerian hormone (AMH), and adjusted for age at sample collection. MAIN OUTCOME MEASURE(S) Ovarian recovery, defined as the geometric mean of the after chemotherapy age-adjusted AMH levels compared with baseline levels. RESULT(S) Compared with the controls, the before chemotherapy treatment AMH levels were 24% and 34% lower in those negative or positive for BRCA mutations, consistent with accelerated ovarian aging in WBM. The WBM had a threefold difference in AMH recovery after chemotherapy treatment (1.6%), when compared with BRCA negative (3.7%) and untested/low risk controls (5.2%). Limiting the analysis to the most common regimen, doxorubicin and cyclophosphamide followed by paclitaxel, showed similar results. These findings were mechanistically confirmed in an in vitro mouse oocyte BRCA knockdown bioassay, which showed that BRCA deficiency results in increased oocyte susceptibility to doxorubicin. CONCLUSION(S) Women who have pathogenic BRCA mutations are more likely to lose ovarian reserve after chemotherapy treatment, suggesting an emphasis on fertility preservation. Furthermore, our findings generate the hypothesis that DNA repair deficiency is a shared mechanism between aging, infertility, and cancer. CLINICAL TRIAL REGISTRATION NUMBER NCT00823654.
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Affiliation(s)
- Kutluk H Oktay
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
| | - Giuliano Bedoschi
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | | | - Enes Taylan
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Shiny Titus
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and Alpert Medical School at Brown University, Providence, Rhode Island
| | - Tessa Cigler
- Weill Medical College of Cornell University, New York, New York
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, New York
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8
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Freites-Martinez A, Chan D, Sibaud V, Shapiro J, Fabbrocini G, Tosti A, Cho J, Goldfarb S, Modi S, Gajria D, Norton L, Paus R, Cigler T, Lacouture ME. Assessment of Quality of Life and Treatment Outcomes of Patients With Persistent Postchemotherapy Alopecia. JAMA Dermatol 2019; 155:724-728. [PMID: 30840033 PMCID: PMC6563563 DOI: 10.1001/jamadermatol.2018.5071] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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] [Received: 07/17/2018] [Accepted: 11/12/2018] [Indexed: 01/03/2023]
Abstract
Importance Persistent alopecia occurs in a subset of patients undergoing chemotherapy, yet the quality of life (QOL) of these patients and their response to therapy have not been described in a large patient cohort. Objective To characterize the clinical presentation of patients with persistent chemotherapy-induced alopecia (pCIA) or endocrine therapy-induced alopecia after chemotherapy (EIAC) and their QOL and treatment outcomes. Design, Setting, and Participants A retrospective multicenter cohort of 192 women with cancer treated with cytotoxic agents who received a clinical diagnosis of persistent alopecia (98 with pCIA and 94 with EIAC) between January 1, 2009, and July 31, 2017, was analyzed. All patients were from the dermatology service in 2 comprehensive cancer centers and 1 tertiary-care hospital. Data on demographics, chemotherapy regimens, severity, clinical patterns, and response to hair-growth promoting agents were assessed. Data from the Hairdex questionnaire were used to assess the QOL of patients with alopecia. Main Outcomes and Measures The clinical presentation, response to dermatologic therapy, and QOL of patients with pCIA were assessed and compared with those of patients with EIAC. Results A total of 98 women with pCIA (median age, 56.5 years [range, 18-83 years]) and 94 women with EIAC (median age, 56 years [range, 29-84 years]) were included. The most common agents associated with pCIA were taxanes for 80 patients (82%); the most common agents associated with EIAC were aromatase inhibitors for 58 patients (62%). Diffuse alopecia was predominant in patients with pCIA compared with patients with EIAC (31 of 75 [41%] vs 23 of 92 [25%]; P = .04), with greater severity (Common Terminology Criteria for Adverse Events, version 4.0, grade 2) among patients with pCIA (29 of 75 [39%] vs 12 of 92 [13%]; P < .001). A negative emotional effect was reported by both groups. After treatment with topical minoxidil or spironolactone, moderate to significant improvement was observed for 36 of 54 patients with pCIA (67%) and for 32 of 42 patients with EIAC (76%). Conclusions and Relevance Persistent chemotherapy-induced alopecia is frequently more severe and diffuse when compared with EIAC, and both groups of patients experienced a negative effect. A modest benefit was observed with dermatologic therapy. Additional studies are warranted to develop effective strategies for prevention and effective therapy for pCIA and EIAC.
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Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Dermatology Service, Hospital Vithas Santa Catalina, Gran Canaria, Canary Islands, Spain
| | - Donald Chan
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vincent Sibaud
- Departments of Oncodermatology and Clinical Research, Institut Claudius Regaud, Institut Universitaire du Cancer, Toulouse Oncopole, France
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine Miami, Florida
| | - Juhee Cho
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Welch Center for Epidemiology, Prevention, and Clinical Research, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shari Goldfarb
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Shanu Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Devika Gajria
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ralf Paus
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine Miami, Florida
- Dermatology Research Centre, University of Manchester, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Tessa Cigler
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mario E. Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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9
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Kehm RD, Hopper JL, John EM, Phillips KA, MacInnis RJ, Dite GS, Milne RL, Liao Y, Zeinomar N, Knight JA, Southey MC, Vahdat L, Kornhauser N, Cigler T, Chung WK, Giles GG, McLachlan SA, Friedlander ML, Weideman PC, Glendon G, Nesci S, Andrulis IL, Buys SS, Daly MB, Terry MB. Regular use of aspirin and other non-steroidal anti-inflammatory drugs and breast cancer risk for women at familial or genetic risk: a cohort study. Breast Cancer Res 2019; 21:52. [PMID: 30999962 PMCID: PMC6471793 DOI: 10.1186/s13058-019-1135-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 12/20/2018] [Accepted: 04/05/2019] [Indexed: 01/23/2023] Open
Abstract
Background The use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced breast cancer risk, but it is not known if this association extends to women at familial or genetic risk. We examined the association between regular NSAID use and breast cancer risk using a large cohort of women selected for breast cancer family history, including 1054 BRCA1 or BRCA2 mutation carriers. Methods We analyzed a prospective cohort (N = 5606) and a larger combined, retrospective and prospective, cohort (N = 8233) of women who were aged 18 to 79 years, enrolled before June 30, 2011, with follow-up questionnaire data on medication history. The prospective cohort was further restricted to women without breast cancer when medication history was asked by questionnaire. Women were recruited from seven study centers in the United States, Canada, and Australia. Associations were estimated using multivariable Cox proportional hazards regression models adjusted for demographics, lifestyle factors, family history, and other medication use. Women were classified as regular or non-regular users of aspirin, COX-2 inhibitors, ibuprofen and other NSAIDs, and acetaminophen (control) based on self-report at follow-up of ever using the medication for at least twice a week for ≥1 month prior to breast cancer diagnosis. The main outcome was incident invasive breast cancer, based on self- or relative-report (81% confirmed pathologically). Results From fully adjusted analyses, regular aspirin use was associated with a 39% and 37% reduced risk of breast cancer in the prospective (HR = 0.61; 95% CI = 0.33–1.14) and combined cohorts (HR = 0.63; 95% CI = 0.57–0.71), respectively. Regular use of COX-2 inhibitors was associated with a 61% and 71% reduced risk of breast cancer (prospective HR = 0.39; 95% CI = 0.15–0.97; combined HR = 0.29; 95% CI = 0.23–0.38). Other NSAIDs and acetaminophen were not associated with breast cancer risk in either cohort. Associations were not modified by familial risk, and consistent patterns were found by BRCA1 and BRCA2 carrier status, estrogen receptor status, and attained age. Conclusion Regular use of aspirin and COX-2 inhibitors might reduce breast cancer risk for women at familial or genetic risk. Electronic supplementary material The online version of this article (10.1186/s13058-019-1135-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca D Kehm
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Esther M John
- Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, 780 Welch Road, Stanford, CA, 94304, USA
| | - Kelly-Anne Phillips
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Cancer Epidemiology, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Gillian S Dite
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Roger L Milne
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Cancer Epidemiology, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Yuyan Liao
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Nur Zeinomar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Julia A Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada.,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T3M7, Canada
| | - Melissa C Southey
- Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Linda Vahdat
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA.,C Anthony and Jean Whittingham Cancer Center, 34 Maple Street, Norwalk, CT, 06856, USA
| | - Naomi Kornhauser
- Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10065, USA
| | - Tessa Cigler
- Weill Cornell Medicine Breast Center, 428 E 72nd St, New York, NY, 10021, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University, 1150 St Nicholas Ave, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia.,Cancer Epidemiology, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - Sue-Anne McLachlan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Medical Oncology, St Vincent's Hospital, 41 Victoria St, Fitzroy, VIC, 3065, Australia
| | - Michael L Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, 2052, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Barker St, Randwick, NSW, 2031, Australia
| | - Prue C Weideman
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Gord Glendon
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada
| | - Stephanie Nesci
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | | | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada.,Departments of Molecular Genetics and Laboratory Medicine and Pathobiology, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada
| | - Saundra S Buys
- Department of Medicine and Huntsman Cancer Institute, University of Utah Health, 2000 Cir of Hope Dr, Salt Lake City, UT, 84103, USA
| | - Mary B Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
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Oktay K, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Abstract PD6-06: Impact of BRCA mutations on chemotherapy-induced loss of ovarian reserve: A prospective longitudinal study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd6-06] [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
Background: The BRCA1/2 genes are key members of the ataxia-telangiectasia mutated (ATM)-mediated DNA double strand break (DSB) repair pathway. Recent research showed that germline mutations in these genes result in DNA repair deficiency in oocytes, leading to accelerated ovarian aging as manifested by lower ovarian reserve and earlier age at natural menopause. Because we discovered that oocyte DNA repair is similarly critical in chemotherapy-induced ovarian follicle loss, we hypothesized that women with pathogenic mutations in BRCA1/2 genes may experience larger declines in ovarian reserve after chemotherapy. To gauge the degree of the chemotherapy-induced ovarian damage, we utilized serum anti-mullerian hormone (AMH), which is the most reliable current marker for assessing oocyte reserve.
Methods: Women with early stage breast cancer were enrolled before chemotherapy (Trial registration number: NCT00823654) between January 2009 and November 2017. Sera were obtained at baseline, before the initiation of treatment, and 18 to 24 months after the completion of chemotherapy. Stored sera were assayed at once for anti-mullerian hormone (AMH) and the results were adjusted for the women's age at sample collection. Of the 235 enrolled, 117 evaluable women were stratified into three groups, those never tested (based on NCCN Guidelines V 1.2018 ; n=38) and those negative (n=65) or positive (n=14) for a pathogenic BRCA mutation. Ovarian recovery was defined as the geometric mean of the post chemotherapy age-adjusted AMH levels compared to baseline.
Results: Compared to the lower risk (BRCA-untested) control group, AMH levels averaged 76% and 66% in those negative or positive for BRCA mutations (p=0.078). The geometric mean recoveries for the three groups (not tested, BRCA negative and BRCA positive) were 3.7%, 5.2% and 1.6%, respectively. The mean recovery in the BRCA mutation positive group was about one-third the 4.6% recovery in the other two groups combined (two group ANOVA, p=0.034, F=4.89). Given the potential of the ovarian recovery to be dependent on type of chemotherapy, the data were reanalyzed for all three BRCA groups after restriction to those treated with the AC-T (doxorubicin and cyclophosphamide followed by paclitaxel) regimen. Of the 108 women in the previous analysis, 83 (77%) were treated with AC-T; 25, 46 and 12 women in the three groups, respectively. The geometric mean AMH recoveries for these new groups were 3.2%, 4.7% and 1.3%. When the BRCA mutation positive group was compared with other two groups, the former had significantly worse recovery of serum AMH levels (ANOVA, p=0.044, F=4.2).
Conclusions: These data show that women with breast cancer and pathogenic BRCA mutations have striking liability to chemotherapy-induced ovarian reserve loss and may have to be preferentially counselled on fertility preservation methods. In addition, taken together with the previous data showing that women with BRCA mutations may have accelerated ovarian aging, even unaffected reproductive age individuals may have to be proactive about family building or early preservation of their fertility (Supported by NIH R01HD053112).
Citation Format: Oktay K, Bedoschi G, Goldfarb SB, Taylan E, Titus S, Palomaki GE, Cigler T, Robson M, Dickler MN. Impact of BRCA mutations on chemotherapy-induced loss of ovarian reserve: A prospective longitudinal study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD6-06.
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Affiliation(s)
- K Oktay
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - G Bedoschi
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - SB Goldfarb
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - E Taylan
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - S Titus
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - GE Palomaki
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - T Cigler
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - M Robson
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
| | - MN Dickler
- Yale University School of Medicine, New Haven; Memorial Sloan Kettering Cancer Center, New York; Women & Infants Hospital and Alpert Medical School at Brown University, Providence; Weill Medical College of Cornell University, New York
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Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, D'Agostino RB, Deluca A, Cigler T. Abstract P1-17-04: Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-04] [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
Scalp cooling has demonstrated efficacy in preventing hair loss in women with early stage breast cancer receiving neo/adjuvant chemotherapy. Data from 2 prospective trials (Rugo et al, and Nangia et al, JAMA 2017) led to FDA clearance of 2 automated scalp-cooling devices to prevent chemotherapy induced alopecia (CIA). Although scalp metastases from breast cancer are rare, historical concerns about scalp cooling included a theoretical increase in risk of recurrence in scalp due to reduced delivery of chemotherapy to the scalp.
Methods
We conducted a multicenter prospective trial evaluating the efficacy and safety of the DigniCap in women with stage I-II breast cancer receiving neo/adjuvant chemotherapy excluding sequential or combination anthracycline/taxanes with concurrent matched controls. The primary endpoint was unblinded patient self-assessment of 5 photographs using the Dean scale to estimate hair loss 4 weeks following the last dose of chemotherapy, with success defined as a Dean score of 0-2 (≤ 50% hair loss); additional endpoints included quality of life (QOL) and both short and long-term safety.
Results
106 patients using the scalp cooling device and 16 concurrent controls were enrolled. As previously reported, the use of scalp cooling was associated with less alopecia and improvement in several measures of QOL (Rugo et al, JAMA 2017). 91 patients have follow-up (FU) out to 3 years; 73 with estrogen receptor (ER) positive and 18 with ER negative disease. 5 DigniCap patients have developed recurrent breast cancer in breast (n=1), liver (n=1), bone, liver and breast (n=1), bone, liver, lung, and nodes (1), and bone, breast, GI tract and bladder (n=1). Of 12 control patients with available FU, 1 developed metastases to liver. 2 patients have died of metastatic disease, one in the DigniCap arm and one in the control arm. No new safety signals have been detected.
Conclusion
Scalp cooling using the DigniCap system in patients with early stage breast cancer receiving taxane based neo/adjuvant chemotherapy is safe and effective. No scalp metastases have been reported 3 years following completion of study treatment. 4 year FU data will be presented.
The study was funded by The Lazlo Tauber Family Foundation (UCSF), the Anne Moore Breast Cancer Research Fund (Weil Cornell), and the Friedman Family Foundation (Mount Sinai Beth Israel), as well as partially by Dignitana.
Citation Format: Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, D'Agostino, Jr. RB, Deluca A, Cigler T. Long-term safety follow-up of patients with early stage breast cancer treated with scalp cooling on the Dignitana scalp cooling trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-04.
