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Spring LM, Tolaney SM, Fell G, Bossuyt V, Abelman RO, Wu B, Maheswaran S, Trippa L, Comander A, Mulvey T, McLaughlin S, Ryan P, Ryan L, Abraham E, Rosenstock A, Garrido-Castro AC, Lynce F, Moy B, Isakoff SJ, Tung N, Mittendorf EA, Ellisen LW, Bardia A. Response-guided neoadjuvant sacituzumab govitecan for localized triple-negative breast cancer: results from the NeoSTAR trial. Ann Oncol 2024; 35:293-301. [PMID: 38092228 DOI: 10.1016/j.annonc.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Sacituzumab govitecan (SG), a novel antibody-drug conjugate (ADC) targeting TROP2, is approved for pre-treated metastatic triple-negative breast cancer (mTNBC). We conducted an investigator-initiated clinical trial evaluating neoadjuvant (NA) SG (NCT04230109), and report primary results. PATIENTS AND METHODS Participants with early-stage TNBC received NA SG for four cycles. The primary objective was to assess pathological complete response (pCR) rate in breast and lymph nodes (ypT0/isN0) to SG. Secondary objectives included overall response rate (ORR), safety, event-free survival (EFS), and predictive biomarkers. A response-guided approach was utilized, and subsequent systemic therapy decisions were at the discretion of the treating physician. RESULTS From July 2020 to August 2021, 50 participants were enrolled (median age = 48.5 years; 13 clinical stage I disease, 26 stage II, 11 stage III). Forty-nine (98%) completed four cycles of SG. Overall, the pCR rate with SG alone was 30% [n = 15, 95% confidence interval (CI) 18% to 45%]. The ORR per RECIST V1.1 after SG alone was 64% (n = 32/50, 95% CI 77% to 98%). Higher Ki-67 and tumor-infiltrating lymphocytes (TILs) were predictive of pCR to SG (P = 0.007 for Ki-67 and 0.002 for TILs), while baseline TROP2 expression was not (P = 0.440). Common adverse events were nausea (82%), fatigue (76%), alopecia (76%), neutropenia (44%), and rash (48%). With a median follow-up time of 18.9 months (95% CI 16.3-21.9 months), the 2-year EFS for all participants was 95%. Among participants with a pCR with SG (n = 15), the 2-year EFS was 100%. CONCLUSIONS In the first NA trial with an ADC in localized TNBC, SG demonstrated single-agent efficacy and feasibility of response-guided escalation/de-escalation. Further research on optimal duration of SG as well as NA combination strategies, including immunotherapy, are needed.
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Affiliation(s)
- L M Spring
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S M Tolaney
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - G Fell
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - V Bossuyt
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - R O Abelman
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - B Wu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S Maheswaran
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - L Trippa
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - A Comander
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - T Mulvey
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S McLaughlin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - P Ryan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - L Ryan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - E Abraham
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - A Rosenstock
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | | | - F Lynce
- Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - B Moy
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - S J Isakoff
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston
| | - N Tung
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - E A Mittendorf
- Brigham and Women's Hospital, Harvard Medical School, Boston
| | - L W Ellisen
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; Ludwig Center, Harvard Medical School, Boston, USA
| | - A Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston.
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Spring LM, Mortensen L, Abraham E, Keenan J, Medford A, Ma A, Padden S, Denault E, Ryan L, Iafrate AJ, Lennerz J, Hochberg E, Wander SA, Moy B, Isakoff SJ, Juric D, Brennan KA, Smith DE, Civiello B, Mulvey T, Comander A, Ellisen LW, Schwartz JH, Bardia A. Virtual Molecular and Precision Medicine Clinic to Improve Access to Clinical Trials for Patients With Metastatic Breast Cancer: An Academic/Community Collaboration. JCO Oncol Pract 2024; 20:69-76. [PMID: 37922440 DOI: 10.1200/op.23.00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/26/2023] [Accepted: 09/26/2023] [Indexed: 11/05/2023] Open
Abstract
PURPOSE There is a demand for improved care delivery surrounding genomic testing and clinical trial enrollment among patients with metastatic breast cancer (MBC). We sought to improve the current process via real-time informal consultation and prescreening assessment for patients with MBC treated by community and academic medical oncologists by implementing a virtual molecular and precision medicine (vMAP) clinic. METHODS The vMAP program used a virtual referral system directed to a multidisciplinary team with precision medicine expertise. Providers contacted vMAP regarding patients with MBC, and on receipt of referral, the vMAP team engaged in discussion to identify if further diagnostics were needed (including genomic testing) and to identify potential clinical trials or standard treatment options. Recommendations were then sent to the referring provider within 72 hours. Pre-/postsurveys were issued to network physicians to assess for barriers, clinical trial access, and vMAP referral experience. Program implementation was evaluated with the Squire 2.0 reporting guidelines for quality improvement in health care as a framework. RESULTS Eighty-one cases from 22 providers were referred to vMAP over a 26-month period. The average response time to the referring provider with a finalized recommendation was 1.90 ± 1.82 days. A total of 86.4% of cases had clinical trial options on vMAP prescreen, with 40.7% initiating formal screening assessments and 27 patients (33.3%) ultimately enrolling on trials. On resurvey, 92% of survey responses across community oncology referring providers said that they were very likely to use vMAP again. CONCLUSION In the initial 2-year period, vMAP demonstrated an efficient means to offer real-time interpretation of genomic testing and identification of clinical trials for patients with MBC, with effective clinical trial enrollment and high rates of referring provider satisfaction.
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Affiliation(s)
- Laura M Spring
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