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Affiliation(s)
- HS Rugo
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - P Klein
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - SA Melin
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - SA Hurvitz
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - ME Melisko
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - A Moore
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - RB D'Agostino
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - A Deluca
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
| | - T Cigler
- University of California San Francisco Comprehensive Cancer Centere, San Francisco; Wake Forest School of Medicine, Winton Salem; Icahn School of Medicine at Mount Sinai, New York; University of California Los Angeles, Los Angeles; Weill Cornell Medical College, New York
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Liu YL, Bager CL, Willumsen N, Kornhauser N, Cobham M, Andreopoulou E, Cigler T, Moore A, LaPolla D, Fitzpatrick V, Ward M, Warren JD, Mittal V, Vahdat LT. Abstract PD9-07: A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with high risk breast cancer (BC): Role of collagen processing and tumor microenvironment. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd9-07] [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: Copper is an important catalytic cofactor in several biological functions and is essential for lysyl oxidase (LOX), a key enzyme in cross-linking collagen, which may play a role in tumor metastasis. We hypothesized that tetrathiomolybdate (TM)-associated copper depletion (CD) would inhibit tumor metastases by altering copper dependent collagen remodeling in the pre-metastatic niche. These results are an update of our previously reported clinical outcomes with longer follow-up and translational outcomes implicating the tumor microenvironment in metastatic transformation of BC. Methods: Pts at high risk for recurrence, node+ triple negative (TNBC) or stage 3/4 BC with no evidence of disease (NED), were enrolled on a phase II study of CD with TM. TM was given to maintain ceruloplasmin (Cp) levels between 8-16 mg/dl for two years (yrs) with an extension phase or until relapse. Median Cp levels were monitored with each cycle. Clinical endpoints included safety/tolerability and progression of disease (POD)/death. Event-free (EFS) and overall survival (OS) were calculated using Kaplan Meier survival analyses. Translational endpoints included markers of collagen cross-linking (LOXL-2), formation (PRO-C3), and degradation (C1M and C6M). Results: Seventy-five pts received 2993 cycles of TM on the primary (24 cycles, 28 days per cycle) and extension study. Median age was 51 yrs (range 29-66). Forty-five pts had stage 2/3 BC, and 30 pts were stage 4 NED. At a median follow-up of 8.4 yrs, the overall EFS was 71.4% and OS was 78.8%. The EFS and OS for the 36 pts with TNBC were 71.7% and 81%, and the EFS and OS for the 39 pts with Luminal/HER2+ BC were 71.2% and 78.6% respectively. TM was well tolerated with grade 3/4 toxicities including: neutropenia (1.9%), febrile neutropenia (0.03%), and fatigue (0.2%). LOXL2 levels were significantly decreased at 12 and 24 cycles compared with baseline (p<0.01) in those who were NED but not in those who had progressive disease (POD). LOXL2 levels were significantly correlated with C1M levels (spearman coefficient -0.34, p=0.02). C1M levels were significantly increased at 5, 11 and 24 cycles as compared with baseline (p<0.01) in those who were NED and were significantly higher as compared to levels in those experiencing POD/death, p<0.05. This difference may be more pronounced in those not achieving adequate CD (<50%) and in luminal/HER2+ BC. Interestingly, the ratio of C1M/PRO-C3 was significantly more elevated over time in those NED as compared to those experiencing POD/death. No associations were found with other collagen markers (PRO-C3 and C6M). Conclusions: TM is safe, well-tolerated and associated with decreased LOXL-2 and increased C1M levels over time in NED pts. This suggests that copper depletion may result in decreased collagen crosslinking and increased collagen degradation over formation, potentially “normalizing” the collagen microenvironment to create an inhospitable environment for tumor metastases. Larger randomized trials in high risk populations with translational outcomes are needed to further investigate the role of collagen processing in the tumor microenvironment and its potential as a biomarker of response.
Citation Format: Liu YL, Bager CL, Willumsen N, Kornhauser N, Cobham M, Andreopoulou E, Cigler T, Moore A, LaPolla D, Fitzpatrick V, Ward M, Warren JD, Mittal V, Vahdat LT. A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with high risk breast cancer (BC): Role of collagen processing and tumor microenvironment [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD9-07.
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Affiliation(s)
- YL Liu
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - CL Bager
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - N Willumsen
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - N Kornhauser
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - M Cobham
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - E Andreopoulou
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - T Cigler
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - A Moore
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - D LaPolla
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - V Fitzpatrick
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - M Ward
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - JD Warren
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - V Mittal
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
| | - LT Vahdat
- Memorial Sloan Kettering Cancer Center, New York, NY; Nordic Bioscience - Proscion, Herley, Denmark; Nordic Bioscience, Herley, Denmark; Weill Cornell Medicine, New York, NY
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Athanasiou A, Orfanelli T, Lapolla D, Andreopoulou E, Moo T, Marti J, Cigler T, Bongiovanni A, Witkin S. Elevated 70kDa heat shock protein (hsp70) and autophagy levels in peripheral blood mononuclear cells (PBMCs) in women with a malignant breast mass. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Breast cancer is the most prevalent cancer in the United States. With an increasing rate of survivorship and extended life span for patients with metastatic disease, the demand for palliative care is increasing. Although uncommon, metastases to gynaecologic organs have been reported and are often present with post-menopausal bleeding. Post-menopausal bleeding can become clinically significant and have a detrimental effect on quality of life. We report the case of a 70-year-old woman with symptomatic vaginal bleeding caused by breast cancer metastatic to her uterus, cervix, fallopian tubes and ovaries. She was successfully treated with minimally invasive hysterectomy, resolving her vaginal bleeding and anemia and allowing her to resume chemotherapy.
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Affiliation(s)
- Amnon A Berger
- Hadassah-Hebrew University School of Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, PO Box 12271, Jerusalem, 9112102, Israel
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Moore A, Carlson A, Kornhauser N, Schneider SE, Andreopoulou E, Cigler T, Vahdat LT, Webster G, Guthrie W. Breast cancer survivorship care plan: Patient satisfaction with a web-based application. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.7_suppl.50] [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: 11/20/2022] Open
Abstract
50 Background: The American College of Surgeons Commission on Cancer Standard 3.3 mandates that by 2018, oncologists provide Survivorship Care Plans (SCPs) to more than 75% of Stage 1-3 breast cancer survivors. Preparation and delivery of SCPs is time-consuming and requires dedicated staff commitment. Working with PatientsWithPower(PWP), a digital health company supporting patient decision-making for breast cancer, we developed a web-based SCP and surveyed patients regarding their satisfaction with the SCP. The objective of this study was to assess patient satisfaction with the PWP SCP. Methods: SCP’s were prepared using data extracted from the electronic medical record (EMR) and PWP software. A one-page SCP was presented to each patient by the Nurse Practitioner (NP) during a routine visit after patients completed active treatment. Results were reviewed after all surveys were completed. Fifty women with Stage 0-3 breast cancer participated in the IRB approved study and reported their satisfaction with the PWP SCP via online survey. Results: Using patient data in the EMR, the PWP plan took about 45 minutes to prepare. Once completed, NPs spent 10-15 minutes with each patient reviewing the SCP. Patient surveys indicated that 98% of patients felt it was important to receive a SCP, 84% planned to use it to plan follow up management, and 75% intended to share the SCP with their primary care physician. According to patients, the most valuable parts of the SCP were diagnosis and treatment history, and the follow up schedule. More than 70% of women requested additional information about future screening for recurrence, nutrition, and long-term side effect management. 92% of women appreciated the electronic “living document” that can be easily updated at subsequent visits. Conclusions: Presenting SCPs to patients is an essential component of high-quality cancer care. PWP’s online platform facilitates the development and delivery of SCPs by organizing and storing on-going patient data to make future SCP updates easy and efficient. Our patient satisfaction survey results underscore the value of SCPs, particularly for follow-up management and communications with primary care doctors.
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Rybstein MD, Nackos E, Kornhauser N, Cigler T, Andreopoulou E, Moore A, Cobham M, Fitzpatrick V, Demaria S, Vahdat LT. Abstract P1-10-10: Tumor infiltrating lymphocytes (TILS) among high risk for recurrence breast cancer patients treated with tetrathimolybdate (TM). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-10-10] [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: Tumor infiltrating lymphocytes (TILs) evaluated in the primary tumor biopsy or surgical resection have been well established as having prognostic significance in patients with triple negative breast cancer (TNBC) and HER2+ breast cancer treated with adjuvant chemotherapy (Savas et. al, Nat Rev Clin Oncol 2016). In TNBC, stromal TILs behave as a continuous variable with every 10% increase in TIL resulting in a decrease in risk of recurrence and death. The definition of lymphocyte-predominant breast cancer (LPBC) has been used for tumors that contain 50%–60% TILs and usually have a particularly good outcome (Salgado et al, Ann Oncol 2015). Our group recently demonstrated in a phase II single arm study that tetrathimolybdate (TM), a copper-depleting agent, resulted in improved event free survival (EFS) for TNBC patients compared to historical controls. The 2-year event-free survival (EFS) for stage 2-3 and stage 4 NED was 91% and 67%, respectively. In this analysis, our goal was to explore whether the encouraging results we observed were influenced by enrolling TNBC patients with better prognostic factors at initial diagnosis, namely higher stromal TIL score, in our copper depletion trial.
Methods: Archived primary breast tissue was available from 67 of the 75 patients enrolled in the phase II TM trial. The phase II study included patients with stage II TNBC or stage III or IV NED breast cancer patients, who were treated with TM for 2 years or until relapse. Here we focused on the 30 patients with TNBC. The demographic data for the patients is included in the following table.
Patient DemographicsAge at diagnosisStage at study entryPrior Adjuvant or Neoadjuvant therapyNumber of prior chemotherapy regimens in metastatic setting%Tumor Infiltrating Lymphocytes504Adjuvant110543AAdjuvantn/a30563AAdjuvantn/a20513CNeoadjuvantn/a<5454Adjuvant230514Neoadjuvant210363CAdjuvantn/a20592BAdjuvantn/a60453CAdjuvantn/a<5544Adjuvant130443CNeoadjuvantn/a20474Adjuvant020563CNeoadjuvantn/a10512AAdjuvantn/a10583AAdjuvantn/a20654None25513CNeoadjuvantn/a50503CNeoadjuvantn/a30543CNeoadjuvantn/a10542AAdjuvantn/a20403CNeoadjuvantn/a40604Adjuvant160564None160554Adjuvant010633CNeoadjuvantn/a5424Adjuvant050454Adjuvant110463AAduvantn/a10523CNeoadjuvantn/a10514Adjuvant1<5
The number of TILs in each sample was calculated by an experienced pathologist using published criteria (Salgado et al, Ann Oncol 2015). We used TILs >50% to define LPBC.
Results: Overall, we found that only 3/30 (10%) of TNBC patients had TILs >50%. In addition, 14/30 (46.7%) of TNBC patients had tumors with <10% TILs. The 2-year EFS for the patients with TILs >10% v. <10% was 76.9% v. 69.8%, respectively. (P=0.65)
Conclusions: Only 10% of TNBC patients enrolled in the study had LPBC at diagnosis thus indicating that this cohort was not enriched for patients with immunogenic tumors. When stratified by TILs >10% or <10%, there was no statistically significant difference in EFS. Although the analysis is limited due to the small sample size, it does suggest that the amount of TILs present at initial diagnosis did not influence the overall outcome for patients treated with TM.
Citation Format: Rybstein MD, Nackos E, Kornhauser N, Cigler T, Andreopoulou E, Moore A, Cobham M, Fitzpatrick V, Demaria S, Vahdat LT. Tumor infiltrating lymphocytes (TILS) among high risk for recurrence breast cancer patients treated with tetrathimolybdate (TM) [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 P1-10-10.
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Affiliation(s)
- MD Rybstein
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - E Nackos
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - N Kornhauser
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - T Cigler
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - E Andreopoulou
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - A Moore
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - M Cobham
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - V Fitzpatrick
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - S Demaria
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
| | - LT Vahdat
- New York Presybsterian - Weill Cornell Medical Center, New York, NY
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Sahota S, Willis A, Kornhauser N, Ward M, Cobham M, Cigler T, Moore A, Andreopoulou E, Fitzpatrick V, Schneider S, Prima N, Wiener A, Ko D, De Laurentiis A, Warren JD, Rubinchik A, Mittal V, Vahdat LT. Abstract P1-10-02: A phase II study of copper-depletion using tetrathiomolybdate in patients with breast cancer at high risk for recurrence: Updated results. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-10-02] [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
Background: Metals have emerged as a viable therapeutic target for a new generation of anti-cancer and anti-metastatic agents. Copper, an essential trace element, serves as an important catalytic cofactor in several biological functions and has emerged as an essential factor in carcinogenesis. Among other elements, bone marrow derived VEGFR2+ endothelial progenitor cells (EPCs) and copper-dependent lysyl oxidase (LOX) are key elements in tumor progression. We hypothesized tetrathiomolybdate (TM)-associated copper depletion (CD) inhibits tumor metastases by reducing the number of EPCs and other copper dependent processes in the pre-metastatic niche. These results are an update of our previously reported study (Chan N, Willis A, Kornhauser N et al. Influencing the Tumor Microenvironment: Phase 2 Study of Copper Depletion with Tetrathiomolybdate in High Risk Breast Cancer and Preclinical Models of Lung Metastases. Clin Cancer Res. October 21, 2016) with longer follow-up.
Methods: A single arm phase II study of breast cancer (BC) patients (pts) at high risk for recurrence, defined as node+ triple negative (TNBC), stage 3 and 4 with no evidence of disease (NED) were enrolled on a trial of CD with TM. TM was given to maintain ceruloplasmin (Cp) levels between 8-16 mg/dl for two years with an extension phase or until relapse. The primary endpoint was a change in EPCs measured by flow cytometry before and during treatment. Secondary endpoints included tolerability, safety, PFS and LOXL-2 levels.
Results: Seventy-five pts received 2778 cycles of TM on the primary and extension study. The primary study treatment duration was 24 cycles (each cycle is 28 days) plus an extension phase. The median age is 51 years (range 29-66). Forty-five pts have stage 2/3 BC and 30 with stage 4 NED. Forty-eight percent of pts are TNBC and 40% of pts are stage 4 NED. Median Cp levels were monitored with each cycle. A decrease from 28 to 16 (p<0.0001) was seen after one cycle. Interestingly, TNBC pts seemed to have a greater decrease from 23.5 to 13 after one cycle. TM was well tolerated with grade 3/4 toxicities including: reversible neutropenia (2.3%), febrile neutropenia (0.04%), fatigue (0.2%). Five-year analysis showed a decrease in EPC's (p=0.004) and LOXL-2 (p<0.001). At a median follow-up of 7.1 years, the EFS for 75 pts is 71.4%. The EFS for 36 pts with TNBC is 71.7%. EFS for stage 2/3 TNBC is 83% and for stage IV TNBC is 59.3%.
Conclusions: TM is safe, well tolerated and appears to affect multiple components of the tumor microenvironment that have been identified in pre-clinical models as important for progression. Ongoing studies in banked specimens are underway to further delineate its effect on copper dependent processes necessary for metastases. Randomized trials are warranted, especially in patients who are at high risk for relapse such as those with TNBC.
Citation Format: Sahota S, Willis A, Kornhauser N, Ward M, Cobham M, Cigler T, Moore A, Andreopoulou E, Fitzpatrick V, Schneider S, Prima N, Wiener A, Ko D, De Laurentiis A, Warren JD, Rubinchik A, Mittal V, Vahdat LT. A phase II study of copper-depletion using tetrathiomolybdate in patients with breast cancer at high risk for recurrence: Updated results [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 P1-10-02.
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Affiliation(s)
- S Sahota
- Weill Cornell-New York Presbyterian, New York, NY
| | - A Willis
- Weill Cornell-New York Presbyterian, New York, NY
| | - N Kornhauser
- Weill Cornell-New York Presbyterian, New York, NY
| | - M Ward
- Weill Cornell-New York Presbyterian, New York, NY
| | - M Cobham
- Weill Cornell-New York Presbyterian, New York, NY
| | - T Cigler
- Weill Cornell-New York Presbyterian, New York, NY
| | - A Moore
- Weill Cornell-New York Presbyterian, New York, NY
| | | | | | - S Schneider
- Weill Cornell-New York Presbyterian, New York, NY
| | - N Prima
- Weill Cornell-New York Presbyterian, New York, NY
| | - A Wiener
- Weill Cornell-New York Presbyterian, New York, NY
| | - D Ko
- Weill Cornell-New York Presbyterian, New York, NY
| | | | - JD Warren
- Weill Cornell-New York Presbyterian, New York, NY
| | - A Rubinchik
- Weill Cornell-New York Presbyterian, New York, NY
| | - V Mittal
- Weill Cornell-New York Presbyterian, New York, NY
| | - LT Vahdat
- Weill Cornell-New York Presbyterian, New York, NY
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Sahota S, Kornhauser N, Willis A, Ward MM, Cigler T, Moore A, Andreopoulou E, Fitzpatrick V, Schneider SE, Wiener A, Rubinchik A, Lee S, Lane ME, Mittal V, Vahdat LT. A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence: Updated results. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2557 Background: The tumor microenvironment (TME) plays a critical role in the spread of tumors. Bone marrow derived VEGFR2+endothelial progenitor cells (EPCs) and copper-dependent lysyl oxidase (LOX) are key in tumor progression. We hypothesized TM-associated copper depletion inhibits tumor metastases by reducing the number of EPCs and other copper dependent (CD) processes in the pre-metastatic niche. These results are an update with longer follow-up. Methods: Phase II study of BC pts at high risk for recurrence, defined as node+ triple negative (TNBC), stage 3 and 4 with no evidence of disease (NED) were enrolled on a trial of CD with TM. Ceruloplasmin (Cp) levels were maintained between 8-16 mg/dl for two years with an extension phase or until relapse. The primary endpoint was change in EPCs measured by flow cytometry before and during treatment. Secondary endpoints included tolerability, safety, PFS and LOXL-2 levels. Results: 75 pts received 2650 cycles of TM on primary and extension study. The median age is 51 years (range 29-66). Forty-five pts have stage 2/3 BC and 30 with stage 4 NED. TNBC pts were 48% and 40% of pts are stage 4 NED. Median Cp level decreased from 28 to 16 (p < 0.0001) after one cycle. Copper depletion was most efficient in TNBC where Cp levels dropped from 23.5 to 13 after one cycle. TM was well tolerated with grade 3/4 toxicities including: reversible neutropenia (2.3%), febrile neutropenia (0.04%), fatigue (0.2%). Five-year analysis showed a decrease in EPC’s (p = 0.004) and LOXL-2 (p < 0.001). At a median follow-up of 6.9 years, the EFS for 75 pts is 75.6%. PFS for 36 pts with TNBC is 79.2%. EFS for stage 2/3 TNBC is 90% and for stage IV TNBC is 66.7%. Conclusions: TM is safe, well tolerated and appears to affect multiple components of the TME creating an inhospitable environment for tumor progression especially in high risk patients such as TNBC. Randomized trials are warranted, especially in patients at high risk for relapse. Clinical trial information: UL1TR000457.
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Affiliation(s)
- Sheena Sahota
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | | | - Amy Willis
- Weill Cornell Medical College, New York, NY
| | | | | | - Anne Moore
- Weill Cornell Medical College, New York, NY
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Somlo G, Frankel PH, Arun BK, Ma CX, Garcia AA, Cigler T, Cream LV, Harvey HA, Sparano JA, Nanda R, Chew HK, Moynihan TJ, Vahdat LT, Goetz MP, Beumer JH, Hurria A, Mortimer J, Piekarz R, Sand S, Herzog J, Van Tongeren LR, Ferry-Galow KV, Chen AP, Ruel C, Newman EM, Gandara DR, Weitzel JN. Efficacy of the PARP Inhibitor Veliparib with Carboplatin or as a Single Agent in Patients with Germline BRCA1- or BRCA2-Associated Metastatic Breast Cancer: California Cancer Consortium Trial NCT01149083. Clin Cancer Res 2017; 23:4066-4076. [PMID: 28356425 DOI: 10.1158/1078-0432.ccr-16-2714] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/05/2016] [Accepted: 03/24/2017] [Indexed: 11/16/2022]
Abstract
Purpose: We aimed to establish the MTD of the poly (ADP-ribose) (PAR) polymerase inhibitor, veliparib, in combination with carboplatin in germline BRCA1- and BRCA2- (BRCA)-associated metastatic breast cancer (MBC), to assess the efficacy of single-agent veliparib, and of the combination treatment after progression, and to correlate PAR levels with clinical outcome.Experimental Design: Phase I patients received carboplatin (AUC of 5-6, every 21 days), with escalating doses (50-20 mg) of oral twice-daily (BID) veliparib. In a companion phase II trial, patients received single-agent veliparib (400 mg BID), and upon progression, received the combination at MTD. Peripheral blood mononuclear cell PAR and serum veliparib levels were assessed and correlated with outcome.Results: Twenty-seven phase I trial patients were evaluable. Dose-limiting toxicities were nausea, dehydration, and thrombocytopenia [MTD: veliparib 150 mg po BID and carboplatin (AUC of 5)]. Response rate (RR) was 56%; 3 patients remain in complete response (CR) beyond 3 years. Progression-free survival (PFS) and overall survival (OS) were 8.7 and 18.8 months. The PFS and OS were 5.2 and 14.5 months in the 44 patients in the phase II trial, with a 14% RR in BRCA1 (n = 22) and 36% in BRCA2 (n = 22). One of 30 patients responded to the combination therapy after progression on veliparib. Higher baseline PAR was associated with clinical benefit.Conclusions: Safety and efficacy are encouraging with veliparib alone and in combination with carboplatin in BRCA-associated MBC. Lasting CRs were observed when the combination was administered first in the phase I trial. Further investigation of PAR level association with clinical outcomes is warranted. Clin Cancer Res; 23(15); 4066-76. ©2017 AACR.
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Affiliation(s)
- George Somlo
- City of Hope Comprehensive Cancer Center, Duarte, California.
| | - Paul H Frankel
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Banu K Arun
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cynthia X Ma
- Washington University School of Medicine, St. Louis, Missouri
| | - Agustin A Garcia
- University of Southern California/Norris Cancer Center, Los Angeles, California
| | | | - Leah V Cream
- Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Joseph A Sparano
- Montefiore Medical Center, Moses & Weuker Divisions, Department of Oncology, Bronx, New York
| | - Rita Nanda
- The University of Chicago, Chicago, Illinois
| | - Helen K Chew
- University of California, Davis Cancer Center, Sacramento, California
| | | | | | | | - Jan H Beumer
- University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joanne Mortimer
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Richard Piekarz
- Investigational Drug Branch, Cancer Therapy Evaluation Program, DCTD, NCI, Bethesda, Maryland
| | - Sharon Sand
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Josef Herzog
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | - Katherine V Ferry-Galow
- Applied/Developmental Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratories, Frederick, Maryland
| | - Alice P Chen
- Investigational Drug Branch, Cancer Therapy Evaluation Program, DCTD, NCI, Bethesda, Maryland
| | | | - Edward M Newman
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - David R Gandara
- University of California, Davis Cancer Center, Sacramento, California
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Elkin EB, Pocus VH, Mushlin AI, Cigler T, Atoria CL, Polaneczky MM. Facilitating informed decisions about breast cancer screening: development and evaluation of a web-based decision aid for women in their 40s. BMC Med Inform Decis Mak 2017; 17:29. [PMID: 28327125 PMCID: PMC5359988 DOI: 10.1186/s12911-017-0423-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Expert groups and national guidelines recommend individualized decision making about screening mammography for women in their 40s at low-to-average risk of breast cancer. We created Breast Screening Decisions (BSD), a personalized, web-based decision aid, to help women decide when to start and how often to have routine screening mammograms. We evaluated BSD in a large, prospective pilot trial of women and their clinicians. Methods Women ages 40–49 were invited to use BSD before a scheduled preventive care visit. One month post-visit, users were asked about decisional conflict, knowledge, perceptions and worry about breast cancer and screening. They were also asked whether they had a screening mammogram since their visit, scheduled an appointment for a screening mammogram, or if they were planning to schedule an appointment within the next six months. Women who responded “no” to each of these successive questions were considered to have no plan for a screening mammogram within the next 6 months, unless they explicitly stated that they were unsure about screening mammography. Clinicians were surveyed regarding mammography discussions and perceived patient knowledge and anxiety. Results Of 1,100 women invited to use BSD, 253 accessed the website, and 168 were eligible to participate in the pilot study. One-fifth had a family history of breast cancer, and at least 76% had any prior mammogram. At follow-up, 88% of BSD users reported discussing mammography at their visit, and 77% said they had a screening mammogram since the visit or that they made or were planning to make a screening mammogram appointment. The average decisional conflict score was 22.5, within the threshold for implementing decisions. Decisional conflict scores were lowest in women who said that they had or planned to have a mammogram (mean 21.4, 95% CI 18.3-24.6), higher in those who did not (mean 24.8, 95% CI 19.2-30.5), and highest in those who were unsure (mean 31.5, 95% CI 13.9-49.1). Most BSD users expressed accurate perceptions of their breast cancer risk and the benefits and limitations of screening. Conclusions A web-based decision aid may support informed, individualized decisions about screening mammography and facilitate discussions about screening between women in their 40s and their clinicians. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0423-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena B Elkin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Valerie H Pocus
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alvin I Mushlin
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Tessa Cigler
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Coral L Atoria
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Margaret M Polaneczky
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
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Cigler T, Melin SA, Klein P, Hurvitz SA, Melisko M, Moore A, Park GD, Bageman E, Ver Hoeve ES, Rugo HS. Abstract P5-11-17: Body image in women with breast cancer using a scalp cooling system to reduce chemotherapy induced alopecia. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-11-17] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Abstract
Background: Most women consider hair to be an important part of body image. Alopecia is an emotionally traumatic side effect for breast cancer patients undergoing adjuvant chemotherapy. The DigniCap™ Scalp Cooling System is the first scalp cooling system cleared by the US Food and Drug Administration to reduce the likelihood of chemotherapy induced alopecia.
Methods: Quality of Life (QOL) data were collected as part of a prospective clinical trial evaluating the clinical performance of scalp cooling in women with early stage BC receiving adjuvant chemotherapy.
The study's primary endpoint was hair loss as evaluated by patient self-assessment. Treatment success was defined as ≤ 50% hair loss. QOL was evaluated by the EORTC-QLQ-BR23 (BR23) administered at baseline, last chemotherapy cycle, and one month later. For BR23, 4 response categories were collapsed to 2 categories (Not at all/A little bit and Quite a bit/Very much) for analysis. QOL was compared between those with success vs. failure of scalp cooling.
Results: 101 patients were evaluable for the primary endpoint: Success was seen in 67 (66.3%) pts. QOL at study entry was comparable between pts with scalp cooling success or failure for each item in the BR23 questionnaire. Results reported as percentages of patients in each group who answered either quite a bit or very much to body image-related questions on the BR23 questionnaire are displayed in Table 1.
BR23 results (% quite a bit/very much) one month after chemotherapyBR23 ItemsTreatment Success % (95% CI)Treatment Failure % (95% CI)Felt physically less attractive18.5% (9.0%, 27.9%)52.2% (31.8%, 72.6%)Felt less feminine15.4% (6.6%, 24.2%)29.1% (19.2%, 59.1%)Found it difficult to see themselves naked13.8% (5.5%, 22.2%)21.7% (4.9%, 38.6%)Felt dissatisfied with their body12.3% (4.3%, 20.3%)26.1% (8.1%, 44.0%)
Conclusions: Women with breast cancer using scalp cooling during chemotherapy who had hair preservation experienced improved quality of life, according to self-assessment of body image, compared to women who had significant hair loss.
Citation Format: Cigler T, Melin SA, Klein P, Hurvitz SA, Melisko M, Moore A, Park GD, Bageman E, Ver Hoeve ES, Rugo HS. Body image in women with breast cancer using a scalp cooling system to reduce chemotherapy induced alopecia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-17.
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Affiliation(s)
- T Cigler
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - SA Melin
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - P Klein
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - SA Hurvitz
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - M Melisko
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - A Moore
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - GD Park
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - E Bageman
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - ES Ver Hoeve
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
| | - HS Rugo
- Weill Cornell Medical College, New York, NY; Wake Forest School of Medicine, Winston Salem, NC; Icahn School of Medicine at Mount Sinai, New York, NY; University of California Los Angeles, Lost Angeles, CA; Univeristy of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco, CA; Target Health Inc., New York, NY; Dignitana AB, Lund, Sweden
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Mundi PS, Lee S, Chi D, Bhardwaj A, Makower D, Cigler T, Crew KD, Hershman DL, Califano A, Silva J, Kalinsky KM. Abstract P4-21-37: Phase I trial of ruxolitinib in combination with trastuzumab in metastatic HER2 positive breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-37] [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
Preclinical and clinical studies suggest that trastuzumab resistance in HER2 amplified breast cancer (HER2+ BC) is mediated by cross-activation of alternative signaling pathways. Computational analysis and pooled whole-genome RNAi screens in HER2 transformed BC cell lines identified the IL6/JAK2/STAT3 axis as a master regulator pathway. The combination of trastuzumab plus ruxolitinib, a JAK1/JAK2 inhibitor, demonstrated synergistic tumor growth inhibition in mouse xenografts of HER2 transformed BC cell lines. These data provide the rationale for studying the efficacy of ruxolitinib and trastuzumab in a clinical trial.
Design
This is a multi-center, open-label, phase I/II trial of ruxolitinib plus trastuzumab in patients (pts) with HER2+ metastatic BC (MBC) who have progressed on >2 HER2-directed therapies in the metastatic setting (including trastuzumab, pertuzumab and T-DM1). The phase I is an adaptive design with 10 pts, using the time-to-event continual reassessment method to determine the recommended phase II dose. Phase II will be a non-randomized, open-label trial with 30 evaluable pts. The duration of a treatment cycle is 21 days, with trastuzumab given on Day 1 and ruxolitinib taken orally twice daily continuously. The primary endpoint of phase I is to determine the maximum tolerated dose of the drug combination. The phase I dose range for ruxolitinib is 10-25 mg BID (dose level 0: 20 mg BID). Response is assessed by imaging every 9 weeks. Blood samples and optional tissue biopsies are obtained for biomarker analysis at the following time points: pre-treatment, on-treatment C2D1, and at progression.
Results
Phase I started accrual in the fall of 2014. The trial has accrued 12 patients, with 9 evaluable and 3 non-evaluable patients. Of the evaluable patients, the mean age was 55.9 (range 32-69). Of these, 7 were postmenopausal (78%) 5/9 (56%) were estrogen receptor positive, and all had measurable disease. The mean number of prior lines of therapy in the metastatic setting was 5.6 (range: 3-8), including a mean of 3.2 (range: 2-5) prior regimens containing HER2 targeted therapies. As of 6/12/16, 2 patients remain on therapy. As this is an adaptive design, efficacy and drug tolerability will not be mentioned in this abstract to not bias the ongoing analysis. However, we anticipate that by SABCS 2016, 10 evaluable patients will have completed the DLT period – at which point, complete data will be presented.
Conclusion
Ruxolitinib plus trastuzumab is a novel, non-chemotherapy containing regimen. The phase I analysis is ongoing. We plan on reporting full safety/tolerability and efficacy data once 10 evaluable patients have completed the phase I (9/10 have currently completed DLT period). Given an early signal in HER2+ breast cancer, in this heavily pretreated population we will proceed directly to a phase II trial with the combination.
Citation Format: Mundi PS, Lee S, Chi D, Bhardwaj A, Makower D, Cigler T, Crew KD, Hershman DL, Califano A, Silva J, Kalinsky KM. Phase I trial of ruxolitinib in combination with trastuzumab in metastatic HER2 positive breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-37.
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Affiliation(s)
- PS Mundi
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - S Lee
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - D Chi
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - A Bhardwaj
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - D Makower
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - T Cigler
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - KD Crew
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - DL Hershman
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - A Califano
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - J Silva
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
| | - KM Kalinsky
- Columbia University Medical Center, New York, NY; Food and Drug Administration; Mount Sinai School of Medicine, New York, NY; Albert Einstein College of Medicine, Bronx, NY; Weill Cornell Medical Center, New York, NY
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Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, Park G, Mitchel J, Bågeman E, D'Agostino RB, Ver Hoeve ES, Esserman L, Cigler T. Association Between Use of a Scalp Cooling Device and Alopecia After Chemotherapy for Breast Cancer. JAMA 2017; 317:606-614. [PMID: 28196257 PMCID: PMC5639721 DOI: 10.1001/jama.2016.21038] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Chemotherapy-induced alopecia is a common and distressing adverse effect. In previous studies of scalp cooling to prevent chemotherapy-induced alopecia, conclusions have been limited. OBJECTIVES To evaluate whether use of a scalp cooling system is associated with a lower amount of hair loss among women receiving specific chemotherapy regimens for early-stage breast cancer and to assess related changes in quality of life. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study conducted at 5 US medical centers of women with stage I or II breast cancer receiving adjuvant or neoadjuvant chemotherapy regimens excluding sequential or combination anthracycline and taxane (106 patients in the scalp cooling group and 16 in the control group; 14 matched by both age and chemotherapy regimen). The study was conducted between August 2013 and October 2014 with ongoing annual follow-up for 5 years. EXPOSURES Use of a scalp cooling system. Scalp cooling was initiated 30 minutes prior to each chemotherapy cycle, with scalp temperature maintained at 3°C (37°F) throughout chemotherapy and for 90 minutes to 120 minutes afterward. MAIN OUTCOMES AND MEASURES Self-estimated hair loss using the Dean scale was assessed 4 weeks after the last dose of chemotherapy by unblinded patient review of 5 photographs. A Dean scale score of 0 to 2 (≤50% hair loss) was defined as treatment success. A positive association between scalp cooling and reduced risk of hair loss would be demonstrated if 50% or more of patients in the scalp cooling group achieved treatment success, with the lower bound of the 95% CI greater than 40% of the success proportion. Quality of life was assessed at baseline, at the start of the last chemotherapy cycle, and 1 month later. Median follow-up was 29.5 months. RESULTS Among the 122 patients in the study, the mean age was 53 years (range, 28-77 years); 77.0% were white, 9.0% were black, and 10.7% were Asian; and the mean duration of chemotherapy was 2.3 months (median, 2.1 months). No participants in the scalp cooling group received anthracyclines. Hair loss of 50% or less (Dean score of 0-2) was seen in 67 of 101 patients (66.3%; 95% CI, 56.2%-75.4%) evaluable for alopecia in the scalp cooling group vs 0 of 16 patients (0%) in the control group (P < .001). Three of 5 quality-of-life measures were significantly better 1 month after the end of chemotherapy in the scalp cooling group. Of patients who underwent scalp cooling, 27.3% (95% CI, 18.0%-36.6%) reported feeling less physically attractive compared with 56.3% (95% CI, 31.9%-80.6%) of patients in the control group (P = .02). Of the 106 patients in the scalp cooling group, 4 (3.8%) experienced the adverse event of mild headache and 3 (2.8%) discontinued scalp cooling due to feeling cold. CONCLUSIONS AND RELEVANCE Among women undergoing non-anthracycline-based adjuvant chemotherapy for early-stage breast cancer, the use of scalp cooling vs no scalp cooling was associated with less hair loss at 4 weeks after the last dose of chemotherapy. Further research is needed to assess outcomes after patients receive anthracycline regimens, longer-term measures of alopecia, and adverse effects. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01831024.
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Affiliation(s)
- Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Paula Klein
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Susan Anitra Melin
- Wake Forest Baptist Health Medical Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sara A Hurvitz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Michelle E Melisko
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Anne Moore
- Weill Cornell Medical College, New York, New York
| | - Glen Park
- Target Health Inc, New York, New York
| | | | | | | | - Elizabeth S Ver Hoeve
- Columbia University, New York, New York10Now with the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Laura Esserman
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Tessa Cigler
- Weill Cornell Medical College, New York, New York
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24
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Chan N, Willis A, Kornhauser N, Ward MM, Lee SB, Nackos E, Seo BR, Chuang E, Cigler T, Moore A, Donovan D, Vallee Cobham M, Fitzpatrick V, Schneider S, Wiener A, Guillaume-Abraham J, Aljom E, Zelkowitz R, Warren JD, Lane ME, Fischbach C, Mittal V, Vahdat L. Influencing the Tumor Microenvironment: A Phase II Study of Copper Depletion Using Tetrathiomolybdate in Patients with Breast Cancer at High Risk for Recurrence and in Preclinical Models of Lung Metastases. Clin Cancer Res 2017; 23:666-676. [PMID: 27769988 DOI: 10.1158/1078-0432.ccr-16-1326] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/13/2016] [Accepted: 09/26/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Bone marrow-derived progenitor cells, including VEGFR2+ endothelial progenitor cells (EPCs) and copper-dependent pathways, model the tumor microenvironment. We hypothesized that copper depletion using tetrathiomolybdate would reduce EPCs in high risk for patients with breast cancer who have relapsed. We investigated the effect of tetrathiomolybdate on the tumor microenvironment in preclinical models. EXPERIMENTAL DESIGN Patients with stage II triple-negative breast cancer (TNBC), stage III and stage IV without any evidence of disease (NED), received oral tetrathiomolybdate to maintain ceruloplasmin (Cp) between 8 and 17 mg/dL for 2 years or until relapse. Endpoints were effect on EPCs and other biomarkers, safety, event-free (EFS), and overall survival (OS). For laboratory studies, MDA-LM2-luciferase cells were implanted into CB17-SCID mice and treated with tetrathiomolybdate or water. Tumor progression was quantified by bioluminescence imaging (BLI), copper depletion status by Cp oxidase levels, lysyl oxidase (LOX) activity by ELISA, and collagen deposition. RESULTS Seventy-five patients enrolled; 51 patients completed 2 years (1,396 cycles). Most common grade 3/4 toxicity was neutropenia (3.7%). Lower Cp levels correlated with reduced EPCs (P = 0.002) and LOXL-2 (P < 0.001). Two-year EFS for patients with stage II-III and stage IV NED was 91% and 67%, respectively. For patients with TNBC, EFS was 90% (adjuvant patients) and 69% (stage IV NED patients) at a median follow-up of 6.3 years, respectively. In preclinical models, tetrathiomolybdate decreased metastases to lungs (P = 0.04), LOX activity (P = 0.03), and collagen crosslinking (P = 0.012). CONCLUSIONS Tetrathiomolybdate is safe, well tolerated, and affects copper-dependent components of the tumor microenvironment. Biomarker-driven clinical trials in high risk for patients with recurrent breast cancer are warranted. Clin Cancer Res; 23(3); 666-76. ©2016 AACR.
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Affiliation(s)
- Nancy Chan
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Amy Willis
- Department of Statistical Science, Cornell University, Ithaca, New York
| | - Naomi Kornhauser
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Maureen M Ward
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Sharrell B Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Eleni Nackos
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Bo Ri Seo
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Ellen Chuang
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Tessa Cigler
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Anne Moore
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Diana Donovan
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | | | - Sarah Schneider
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Alysia Wiener
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | | | - Elnaz Aljom
- Investigational Pharmacy, New York Presbyterian Hospital, New York, New York
| | | | - J David Warren
- Department of Biochemistry, Weill Cornell Medicine, New York, New York
| | - Maureen E Lane
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Claudia Fischbach
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Vivek Mittal
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Linda Vahdat
- Department of Medicine, Weill Cornell Medicine, New York, New York.
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25
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Adelson K, Ramaswamy B, Sparano JA, Christos PJ, Wright JJ, Raptis G, Han G, Villalona-Calero M, Ma CX, Hershman D, Baar J, Klein P, Cigler T, Budd GT, Novik Y, Tan AR, Tannenbaum S, Goel A, Levine E, Shapiro CL, Andreopoulou E, Naughton M, Kalinsky K, Waxman S, Germain D. Randomized phase II trial of fulvestrant alone or in combination with bortezomib in hormone receptor-positive metastatic breast cancer resistant to aromatase inhibitors: a New York Cancer Consortium trial. NPJ Breast Cancer 2016; 2:16037. [PMID: 28721390 PMCID: PMC5515340 DOI: 10.1038/npjbcancer.2016.37] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/09/2016] [Accepted: 10/18/2016] [Indexed: 11/09/2022] Open
Abstract
The proteasome inhibitor bortezomib enhances the effect of the selective estrogen receptor (ER) downregulator (SERD) fulvestrant by causing accumulation of cytoplasmic ER aggregates in preclinical models. The purpose of this trial was to determine whether bortezomib enhanced the effectiveness of fulvestrant. One hundred eighteen postmenopausal women with ER-positive metastatic breast cancer resistant to aromatase inhibitors (AIs) were randomized to fulvestrant alone (Arm A-500 mg intramuscular (i.m.) day -14, 1, 15 in cycle 1, and day 1 of additional cycles) or in combination with bortezomib (Arm B-1.6 mg/m2 intravenous (i.v.) on days 1, 8, 15 of each cycle). The study was powered to show an improvement in median progression-free survival (PFS) from 5.4 to 9.0 months and compare PFS rates at 6 and 12 months (α=0.10, β=0.10). Patients with progression on fulvestrant could cross over to the combination (arm C). Although there was no difference in median PFS (2.7 months in both arms), the hazard ratio for PFS in Arm B versus Arm A (referent) was 0.73 (95% confidence interval (CI)=0.49, 1.09, P=0.06, 1-sided log-rank test, significant at the prespecified 1-sided 0.10 α level). At 12 months, the PFS proportion in Arm A and Arm B was 13.6% and 28.1% (P=0.03, 1-sided χ2-test; 95% CI for difference (14.5%)=-0.06, 29.1%). Of 27 patients on arm A who crossed over to the combination (arm C), 5 (18%) were progression-free for at least 24 weeks. Bortezomib likely enhances the effectiveness of fulvestrant in AI-resistant, ER-positive metastatic breast cancer by reducing acquired resistance, supporting additional evaluation of proteasome inhibitors in combination with SERDs.
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Affiliation(s)
- Kerin Adelson
- Yale Cancer Center and Smilow Cancer Hospital, Yale University School of Medicine, New Haven, CT, USA
| | | | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Paul J Christos
- Department of Healthcare Policy & Research, Weill Cornell Medical Center, New York, NY, USA
| | - John J Wright
- Investigational Drug Branch, Cancer Therapy and Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - George Raptis
- Department of Medicine, Northwell Health, Lake Success NY and Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | | | - Cynthia X Ma
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Dawn Hershman
- Department of Medicine and Epidemiology New York Presbyterian-Columbia University Medical Center, New York, NY, NY, USA
| | - Joseph Baar
- Department of Medicine, Division of Hematology/Oncology, Seidman Cancer Center of the University Hospitals of the Cleveland Medical Center, Cleveland, OH, USA
| | - Paula Klein
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Tessa Cigler
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - G Thomas Budd
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA
| | - Yelena Novik
- Perlmutter Cancer Center, NYU Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Antoinette R Tan
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Susan Tannenbaum
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Anupama Goel
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Ellis Levine
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, State University of New York at Buffalo, Buffalo, NY, USA
| | - Charles L Shapiro
- The Ohio State Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | | | - Michael Naughton
- Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Kevin Kalinsky
- Department of Medicine, Division of Hematology and Oncology, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Sam Waxman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Doris Germain
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Nackos E, Lee S, Willis A, Kornhauser N, Ward M, Cobham M, Cigler T, Moore A, Fitzpatrick V, Schneider S, Wiener A, Guillaume-Abraham J, Seo BR, Warren JD, Rubinchik A, Fischbach C, Mittal V, Vahdat L. Abstract LB-349: Copper depletion as a strategy to affect the tumor microenvironment in breast cancer patients at high risk of relapse and in triple negative preclinical models of breast cancer: Updated results of a phase II study of tetrathiomolybdate (TM) in breast cancer (BC) patients (pts) at high risk for recurrence. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-349] [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 pre-metastatic niche mobilizes copper to assist in conditioning the tumor microenvironment facilitating tumor progression. This includes bone marrow derived VEGFR2+ endothelial progenitor cells (EPCs) and copper-dependent lysyl oxidase (LOX). We hypothesized that TM-associated CD would reduce EPCs and other copper dependent processes in the pre-metastatic niche in BC pts.
Methods: Stage 2 triple negative BC, Stage 3 and stage 4 without any evidence of disease, (NED) BC pts, received oral TM to maintain ceruloplasmin (Cp) between 8-17mg/dL for 2 years or until relapse. Endpoints included change in EPCs, safety, disease-free (DFS) and overall survival (OS) and effect on biomarkers. Laboratory studies: MDA-LM2-luciferase cells were implanted into CB17-SCID mice, and treated with TM or water. Tumor progression was quantified by bioluminescence imaging (BLI), CD status by Cp oxidase levels, lysyl oxidase (LOXL2) activity by ELISA, and collagen deposition by Picrosirius Red staining and Second Harmonic Generation (SHG) imaging analysis.
Results: 75 pts (45 stage 2/3 BC, 30 stage 4 NED) received over 2400 cycles of TM on the primary and extension studies. Median age: 51 yrs (range 29-66). Of the 75 pts, 48% had TNBC, 40% were stage 4 NED. Median Cp level decreased from 28 at baseline to 15.5 (p<0.0001) after one cycle. Grade 3/4 toxicities included reversible neutropenia (2.3%), anemia (0.04%), leukopenia (1.2%) and fatigue (0.09%). CD was associated with a decrease in EPCs (p = 0.0014) and serum LOX (p<0.001). At a median follow-up of 5.9 years, the PFS for all 75 pts is 72%, including a PFS of 90% for all stage 2/3 pts with TNBC. The overall survival is 84%. Relapse after two years is a rare event. In pre-clinical models, TM had no effects on the primary tumor, but decreased secondary lung metastases (p = 0.04) as seen by BLI. Western blots demonstrated decreased LOX in the pre-metastatic lungs vs controls (p = 0.03), and IHC showed reduced collagen cross-linking by image J (p = 0.01). SHG analysis showed reduced collagen fiber length.
Conclusions: TM is safe, well tolerated and appears to affect multiple copper dependent biologic processes in the tumor microenvironment known to be important for tumor progression, most striking in TNBC. Randomized trials in a high risk for relapse population are warranted.
Citation Format: Eleni Nackos, Sharrell Lee, Amy Willis, Naomi Kornhauser, Maureen Ward, Marta Cobham, Tessa Cigler, Anne Moore, Veronica Fitzpatrick, Sarah Schneider, Alysia Wiener, Jessica Guillaume-Abraham, Bo Ri Seo, J David Warren, Anna Rubinchik, Claudia Fischbach, Vivek Mittal, Linda Vahdat. Copper depletion as a strategy to affect the tumor microenvironment in breast cancer patients at high risk of relapse and in triple negative preclinical models of breast cancer: Updated results of a phase II study of tetrathiomolybdate (TM) in breast cancer (BC) patients (pts) at high risk for recurrence. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-349.
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Weitzel JN, Frankel PH, Herzog J, Arun B, Beumer JH, Ma CX, Cigler T, Cream L, Harvey HA, Sparano JA, Nanda R, Chew HK, Vahdat LT, Goetz MP, Gandara DR, Piekarz R, Van Tongeren LR, Ferry-Galow KV, Synold TW, Somlo G. Suppression of poly-ADP ribose (PAR) levels in PBMCs by veliparib (vel) as a pharmacodynamic (PD) marker associated with survival among women with BRCA1- or BRCA2- ( BRCA)-associated metastatic breast cancer (MBC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Cynthia X. Ma
- Washington University School of Medicine, St. Louis, MO
| | | | - Leah Cream
- Penn State Hershey Medical Center, Hershey, PA
| | | | | | | | | | | | | | | | - Richard Piekarz
- Cancer Therapy Evaluation Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
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28
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Nackos E, Willis A, Kornhauser N, Ward M, Andreopoulou E, Cigler T, Moore A, Fitzpatrick V, Cobham M, Schneider S, Wiener A, Guillaume-Abraham J, Warren JD, Rubinchik A, Lane M, Mittal V, Vahdat L. Abstract P3-02-02: Targeting the tumor microenvironment: A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-02-02] [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: Bone marrow derived VEGFR2+ endothelial progenitor cells (EPCs) and copper-dependent pathways, including lysyl oxidase (LOX), are critical components to remodeling the tumor microenvironment and establishing the pre-metastatic niche. In preclinical models, it has been well established that copper depletion (CD) inhibits tumor progression. We hypothesized that TM-associated CD would reduce EPCs and other copper dependent processes in the pre-metastatic niche in BC pts at high risk for relapse. We investigated the relationship between CD and its effect on EPCs and other components of the tumor microenvironment including LOX, an enzyme critical for cross-linkage of collagen and priming the pre-metastatic niche.
Methods: In this single arm, phase II study, BC pts at high risk for recurrence, defined as node+ triple negative (TN), stage 3 and 4 with no evidence of disease (NED) were enrolled on a trial of CD with TM. Pts received oral TM to maintain ceruloplasmin (Cp) between 5-17 mg/dl for 2 years on the primary study. The primary endpoint was change in EPCs measured by flow cytometry before and during treatment with TM. Secondary endpoints included tolerability, safety and effect of copper depletion on other markers including LOX, quantified by ELISA.
Results: We enrolled 75 pts. The study treatment duration was 24 cycles (each cycle is 28 days). Over 2200 cycles have been administered. The median age is 51 (range 29-66). 45 pts have Stage 2/3 BC and 30 are Stage 4 NED. TNBC pts represent 48%, and 40% of pts are Stage 4 NED. Median Cp level decreased from 28 at baseline to 15.5 (p<0.0001) after one cycle. Copper depletion was most efficient in TNBC, with 91% achieving a target CP within 4 weeks. TM was well tolerated and the only grade 3/4 toxicities were reversible neutropenia (3.2%) and anemia (0.0005%). CD was associated with a significant decrease in EPCs (p=0.0014) and LOX (p<0.001). At a median follow-up of 5.4 years, the PFS for all 75 pts from the start of TM treatment was 71%, including a PFS of 90% for all stage 2/3 pts with TNBC. The overall survival of all patients enrolled in the trial is 86%. Relapse after two years is a rare event. Conclusions: TM is safe, well tolerated and appears to affect multiple copper dependent biologic processes in the tumor microenvironment known to be important for tumor progression. This seems to be most striking in TNBC. We believe, further phase III trials in a high risk for relapse population are warranted.
Citation Format: Nackos E, Willis A, Kornhauser N, Ward M, Andreopoulou E, Cigler T, Moore A, Fitzpatrick V, Cobham M, Schneider S, Wiener A, Guillaume-Abraham J, Warren JD, Rubinchik A, Lane M, Mittal V, Vahdat L. Targeting the tumor microenvironment: A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-02-02.
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Affiliation(s)
- E Nackos
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - A Willis
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - N Kornhauser
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - M Ward
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - E Andreopoulou
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - T Cigler
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - A Moore
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - V Fitzpatrick
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - M Cobham
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - S Schneider
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - A Wiener
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - J Guillaume-Abraham
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - JD Warren
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - A Rubinchik
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - M Lane
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - V Mittal
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
| | - L Vahdat
- Weill Cornell Medical College, NY, NY; Weill Cornell, New York Presbyterian Hospital, NY, NY; Cornell University, Ithaca, NY
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Kalinsky K, Chi DC, Lee S, Bhardwaj A, Makower D, Cigler T, Crew KD, Hershman DL, Califano A, Silva J, Maurer M. Abstract OT3-01-06: Phase I/II trial of ruxolitinib in combination with trastuzumab in metastatic HER2 positive breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-01-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Integrated analysis of whole genome RNAi screening with computationally reverse engineered interactome models identified IL6/JAK/STAT as a master regulator pathway essential for growth of ErbB2/HER2 positive breast cancer. Ruxolitinib (R), FDA-approved treatment for myelofibrosis, inhibits JAK1 and JAK2. The combination of R plus Trastuzumab (T) is synergistic in tumor growth inhibition in mouse xenografts of HER2 amplified breast cancer cell lines. These data provide a strong rationale for studying the efficacy of combination R and T in a clinical trial.
Trial Design:
A multi-center, open-label, phase I/II (P1/2) trial of R plus T in HER2+ metastatic breast cancer (MBC) who have progressed on T-based therapy. P1 will be an adaptive design with 10 patients, using the time-to-event continual reassessment method. The recommended P2 dose (RP2D) will be used in a non-randomized, open-label P2 trial with 30 evaluable patients (pts). Given the anticipated limited overlapping toxicities, approximately 36 pts (range: 32-40) are expected for the P1/2. The duration of a treatment cycle will be 21 days. R will be taken orally twice a day continuously. The P1 dosing range will be 10-25 mg BID (dose level 0: 20 mg BID). T will be administered on Day 1 of each cycle at standard dosing. Objective Response Rate (ORR) will be assessed by imaging every 9 weeks. Blood samples will be obtained for biomarker analysis, pre-treatment, on-treatment on C2D1, and then at progression. Pre-treatment biopsies from archival tissue or new biopsy, on treatment biopsy on C2D1, and upon progression of disease will be discussed with pts with accessible disease.
Main Eligibility Criteria:
1. HER2 positive MBC
2. Progression on HER2-directed therapy in metastatic setting, including Pertuzumab and T-DM1
3. Measurable or non-measurable disease
4. LVEF great than 50%
5. No history of prior JAK2 inhibitor
6. No HIV-positive or active infection
7. No concurrent medications that are potent CYP3A4 inhibitor or inducer
Specific Aims:
1. Primary: P1: MTD of combined R + T. P2: Progression Free Survival (PFS)
2. Secondary: a) Clinical: ORR, clinical benefit rate (CBR), and tolerability. Pts will be stratified by hormone receptor (HR) status to explore differences in efficacy between HR+ and HR-.
b) Explore potential predictive tumor and blood-based predictive biomarkers at baseline, on treatment, and progression: (tumor: pSTAT3 expression); serum: IL-6, IL-8, C-reactive protein; circulating tumor cell pSTAT3 expression; and tumor gene expression.
Statistical Methods:
Assuming a historical PFS of 8 weeks with single-agent agent HER2-targeted therapy in HER2+ MBC after progressing on T-based therapy, we predict that pts receiving the combination of R plus T will have a PFS of at least 13 weeks. With a 2-sided alpha of 0.05, we have 80% power to detect a difference with 30 pts.
Target Accrual:
Sample Size: 32-40 pts; projected over 2 years at 4 sites: Columbia, Einstein, Mount Sinai, and Cornell. Trial accruing since Fall 2014.
Citation Format: Kalinsky K, Chi D-C, Lee S, Bhardwaj A, Makower D, Cigler T, Crew KD, Hershman DL, Califano A, Silva J, Maurer M. Phase I/II trial of ruxolitinib in combination with trastuzumab in metastatic HER2 positive breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-01-06.
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Affiliation(s)
- K Kalinsky
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - D-C Chi
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - S Lee
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - A Bhardwaj
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - D Makower
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - T Cigler
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - KD Crew
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - DL Hershman
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - A Califano
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - J Silva
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
| | - M Maurer
- New York Presbyterian - Columbia University Medical Center; Mount Sinai Medical Center; Montefiore Medical Center; New York Presbyterian - Weill Cornell Medical Center
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Nackos EN, Kornhauser N, Ward MM, Cigler T, Moore A, Andreopoulou E, Chan N, Fitzpatrick V, Schneider SE, Wiener A, Warren JD, Rubinchik A, Willis A, Lee S, Lane ME, Mittal V, Vahdat LT. Altering the tumor microenvironment: A phase II study of copper depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.11008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Nancy Chan
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | - Amy Willis
- Weill Cornell Medical College, New York, NY
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31
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Goldfarb SB, Bedoschi G, Grunblatt E, Goswami S, Cigler T, Quistorff J, Pacheco F, Stobezki R, Robson ME, Moy F, Hudis CA, Patil S, Dickler MN, Oktay K. The impact of adjuvant breast cancer (BC) chemotherapy on ovarian reserve and menses. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Fernanda Pacheco
- Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| | - Robert Stobezki
- Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| | | | - Fred Moy
- Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| | | | - Sujata Patil
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kutluk Oktay
- Institute for Fertility Preservation and New York Medical College, New York, NY
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Somlo G, Frankel PH, Luu TH, Ma CX, Arun B, Garcia AA, Cigler T, Cream L, Harvey HA, Sparano JA, Nanda R, Chew HK, Moynihan TJ, Vahdat LT, Goetz MP, Hurria A, Mortimer JE, Gandara DR, Chen AP, Weitzel JN. Efficacy of the PARP inhibitor (PI) ABT-888 (veliparib [vel]) either with carboplatin (carb) or as a single agent followed by post-progression therapy in combination with carb in patients (pts) with BRCA1- or BRCA2- (BRCA)-associated metastatic breast cancer (MBC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.520] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Agustin A. Garcia
- Los Angeles County Hospital/ University of Southern California, Los Angeles, CA
| | | | - Leah Cream
- Penn State College of Medicine, Hershey, PA
| | | | | | | | | | | | | | | | | | | | - David R. Gandara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
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Rugo HS, Klein P, Melin SA, Hurvitz SA, Melisko ME, Moore A, Park GD, Bageman E, D'Agostino R, Ver Hoeve ES, Cigler T. Clinical performance of the DigniCap system, a scalp hypothermia system, in preventing chemotherapy-induced alopecia. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hope S. Rugo
- University of California, San Francisco, San Francisco, CA
| | - Paula Klein
- Beth Israel Compresensive Cancer Ctr, New York, NY
| | | | - Sara A. Hurvitz
- UCLA Healthcare Hematology-Oncology Breast Oncology Program, Santa Monica, CA
| | - Michelle E. Melisko
- UC San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Adelson KB, Ramaswamy B, Sparano JA, Christos PJ, Wright JJ, Raptis G, Villalona MC, Ma CX, Hershman D, Baar J, Klein P, Cigler T, Budd GT, Novik Y, Tan AR, Tannenbaum S, Goel A, Levine E, Shapiro CL, Andreopoulou E, Naughton M, Kalinsky K, Waxman S, Germain D. Abstract S6-03: Randomized phase II trial of fulvestrant alone or in combination with bortezomib in hormone receptor-positive metastatic breast cancer resistant to aromatase inhibitors: A New York cancer consortium trial. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-s6-03] [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
Purpose: Fulvestrant (F) is a selective estrogen receptor downregulator (SERD) with activity in aromatase-inhibitor (AI) resistant estrogen receptor (ER)-positive metastatic breast cancer (MBC). In preclinical studies, the proteasome inhibitor bortezomib (B) enhances the antineoplastic effects of F, in part by promoting accumulation of large ER-aggregates that lead to cell death (Ishii et al. Clin Cancer Res 2011 17:2292). The objective of this study was to determine if the combination of F+B was more efficacious than F alone in MBC after AI progression.
Patients and Methods: Postmenopausal women with ER-positive MBC who had progressive disease after prior AI therapy were eligible. They were randomized to F alone (500 mg IM days -15, 1, 15 in cycle 1, and day 1 of each subsequent cycle) or in combination with B (1.6 mg/m2 IV on days 1, 8, 15). The primary endpoint was progression free survival (PFS), measured from cycle 1, day 1 of starting F. A sample size of 118 was pre-specified in order to provide sufficient power to detect an improvement in median PFS from 5.4 to 9.0 months, and compare PFS rates after 6 and 12 months (1-sided alpha=0.10, beta=0.10). Patients with progression on F could cross over to the F+B combination.
Results: Of 118 patients enrolled, 59 received F alone (arm A), 57 received F+B (arm B), and 2 assigned to arm B never initiated protocol therapy. There were no significant differences in patient characteristics between arms with regard to median age (57 vs. 59 years), ECOG performance status (0 and 1, 64% and 36%, respectively), prior chemotherapy for metastasis (25%), or liver metastases (37%), although patients in arm A had longer median interval between diagnosis and metastasis (49 vs. 28 months) and were more likely to present with metastasis (32% vs. 26%). Patients in arm B had more adverse events (all grades), including nausea (63% vs. 29%), diarrhea (47% vs. 8%), sensory neuropathy (46% vs. 29%), and limb edema (37% vs. 19%), although grade 3-4 events were uncommon, and only 11% discontinued B due to toxicity. At 12 months, the PFS proportion in Arm A and Arm B was 13.6% vs. 28.1%, respectively (P=0.03, 1-sided chi-square test) (95% CI for difference [14.5%] = -0.06%, 29.1%). Although median PFS was similar in the two arms (2.69 vs. 2.73 months, respectively), the hazard ratio for Arm B vs. Arm A (referent) was 0.73 (95% CI = 0.49, 1.09, P=0.06, 1-sided log rank test). Both results were significant at the pre-specified 1-sided 0.10 alpha level. Of 27 patients on arm A who crossed over to F+B at progression, 4 (15%) were progression-free for at least 24 weeks and had periods of disease control that were longer than when treated with F alone.
Conclusion: Adding bortezomib to fulvestrant in AI-resistant ER-positive MBC enhances its effectiveness by delaying acquired fulvestrant resistance. These results support additional evaluation of proteasome inhibitors in combination with SERDs.
Acknowledgement: Supported by contract N01-CM-62204 to the New York Cancer Consortium (P.I. J. Sparano) and grant P30 CA013330 (P.I. D. Goldman) from the National Institutes of Health, and by a grant from Millennium, Inc.
Citation Format: Kerin B Adelson, Bhuvaneswari Ramaswamy, Joseph A Sparano, Paul J Christos, John J Wright, George Raptis, Miguel C Villalona, Cynthia X Ma, Dawn Hershman, Joseph Baar, Paula Klein, Tessa Cigler, G Thomas Budd, Yelena Novik, Antoinette R Tan, Susan Tannenbaum, Anupama Goel, Ellis Levine, Charles L Shapiro, Eleni Andreopoulou, Michael Naughton, Kevin Kalinsky, Samuel Waxman, Doris Germain. Randomized phase II trial of fulvestrant alone or in combination with bortezomib in hormone receptor-positive metastatic breast cancer resistant to aromatase inhibitors: A New York cancer consortium trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr S6-03.
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Affiliation(s)
| | | | | | | | - John J Wright
- 5Cancer Therapy Evaluation Program â National Cancer Institute
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Samuel Waxman
- 17Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai
| | - Doris Germain
- 17Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai
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Kornhauser N, Terry MB, Vahdat LT, Andrulis I, Buys S, Daly M, John E, Hopper JL, Cigler T. Abstract P3-08-04: Aspirin and breast cancer risk for BRCA1 and BRCA2 mutation carriers. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p3-08-04] [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 : Although epidemiologic studies have found evidence that aspirin use may be inversely associated with breast cancer (BC) risk, little is known about whether this applies to BRCA1 and BRCA2 mutation carriers.
Methods : We compared aspirin use in 613 women with BRCA1 or BRCA2 mutations from the six centers of the Breast Cancer Family Registry (BCFR) who were recruited at baseline and completed a questionnaire at 10 year follow-up. We defined cases as carriers with BC (n = 215 with BRCA1 mutations and 137 with BRCA2 mutations) and controls as carriers unaffected with BC (n = 141 with BRCA1 mutations and 120 with BRCA2 mutations). We used logistic regression to estimate odds ratios and 95% confidence intervals separately by gene mutation type.
Results : Three cases (1.4%) and 27 controls (19.1%) among the BRCA1 carriers and 3 cases (2.2%) and 25 controls (20.8%) among the BRCA2 carriers reported ever use of aspirin-based medications before diagnosis. Aspirin use before diagnosis was inversely associated with BC risk for both BRCA1 (OR, 0.13; 95% CI, 0.04-0.46 for ever vs. never use) and BRCA2 (OR, 0.12; 95% CI, 0.03-0.41 for ever vs. never use) carriers, after adjusting for age and center for BRCA1 carriers and age for BRCA2 carriers.
Conclusion : If replicated by larger, prospective studies, aspirin use could become an inexpensive and acceptable risk-reducing measure for BRCA1 and BRCA2 mutation carriers.
Citation Format: Naomi Kornhauser, Mary Beth Terry, Linda T Vahdat, Irene Andrulis, Saundra Buys, Mary Daly, Esther John, John L Hopper, Tessa Cigler. Aspirin and breast cancer risk for BRCA1 and BRCA2 mutation carriers [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P3-08-04.
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Affiliation(s)
| | | | | | | | - Saundra Buys
- 4Huntsman Cancer Institute, University of Utah Health Sciences Center
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Stanton SE, Ward MM, Christos P, Sanford R, Lam C, Cobham MV, Donovan D, Scheff RJ, Cigler T, Moore A, Vahdat LT, Lane ME, Chuang E. Pro1170 Ala polymorphism in HER2-neu is associated with risk of trastuzumab cardiotoxicity. BMC Cancer 2015; 15:267. [PMID: 25885598 PMCID: PMC4403678 DOI: 10.1186/s12885-015-1298-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
Abstract
Background Variations in single nucleotide polymorphisms (SNPs) have been associated with enhanced drug efficacy and toxicity in cancer therapy. SNP variations in the ErbB2 gene have been identified that alter the protein sequence of the HER2-neu protein, but how these polymorphisms affect prognosis and response to HER2 targeted therapy is unknown. We examined eleven ErbB2 SNPs that alter the HER2-neu amino acid sequence to determine whether any of these particular polymorphisms were associated with increased trastuzumab cardiotoxicity in a case–control study. Methods 140 subjects were enrolled from a single institution under Weill Cornell Medical College IRB protocol #0804009734. Patients were eligible if they had histologically or cytologically proven HER2-neu positive breast cancer and more than 3 months of trastuzumab therapy. Cases had either symptomatic CHF or a decline in LVEF of 15% (or if the LVEF <55%, a decline in LVEF of 10%) that resulted in at least temporary discontinuation of trastuzumab, whereas controls had no decline in their LVEF. Eleven ErbB2 single gene SNPs that resulted in an alteration in the HER2-neu protein amino acid sequence were studied. Single gene SNP analysis was carried out using SNP genotyping assays from genomic DNA obtained from peripheral blood or buccal swab. Results Only two of the ErbB2 SNPs (Ile 655 Val and Pro 1170 Ala) were found to have variation. There was no association between codon 665 and cardiotoxicity; however the proline variant of amino acid 1170 was more likely than the alanine variant to be found in cases with trastuzumab cardiotoxicity (35% of case patients as compared to 17% of controls, p = 0.04). This association remained significant in multivariable analysis taking into account age, race, and history of hypertension (adjusted OR = 2.60, 95% CI = 1.02, 6.62, p = 0.046). Conclusions The Her2/neu Pro 1170 Ala polymorphism can be used to identify a subset of patients who are at increased risk of cardiotoxicity from trastuzumab therapy. Her2/neu single nucleotide polymorphisms may be useful in conjunction with other biomarkers to risk stratify patients in order to optimize clinical management.
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Affiliation(s)
- Sasha E Stanton
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA. .,Current address: Tumor Vaccine Group, University of Washington, 850 Republican Street Box 358050, Seattle, WA, 98102, USA.
| | - Maureen M Ward
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Paul Christos
- Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, 10065, USA.
| | - Rachel Sanford
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Christina Lam
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Marta V Cobham
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Diana Donovan
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Ronald J Scheff
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Tessa Cigler
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Anne Moore
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Linda T Vahdat
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Maureen E Lane
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
| | - Ellen Chuang
- Department of Medicine, Weill Cornell Medical College, 425 E 61st St. 8th floor, New York, NY, 10065, USA.
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Yardley DA, Weaver R, Melisko ME, Saleh MN, Arena FP, Forero A, Cigler T, Stopeck A, Citrin D, Oliff I, Bechhold R, Loutfi R, Garcia AA, Cruickshank S, Crowley E, Green J, Hawthorne T, Yellin MJ, Davis TA, Vahdat LT. EMERGE: A Randomized Phase II Study of the Antibody-Drug Conjugate Glembatumumab Vedotin in Advanced Glycoprotein NMB-Expressing Breast Cancer. J Clin Oncol 2015; 33:1609-19. [PMID: 25847941 DOI: 10.1200/jco.2014.56.2959] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Glycoprotein NMB (gpNMB), a negative prognostic marker, is overexpressed in multiple tumor types. Glembatumumab vedotin is a gpNMB-specific monoclonal antibody conjugated to the potent cytotoxin monomethyl auristatin E. This phase II study investigated the activity of glembatumumab vedotin in advanced breast cancer by gpNMB expression. PATIENTS AND METHODS Patients (n = 124) with refractory breast cancer that expressed gpNMB in ≥ 5% of epithelial or stromal cells by central immunohistochemistry were stratified by gpNMB expression (tumor, low stromal intensity, high stromal intensity) and were randomly assigned 2:1 to glembatumumab vedotin (n = 83) or investigator's choice (IC) chemotherapy (n = 41). The study was powered to detect overall objective response rate (ORR) in the glembatumumab vedotin arm between 10% (null) and 22.5% (alternative hypothesis) with preplanned investigation of activity by gpNMB distribution and/or intensity (Stratum 1 to Stratum 3). RESULTS Glembatumumab vedotin was well tolerated as compared with IC chemotherapy (less hematologic toxicity; more rash, pruritus, neuropathy, and alopecia). ORR was 6% (five of 83) for glembatumumab vedotin versus 7% (three of 41) for IC, without significant intertreatment differences for predefined strata. Secondary end point revealed ORR of 12% (10 of 83) versus 12% (five of 41) overall, and 30% (seven of 23) versus 9% (one of 11) for gpNMB overexpression (≥ 25% of tumor cells). Unplanned analysis showed ORR of 18% (five of 28) versus 0% (0 of 11) in patients with triple-negative breast cancer (TNBC), and 40% (four of 10) versus 0% (zero of six) in gpNMB-overexpressing TNBC. CONCLUSION Glembatumumab vedotin is well tolerated in heavily pretreated patients with breast cancer. Although the primary end point in advanced gpNMB-expressing breast cancer was not met for all enrolled patients (median tumor gpNMB expression, 5%), activity may be enhanced in patients with gpNMB-overexpressing tumors and/or TNBC. A pivotal phase II trial (METRIC [Metastatic Triple-Negative Breast Cancer]) is underway.
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Affiliation(s)
- Denise A Yardley
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Robert Weaver
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Michelle E Melisko
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Mansoor N Saleh
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Francis P Arena
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Andres Forero
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Tessa Cigler
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Alison Stopeck
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Dennis Citrin
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Ira Oliff
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Rebecca Bechhold
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Randa Loutfi
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Agustin A Garcia
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Scott Cruickshank
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Elizabeth Crowley
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Jennifer Green
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Thomas Hawthorne
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Michael J Yellin
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Thomas A Davis
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ
| | - Linda T Vahdat
- Denise A. Yardley, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN; Robert Weaver, Florida Cancer Specialists, Tampa, FL; Michelle E. Melisko, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; Scott Cruickshank, Scott Cruickshank & Associates, Santa Barbara; Agustin A. Garcia, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; Mansoor N. Saleh, Georgia Cancer Specialists, Sandy Springs, GA; Francis P. Arena, New York University Langons Arena Oncology, Lake Success; Tessa Cigler and Linda T. Vahdat, Weill Cornell Medical College, New York, NY; Andres Forero, University of Alabama, Birmingham, AL; Alison Stopeck, University of Arizona Cancer Center, Tucson, AZ; Dennis Citrin, Cancer Treatment Centers of America/Midwestern Regional Medical Center, Zion; Ira Oliff, Orchard Healthcare Research, Skokie, IL; Rebecca Bechhold, Oncology Hematology Care, Cincinnati, OH; Randa Loutfi, Henry Ford Health System, Detroit, MI; and Elizabeth Crowley, Jennifer Green, Thomas Hawthorne, Michael J. Yellin, and Thomas A. Davis, Celldex Therapeutics, Hampton, NJ.
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Cigler T, Isseroff D, Fiederlein B, Schneider S, Chuang E, Vahdat L, Moore A. Efficacy of Scalp Cooling in Preventing Chemotherapy-Induced Alopecia in Breast Cancer Patients Receiving Adjuvant Docetaxel and Cyclophosphamide Chemotherapy. Clin Breast Cancer 2015; 15:332-4. [PMID: 25749072 DOI: 10.1016/j.clbc.2015.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/14/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chemotherapy-induced alopecia (CIA) is a distressing adverse effect of many chemotherapy agents. The TC (docetaxel [Taxotere] and cyclophosphamide) chemotherapy regimen is typically associated with complete alopecia. Scalp cooling with cold caps has been reported to minimize or prevent CIA. We conducted a prospective study to assess efficacy of scalp cooling in preventing CIA among women receiving adjuvant TC chemotherapy for breast cancer. METHODS Women at the Weill Cornell Breast Center who independently elected to use scalp cooling with cold caps during adjuvant TC chemotherapy were asked to participate. Degree of hair loss was assessed by a single practitioner using Dean's alopecia scale (grade 1/excellent [< 25% hair loss], grade 2/good [25%-50% hair loss], grade 3/moderate [50%-75% hair loss], grade 4/poor [> 75% hair loss]), by digital photographs, and by patient self-report of hair thinning or the need to wear a wig/head covering, or both. Assessments were made before each chemotherapy treatment and at follow-up visits between 3 weeks and 3 months after completion of chemotherapy. RESULTS Of 20 evaluable patients, 10% reported a need to wear a wig/head covering at the follow-up visit. Dean's alopecia score was excellent for 65% of patients, good for 25% of patients, and moderate or poor for 10% of patients. The majority of patients reported hair thinning after every chemotherapy cycle. No patient discontinued therapy because of an intolerance to cold caps. CONCLUSION Scalp cooling with cold caps appears to be effective in preventing CIA among the majority of women undergoing treatment with TC chemotherapy.
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Affiliation(s)
- Tessa Cigler
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY.
| | - Devora Isseroff
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY
| | - Barbara Fiederlein
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY
| | - Sarah Schneider
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY
| | - Ellen Chuang
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY
| | - Linda Vahdat
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY
| | - Anne Moore
- Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY
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Chan N, Kornhauser N, Ward M, Willis A, Cigler T, Chuang E, Moore A, Donovan D, Schneider SE, Lam C, Warren DJ, Rubinchik A, Rua SH, Lee S, Lane M, Mittal V, Vahdat L. Abstract CT309: Influencing the tumor microenvironment: A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-ct309] [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: Bone marrow derived endothelial progenitor cells (EPCs) and copper-dependent angiogenic pathways are critical to the metastatic process. Copper depletion (CD) therapy inhibits tumor metastases in preclinical models. We hypothesized that TM-associated CD would reduce EPCs in pts at high risk for BC recurrence, and we explored the relationship between CD and its effects on the tumor microenvironment in pre-clinical models.
Methods: In this single arm, phase II study, BC pts at high risk for recurrence, defined as node positive triple negative (TN), stage 3 and 4 with no evidence of disease (NED) were enrolled on a trial of CD with TM. We CD’d to maintain ceruloplasmin (Cp) between 5-17 mg/dl for 2 years or until relapse. The primary endpoint was change in EPCs measured before and during treatment with TM. Secondary endpoints included tolerability, safety, and efficacy of CD. Laboratory studies: MDA-LM2-luciferase cells were implanted into CB17-SCID mice gavaged with water or TM. The tumors were quantified by bioluminescence images (BLI). We measured Cp oxidase to determine copper status. Western blots were used to assess LOX activity, and IHC was used to quantify collagen cross-linking and CD11b+ macrophage infiltration.
Results: We enrolled 43 pts. Treatment duration was 24 cycles (each cycle is 28 days) for the primary study. A total of 752 cycles were completed in 2 years. The mean age was 49 (range 29-66). Mean Cp level decreased from 29 at baseline to 16 (p<0.001) at 4 weeks. 94% of pts achieved CD by cycle 2. TM was well tolerated in most pts and the only grade 3 and 4 toxicities were neutropenia (3.9%) and anemia (0.1%). CD was most effective in TNBC pts with significantly reduced time to CD (P=0.0153). At one year of analysis, TM reduced EPCs (p=0.044). The 2-year analysis of effect of TM on EPCs is ongoing. The 2 year PFS for the entire cohort from the start of TM treatment was 81%. The overall survival from the start of treatment was 90.6% with median follow up of 4.5 years. In pre-clinical models, TM had no effects on the primary tumor, but decreased secondary metastases as seen by BLI. Western blots demonstrated decreased LOX, and IHC showed reduced collagen cross-linking with less CD11b+ macrophage recruitment.Conclusion: TM is safe, well tolerated and effective in achieving CD in breast cancer patients, and appears to affect the tumor microenvironment in pre-clinical models. Molecular subtype may affect CD and TM may be most effective in TN patients.
Citation Format: Nancy Chan, Naomi Kornhauser, Maureen Ward, Amy Willis, Tessa Cigler, Ellen Chuang, Anne Moore, Diana Donovan, Sarah E. Schneider, Christina Lam, David J. Warren, Anna Rubinchik, Sandra Hurtado Rua, Sharrell Lee, Maureen Lane, Vivek Mittal, Linda Vahdat. Influencing the tumor microenvironment: A phase II study of copper-depletion using tetrathiomolybdate (TM) in patients (pts) with breast cancer (BC) at high risk for recurrence. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr CT309. doi:10.1158/1538-7445.AM2014-CT309
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Affiliation(s)
- Nancy Chan
- New York Presbyterian Weill Cornell, New York, NY
| | | | - Maureen Ward
- New York Presbyterian Weill Cornell, New York, NY
| | - Amy Willis
- New York Presbyterian Weill Cornell, New York, NY
| | - Tessa Cigler
- New York Presbyterian Weill Cornell, New York, NY
| | - Ellen Chuang
- New York Presbyterian Weill Cornell, New York, NY
| | - Anne Moore
- New York Presbyterian Weill Cornell, New York, NY
| | | | | | | | | | | | | | - Sharrell Lee
- New York Presbyterian Weill Cornell, New York, NY
| | - Maureen Lane
- New York Presbyterian Weill Cornell, New York, NY
| | - Vivek Mittal
- New York Presbyterian Weill Cornell, New York, NY
| | - Linda Vahdat
- New York Presbyterian Weill Cornell, New York, NY
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Ebenezer GJ, Carlson K, Donovan D, Cobham M, Chuang E, Moore A, Cigler T, Ward M, Lane ME, Ramnarain A, Vahdat LT, Polydefkis M. Ixabepilone-induced mitochondria and sensory axon loss in breast cancer patients. Ann Clin Transl Neurol 2014; 1:639-49. [PMID: 25493278 PMCID: PMC4241791 DOI: 10.1002/acn3.90] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/25/2014] [Accepted: 07/15/2014] [Indexed: 01/03/2023] Open
Abstract
Background We sought to define the clinical and ultrastructure effects of ixabepilone (Ix), a microtubule-stabilizing chemotherapy agent on cutaneous sensory nerves and to investigate a potential mitochondrial toxicity mechanism. Methods Ten breast cancer patients receiving Ix underwent total neuropathy score clinical (TNSc) assessment, distal leg skin biopsies at cycle (Cy) 3 (80–90 mg/m2), Cy5 (160–190 mg/m2), and Cy7 (>200 mg/m2) and were compared to 5 controls. Skin blocks were processed for EM and ultrastructural morphometry of Remak axons done. Results At baseline, Ix-treated subjects had higher TNSc values (4.5 ± 0.8 vs. 0.0 ± 0.0), greater percentage of empty (denervated) Schwann cells (29% vs. 12%), altered axonal diameter (422.9 ± 17 vs. 354.9 ± 14.8 nm, P = 0.01), and axon profiles without mitochondria tended to increase compared to control subjects (71% vs. 70%). With increasing cumulative Ix exposure, an increase in TNSc values (Cy3: 5.4 ± 1.2, Cy7: 10 ± 4, P < 0.001), empty Schwann cells (39% by Cy7), and dilated axons (in nm, Cy3: 506.3 ± 22.1, Cy5: 534.8 ± 33, Cy7: 527.8 ± 24.4; P < 0.001) was observed. In addition, axon profiles without mitochondria (Cy3:74%, Cy7:78%) and mitochondria with abnormal morphology (grade 3 or 4) increased from 24% to 79%. Schwann cells with atypical mitochondria and perineuronal macrophage infiltration in dermis were noted. Interpretation This study provides functional and structural evidence that Ix exposure induces a dose-dependent toxicity on small sensory fibers with an increase in TNSc scores and progressive axonal loss. Mitochondria appear to bear the cumulative toxic effect and chemotherapy-induced toxicity can be monitored through serial skin biopsy-based analysis.
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Affiliation(s)
| | - Karen Carlson
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Diana Donovan
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Marta Cobham
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Ellen Chuang
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Anne Moore
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Tessa Cigler
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Maureen Ward
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Maureen E Lane
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Anita Ramnarain
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
| | - Linda T Vahdat
- Breast Cancer Research Program, Weill Cornell Medical College New York City, New York
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Somlo G, Frankel PH, Luu TH, Ma C, Arun B, Garcia A, Cigler T, Cream L, Harvey HA, Sparano JA, Nanda R, Chew HK, Moynihan TJ, Vahdat LT, Goetz MP, Hurria A, Mortimer JE, Gandara DR, Chen A, Weitzel JN. Phase II trial of single agent PARP inhibitor ABT-888 (veliparib [vel]) followed by postprogression therapy of vel with carboplatin (carb) in patients (pts) with stage BRCA-associated metastatic breast cancer (MBC): California Cancer Consortium trial PHII-96. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Thehang H. Luu
- City of Hope Cancer Center/Beckman Research Institute, Duarte, CA
| | - Cynthia Ma
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Leah Cream
- Penn State MS Hershey Medical Center, Hershey, PA
| | - Harold A. Harvey
- Hematology/Oncology Division and Penn State Hershey Cancer Institute, Hershey, PA
| | | | | | | | | | | | | | | | | | | | - Alice Chen
- National Cancer Institute, Rockville, MD
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Singer O, Cigler T, Moore AB, Levine AB, Do HT, Mandl LA. Hypovitaminosis D is a Predictor of Aromatase Inhibitor Musculoskeletal Symptoms. Breast J 2014; 20:174-9. [DOI: 10.1111/tbj.12227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ora Singer
- Division of Rheumatology; Department of Medicine; Georgia Health Sciences University; Augusta Georgia
| | - Tessa Cigler
- Division of Oncology; Department of Medicine; Weill Cornell Medical Center; New York New York
| | - Anne B. Moore
- Division of Oncology; Department of Medicine; Weill Cornell Medical Center; New York New York
| | - Alana B. Levine
- Division of Rheumatology; Department of Medicine; Hospital for Special Surgery; New York New York
| | - Huong T. Do
- Department of Biostatistics; Hospital for Special Surgery; New York New York
| | - Lisa A. Mandl
- Division of Rheumatology; Department of Medicine; Hospital for Special Surgery; New York New York
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Chuang E, Stanton S, Ward MM, Christos P, Sanford R, Lam C, Cobham MV, Donovan D, Scheff R, Cigler T, Moore A, Vahdat LT, Lane ME. Abstract P6-05-06: Association of HER2/neu single nucleotide polymorphism with trastuzumab-related cardiotoxicity. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-05-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Treatment with trastuzumab prolongs overall survival when given to patients (pts) with Her2/neu+ breast cancer (BC). The primary toxicity of trastuzumab is cardiotoxicity and the incidence is estimated at 2-4% in the adjuvant setting. The mechanism for trastuzumab-induced cardiotoxicity is not known. Although Her2neu expression is usually not seen on cardiac myocytes, its expression has been shown to be upregulated after chemotherapy. Trastuzumab is a monoclonal antibody that binds to the extracellular domain of Her2/neu. We hypothesized that single nucleotide polymorphisms (SNPs) in the Her2/neu receptor may play a role in trastuzumab associated cardiotoxicity.
Methods: 140 pts with BC who were treated with chemotherapy and trastuzumab were enrolled into an IRB approved protocol at the Weill Cornell Medical College between July 2008 and March 2013. Cardiotoxicity was defined as either symptomatic CHF, or a decline in LVEF of 15% (or if LVEF <55% a decline in LVEF of 10%) that required management with medications and led to temporary or permanent discontinuation of trastuzumab. 11 nonsynonomous human ErbB2 SNPs were identified in the National Center for Biotechnology Information SNP database (rs1136201, rs2172826, rs28933368, rs28933369, rs28933370, rs34602395, rs36085723, rs4252633, rs55943169, rs56366519, rs61552325). Genotyping of SNPs was performed on DNA prepared from blood or buccal washes. The relationship between SNP characteristics and cardiotoxicity status was assessed by the chi-square test and multivariable logistic regression analysis.
Results: 140 subjects (29 with cardiotoxicity and 111 without) had 11 SNPs sequenced. Median age of subjects was 56 years (range: 32-85), mean baseline LVEF was 65% (±6%). 16.4% of subjects had hypertension (HTN). 80% of patients were Caucasian, 10% East Asian, 7.1% African American, 2.9% South Asian. There were two SNPs for which there was variation seen among subjects: rs 1136201 (corresponding to codon 655) and rs61552325 (codon 1170). The frequencies of the codon 655 polymorphisms were: AA (Ile/Ile) 67.9%, AG (Ile/Val) 29.3%, and GG (Val/Val) 2.9%. The frequencies of the codon 1170 polymorphisms were: CC (Pro/Pro) 20.7%, GC (Ala/Pro) 45.7%, and GG (Ala/Ala) 33.6%. There was no association observed between the codon 655 polymorphism and cardiotoxicity (p = 0.96). A significant association between cardiotoxicity and the codon 1170 polymorphism was observed, with subjects having cardiotoxicity being more likely to carry the CC allele compared with subjects without cardiotoxicity (34.5% vs 17.1%, p = 0.04). This association persisted after multivariable adjustment for age, race, and HTN status (adjusted OR = 2.60, 95% CI = 1.02-6.62, p = 0.046).
Conclusion: In this study, the Her2/neu 1170 Pro/Pro polymorphism was associated with trastuzumab cardiotoxicity. If confirmed in a larger series, this polymorphism could be used to identify pts who may be at increased risk for cardiotoxicity and who may benefit from treatments associated with less cardiotoxicity. Furthermore, the Her2/neu 1170 SNP has previously been implicated as a minor histocompatibility antigen, and our findings raise the possibility that immune mediated mechanisms may play a role in trastuzumab related cardiotoxicity.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-06.
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Affiliation(s)
- E Chuang
- Weill Cornell Medical College, New York, NY
| | - S Stanton
- Weill Cornell Medical College, New York, NY
| | - MM Ward
- Weill Cornell Medical College, New York, NY
| | - P Christos
- Weill Cornell Medical College, New York, NY
| | - R Sanford
- Weill Cornell Medical College, New York, NY
| | - C Lam
- Weill Cornell Medical College, New York, NY
| | - MV Cobham
- Weill Cornell Medical College, New York, NY
| | - D Donovan
- Weill Cornell Medical College, New York, NY
| | - R Scheff
- Weill Cornell Medical College, New York, NY
| | - T Cigler
- Weill Cornell Medical College, New York, NY
| | - A Moore
- Weill Cornell Medical College, New York, NY
| | - LT Vahdat
- Weill Cornell Medical College, New York, NY
| | - ME Lane
- Weill Cornell Medical College, New York, NY
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Somlo G, Frankel P, Luu T, Ma C, Arun B, Garcia A, Cigler T, Fleming G, Harvey H, Sparano J, Nanda R, Chew H, Moynihan T, Vahdat L, Goetz M, Hurria A, Mortimer J, Gandara D, Chen A, Weitzel J. Abstract P2-16-05: Efficacy of ABT-888 (veliparib) in patients with BRCA-associated breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p2-16-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The potential for exploiting BRCA deficiencies with DNA repair inhibitors has both pre-clinical and clinical support. ABT-888 (veliparib), a DNA repair inhibitor initially thought to target Poly(ADP-Ribose) Polymerases (PARP), has demonstrated in vitro inhibition of BRCA1 and BRCA2 deficient mouse embryonic stell cells, with a larger effect on BRCA1 cells. We report on the pre-planned interim analysis of the efficacy of single agent veliparib in patients with either BRCA1 or BRCA2-associated stage IV breast cancer. Methods: BRCA 1 or 2 carrier patients with stage IV breast cancer, with measurable disease, without prior exposure to a PARP inhibitor or a platinum compound in the metastatic setting, were eligible. Velapirib was administered orally, at doses of 400 mg twice daily. Dose adjustments based on toxicity were permitted. Patients progressing on velapirib alone received carboplatin at an AUC of 5, IV, given Q 21 days, and velapirib 150 mg twice daily (the maximum tolerated dose [MTD] of the combination from our completed Phase I study: J Clin Oncol 30, 2012 [suppl; abstr 1024]). Patients were to be accrued from 7 NCI NO1- supported consortia. Initially 10 patients were to be accrued to each stratum (BRCA1 and BRCA2) to provide evidence of single agent activity. If there was sufficient activity to warrant consideration of velapirib as single agent therapy (defined as 2 or more confirmed partial [PR] or better responses out of 10 per stratum), an additional 12 patients would be accrued per stratum. Results: 20 evaluable patients (11 BRCA1 and 9 BRCA2 [1 in screening]) have been accrued, the majority with lung or liver as visceral metastatic sites of disease. Median age (range) is 46 (29-68) years. Tumors from 9 patients were hormone receptor positive. BRCA1 cohort: 4 of 11 patients are off treatment at a median of 2 months (1-4); 1 patient stopped velapirib due to toxicity (grade 2 rash/pruritus, grade 2 vomiting), 3 stopped for progressive disease (one with an unconfirmed PR). Seven patients are still on single agent veliparib with 1 unconfirmed PR, and 1 patient with two evaluations showing stable disease. BRCA2 cohort: 2 patients are off treatment at 2 months for progressive disease, 7 are still on treatment with 1 confirmed PR, and 3 unconfirmed PRs. Data on patients receiving combination of velapirib and carboplatin after progression is too early. Treatment-related toxicity is being updated and has so far been reported from 14 patients: 1 patient had grade 3 fatigue, 1 patient with liver metastasis had both grade 3 alanine aminotransferase elevation and grade 3 abdominal pain. Grade 2 toxicities occurring in more than 1 patient included nausea/vomiting (6 patients), chills (2 patients), and fatigue (2 patients). Conclusion: Velapirib has single agent activity in both BRCA1 and BRCA2-associated stage IV breast cancer patients, and is well-tolerated. Mature response, treatment, and toxicity data will be presented.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-16-05.
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Affiliation(s)
- G Somlo
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - P Frankel
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - T Luu
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - C Ma
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - B Arun
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - A Garcia
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - T Cigler
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - G Fleming
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - H Harvey
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - J Sparano
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - R Nanda
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - H Chew
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - T Moynihan
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - L Vahdat
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - M Goetz
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - A Hurria
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - J Mortimer
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - D Gandara
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - A Chen
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
| | - J Weitzel
- City of Hope Cancer Center, Duarte, CA; Washington University School of Medicine, St. Louis, MO; The University of Texas MD Anderson Cancer Center, Houston, TX; USC Norris Comprehensive Cancer Center, Los Angeles, CA; Weill Cornell Medical College, New York, NY; Alliance for Clinical Trials in Oncology, Chicago, IL; Milton S. Hershey Medical Center, Hershey, PA; Montefiore Medical Center, Bronx, NY; University of Chicago, Chicago, IL; University of California, Davis Cancer Center, Sacramento, CA; Mayo Clinic, Rochester, MN; National Cancer Institute, Bethesda, MD
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Somlo G, Frankel PH, Luu TH, Ma C, Arun B, Garcia A, Cigler T, Fleming GF, Harvey HA, Sparano JA, Nanda R, Chew HK, Moynihan TJ, Vahdat LT, Goetz MP, Hurria A, Mortimer JE, Gandara DR, Chen AP, Weitzel JN. Efficacy of the combination of ABT-888 (veliparib) and carboplatin in patients with BRCA-associated breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1024 Background: The combination of platinum agents and PARP inhibitors may benefit patients (pts) with BRCA-associated metastatic breast cancer (MBC). We report on the response and clinical benefit rates when combining the PARP inhibitor veliparib (V) and carboplatin (carb) in a phase I trial. Methods: BRCA carriers with MBC were eligible. Carb starting at an AUC of 6 was given IV in 21-day cycles (C) and V was given orally twice daily (BID) at dose levels (L) L1 through L5. Results: Twenty-eight pts (26 eligible) carrying BRCA1 (12) or BRCA2 (15), or both (1) mutations were accrued between June 2010 and June 2012. The median age (32-66) was 45 years. The number (#) of prior chemotherapy regimens given for MBC was 1 (0-5); 70% of BCs were ER+, and 7% were HER2+. The schema, dose limiting toxicities (DLT) during C 1, median # of Cs on trial, and maximum tolerated dose (MTD) are shown. There were 3 (12%) complete and 9 (35%) partial responses (PR). Unconfirmed PR or stable MBC (median duration: 8 months [6-10+]) were seen in 7 pts (27%); the clinical benefit rate was74%. The median progression-free survival (PFS) is 7.8 months (95% CI 7.3-9.5). The pt with Fallopian tube cancer had a CR. DLTs with C 1 were seen in 2/6 evaluable pts at L1 (1 pt w/grade 3 hyponatremia and dehydration, and 1pt w/grade 4 thrombocytopenia [PLT]), leading to de-escalation of carb. At L2, 1 pt had grade 4 PLT. At L5, 1 pt had grade 4 PLT, and 2 pts grade 3 PLT (1 pt also experienced grade 4 granulocytopenia [ANC]), defining the MTD at carb AUC 5 and V 150 mg BID (L4). Dose delays and/or dose adjustments due to grade ≥ 2 toxicities for ANC or PLT were seen during the first 3 Cs at L1 (100%), L2 (50 %), L3 (67%), L4 (83 %), and at L5 (67%). Conclusions: The combination of carb and V is active, and is associated with substantial clinical benefit rate and managable hematologic toxicities in BRCA carriers with MBC. Further definition of the role of V is warranted. [Table: see text]
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Affiliation(s)
| | | | | | - Cynthia Ma
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Helen K. Chew
- University of California, Davis Cancer Center, Sacramento, CA
| | | | | | | | | | | | - David R. Gandara
- University of California, Davis Comprehensive Cancer Center, Sacramento, CA
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Cigler T, Fiederlein B, Schneider SE, Chuang E, Vahdat LT, Donovan D, Welch R, Cobham ME, Moore A. Efficacy of scalp cryotherapy in preventing alopecia among patients with breast cancer patients receiving adjuvant docetaxel and cyclophosphamide. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e20641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20641 Background: Chemotherapy induced alopecia (CIA) is a distressing adverse effect of many chemotherapy agents. The TC chemotherapy regimen (four cycles of docetaxel 75mg/m2 and cyclophosphamide 600mg/m2 given every 3 weeks apart) commonly used for aduvant therapy of breast cancer is associated with complete alopecia, with rare reports of permanent alopecia. Scalp cryotherapy has been reported to minimize or prevent CIA. Penguin cold caps are a commercially available scalp cooling product gaining increasing media attention. We conducted a prospective study aimed to assess efficacy of scalp cryotherpy in preventing CIA among women receiving adjuvant TC chemotherapy for early stage breast cancer who independently elected to use Penguin cold caps. Methods: Women at the Weill Cornell Breast Center who elected to use scalp cryotherapy with Penguin cold caps during adjuvant TC chemotherapy were asked to participate in the study. Degree of hair loss was rated by practitioner assessment using Dean’s alopecia scale (poor (>75% hair loss), moderate (50-75%), good (25-50%) or excellent (<25%)), by digital photographs, and by asking patients whether they felt a need to wear a wig or head covering due to hair loss. Assessments were made before each chemotherapy treatment and at a follow up visit between 3 weeks and 3 months after the completion of chemotherapy. Results: 17 patients have enrolled. 13 patients have completed chemotherapy. 2 patients currently undergoing chemotherapy and 2 patients who discontinued chemotherapy due to toxicity not related to alopecia are excluded from analysis. Dean’s alopecia scale score was excellent for 10 patients (77%) at every assessment. Dean’s score was good for 2 participants (15%) and moderate for 1 participant (8%) starting prior to fourth cycle of chemotherapy. Only 1 patient (8%) reported needing to wear a wig or head covering as a result of alopecia. Conclusions: Scalp cryotherapy using Penguin cold caps appears to be effective in preventing CIA among women undergoing chemotherapy with the TC regimen.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anne Moore
- Weill Cornell Medical College, New York, NY
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Jain S, Cohen J, Ward MM, Kornhauser N, Chuang E, Cigler T, Moore A, Donovan D, Lam C, Cobham MV, Schneider S, Hurtado Rúa SM, Benkert S, Mathijsen Greenwood C, Zelkowitz R, Warren JD, Lane ME, Mittal V, Rafii S, Vahdat LT. Tetrathiomolybdate-associated copper depletion decreases circulating endothelial progenitor cells in women with breast cancer at high risk of relapse. Ann Oncol 2013; 24:1491-8. [PMID: 23406736 DOI: 10.1093/annonc/mds654] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bone marrow-derived endothelial progenitor cells (EPCs) are critical for metastatic progression. This study explores the effect of tetrathiomolybdate (TM), an anti-angiogenic copper chelator, on EPCs in patients at high risk for breast cancer recurrence. PATIENTS AND METHODS This phase 2 study enrolled breast cancer patients with stage 3 and stage 4 without evidence of disease (NED), and stage 2 if triple-negative. TM 100 mg orally was administered to maintain ceruloplasmin <17 mg/dl for 2 years or until relapse. The primary end point was change in EPCs. RESULTS Forty patients (28 stage 2/3, 12 stage 4 NED) were enrolled. Seventy-five percent patients achieved the copper depletion target by 1 month. Ninety-one percent of triple-negative patients copper-depleted compared with 41% luminal subtypes. In copper-depleted patients only, there was a significant reduction in EPCs/ml by 27 (P = 0.04). Six patients relapsed while on study, of which only one patient had EPCs maintained below baseline. The 10-month relapse-free survival was 85.0% (95% CI 74.6%-96.8%). Only grade 3/4 toxicity was hematologic: neutropenia (3.1% of cycles), febrile neutropenia (0.2%), and anemia (0.2%). CONCLUSIONS TM is safe and appears to maintain EPCs below baseline in copper-depleted patients. TM may promote tumor dormancy and ultimately prevent relapse.
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Affiliation(s)
- S Jain
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
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Singer O, Cigler T, Moore AB, Levine AB, Hentel K, Belfi L, Do HT, Mandl LA. Defining the aromatase inhibitor musculoskeletal syndrome: a prospective study. Arthritis Care Res (Hoboken) 2013; 64:1910-8. [PMID: 22730307 DOI: 10.1002/acr.21756] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 06/01/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To define the musculoskeletal syndrome associated with use of aromatase inhibitors (AIs), specifically, to describe its incidence, time to onset, risk factors, and clinical presentation. METHODS Postmenopausal women with hormone-sensitive, nonmetastatic breast cancer starting AI therapy were enrolled in this prospective cohort study. They underwent complete rheumatologic evaluation and contrast-enhanced magnetic resonance imaging (MRI) of the hands and wrists prior to starting AI, at 3 and 6 months. The primary outcome was change in grip strength. RESULTS Twenty-eight (54%) of 52 women reported new or worsening musculoskeletal symptoms. Two discontinued AIs due to pain. Mean time to symptom onset was 6 weeks (range 2-18 weeks), and 75% of symptomatic patients developed symptoms by 8 weeks. Later-stage cancer and worse quality of life (QOL) pretreatment were significantly associated with symptom development. Sixty-eight percent of symptomatic subjects had involvement of the hands; however, there was no difference in the mean change in grip strength (-2.9 kg versus -1.3 kg; P = 0.6). Among symptomatic subjects, 46% had evidence of focal tenosynovitis of the hands and feet on examination. Although some symptomatic subjects had new MRI abnormalities, Rheumatoid Arthritis Magnetic Resonance Imaging Scoring did not significantly change. CONCLUSION The incidence of AI-associated musculoskeletal syndrome is more than 50%, with most women developing symptoms by 8 weeks. The key finding in symptomatic women was focal tenosynovitis of the hands and feet, without evidence of autoimmune disease or systemic inflammation. Later-stage cancer and poorer QOL were predictive of symptom development.
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Affiliation(s)
- Ora Singer
- Department of Medicine, Division of Rheumatology, Georgia Health Sciences University, 1120 15th Street, Augusta, GA 30907, USA.
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Jain S, Carlson K, Chuang E, Cigler T, Moore A, Donovan D, Lam C, Cobham MV, Schneider S, Ramnarain A, Carey B, Ward M, Lane M, Strickland S, Vahdat L. Abstract P1-15-07: Ixabepilone-associated peripheral neuropathy in metastatic breast cancer patients and its effects on the ultrastructure of neurons. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-15-07] [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: Peripheral neuropathy is a dose-limiting toxicity of most microtubule-stabilizing chemotherapeutic agents. Ixabepilone, a semisynthetic analog of the natural epothilone B, has activity in a wide range of tumors including taxane-resistant disease. In this study, we sought to understand the effect of ixabepilone on the development of peripheral neuropathy both clinically and its effect at the ultrastructural level of the peripheral nerves and circulating factors over time. Parallel studies in animal models of neuropathy were performed at the same time (Proc AACR 2010 Abstract 4184).
Methods: This open-label, non-randomized phase II study enrolled 14 patients with metastatic breast cancer. Ixabepilone was administered by 2 schedules: the FDA approved dose of 40 mg/m2 every 3 weeks (q3w) and 16 mg/m2 on day 1, 8, and 15 of a 28-day cycle (weekly). Five controls, 2 with residual taxane-associated peripheral neuropathy and 3 with no prior chemotherapy or peripheral neuropathy, were also accrued. The primary objectives were to characterize the natural history of ixabepilone-associated peripheral neuropathy using the Total Neuropathy Score Clinical (TNSc) assessment tool prior to each cycle and to correlate changes in the ultrastructure of dermal myelinated nerve fibers via a 3 mm punch biopsy of an area 10 cm above the lateral malleolus every 2 cycles with electron microscopy (EM), as well as circulating factors (both inflammatory and neurotrophic) considered to be important in the pathogenesis of chemotherapy-induced peripheral neuropathy. Secondary objectives included progression-free survival (PFS) and non-neurologic toxicity.
Results: 14 patients were enrolled and were equally divided between the 2 schedules of ixabepilone chemotherapy. There were no differences in baseline characteristics between the two groups. Mean age was 54 years (range 32–71). Mean number of previous chemotherapy regimens was 3.5 (range 0–8). 57% of patients had received a taxane in the adjuvant setting and 64% in the metastatic setting. The mean neuropathy score (TNSc) at baseline was 4.6 (range 1–11). At a mean cumulative dose of 185 mg/m2, the TNSc with ixabepilone q3w schedule was 3.7 points higher/worse (95% CI: 2.2–5.3, p = 0.03) than the mean score observed in patients on the weekly schedule. The sensory component was most significantly affected, predominantly numbness. In 3 patients, the chemotherapy schedule was changed from every 3 weeks to weekly due to > grade 2 toxicity at a mean cumulative dose of 107 mg/m2, and TNSc decreased/improved by 2.7 points. PFS in patients on q3w ixabepilone was 133 days (range 28–280) and in patients on weekly ixabepilone was 179 days (range 66–336), nonsignificant. Evaluation of EM and circulating factors is ongoing.
Conclusions: Weekly ixabepilone appears to have a more favorable neurotoxicity profile compared to the standard q3w schedule. Integration of the EM data and the circulating factor data are underway and will be presented. Ixabepilone-associated peripheral neuropathy may improve in patients switched to weekly ixabepilone without compromising efficacy.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-15-07.
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Affiliation(s)
- S Jain
- Weill Cornell Medical College; Rockefeller University
| | - K Carlson
- Weill Cornell Medical College; Rockefeller University
| | - E Chuang
- Weill Cornell Medical College; Rockefeller University
| | - T Cigler
- Weill Cornell Medical College; Rockefeller University
| | - A Moore
- Weill Cornell Medical College; Rockefeller University
| | - D Donovan
- Weill Cornell Medical College; Rockefeller University
| | - C Lam
- Weill Cornell Medical College; Rockefeller University
| | - MV Cobham
- Weill Cornell Medical College; Rockefeller University
| | - S Schneider
- Weill Cornell Medical College; Rockefeller University
| | - A Ramnarain
- Weill Cornell Medical College; Rockefeller University
| | - B Carey
- Weill Cornell Medical College; Rockefeller University
| | - M Ward
- Weill Cornell Medical College; Rockefeller University
| | - M Lane
- Weill Cornell Medical College; Rockefeller University
| | - S Strickland
- Weill Cornell Medical College; Rockefeller University
| | - L Vahdat
- Weill Cornell Medical College; Rockefeller University
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Jain S, Kornhauser N, Lam C, Ward MM, Chuang E, Cigler T, Moore A, Donovan D, Cobham MV, Schneider S, Hurtado RSM, Lane ME, Mittal V, Vahdat LT. Abstract P6-11-04: Targeting the tumor microenvironment: tetrathiomolybdate decreases circulating endothelial progenitor cells in women with breast cancer at high risk of relapse. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-11-04] [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: Bone marrow-derived endothelial progenitor cells (EPCs) constitute an important part of the tumor microenvironment and are critical for metastatic progression in preclinical models and breast cancer patients (Jain et al, Breast Cancer Res Treat, 2012). Tetrathiomolybdate (TM), a copper-depleting compound inhibits angiogenesis, tumor growth, and metastasis. This study explores the effect of TM on EPCs in patients at high risk for breast cancer recurrence.
Methods: This phase II study enrolled stage 3, 4 without evidence of disease (NED), and any node-positive triple negative breast cancer patient. Only concomitant hormone therapy was allowed. Patients received induction TM 180 mg daily at baseline followed by an equal or lower daily dose (median 100 mg, range 0–140) to maintain ceruloplasmin (Cp) level < 17 mg/dl (target for copper depletion). We monitored EPCs (CD45dim/CD133+/VEGFR2+), Cp, CEA, and CA15-3 at baseline and monthly. Wilcoxon signed-rank was used to compare Cp and EPC levels between baseline and subsequent time points. All p-values were two-sided with statistical significance evaluated at the 0.05 alpha level.
Results: 50 patients (33 adjuvant, 17 Stage 4 NED, and 22 triple negative) were enrolled. In the first 40 patients enrolled who had received at least 24 months of TM, EPC and Cp data were available for analysis. Of these 40 patients, 1 patient did not take TM due to patient preference, and 736 cycles of TM (average 18.9 per patient) were administered. Median age was 50 years (range 29–66). Median number of tumor size and positive lymph nodes among adjuvant patients were 3.5 cm (range 1.2–7) and 9 (range 0–42), respectively. Of the patients receiving hormone therapy, 11 patients were on tamoxifen and 16 patients were on an aromatase inhibitor. Median baseline Cp level was 30 mg/dL (range 20–47). 71% patients adequately copper depleted at month 1 to a mean Cp of 14.8 mg/dL. A larger proportion of triple negative patients copper depleted (82%) compared to hormone receptor positive subtypes (47%) and HER2/neu positive subtypes (67%). Median EPCs/ml decreased from baseline to last dose by 16 in patients that achieved the copper depletion target, p = 0.014. Conversely, in patients that did not copper deplete, median EPCs/ml increased by 136, p = 0.005. Of the 50 patients on study, 7 patients relapsed in which a significant increase in EPCs preceded an objective clinical relapse and a tumor marker rise by a median of 1 month. Only grade 3/4 toxicity was hematologic, occurred in 49 cycles (6.7%), and resolved in 5–13 days with TM held and resumed at a lower dose.
Conclusions: TM is a well-tolerated oral copper chelator that may contribute to maintaining EPCs below baseline in copper-depleted patients. Molecular subtype may impact on the ability to copper deplete. EPCs may have potential as a surrogate marker for early relapse and as a therapeutic target for interrupting the metastatic progression.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-11-04.
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Affiliation(s)
- S Jain
- Weill Cornell Medical College
| | | | - C Lam
- Weill Cornell Medical College
| | - MM Ward
- Weill Cornell Medical College
| | | | | | - A Moore
- Weill Cornell Medical College
| | | | | | | | | | - ME Lane
- Weill Cornell Medical College
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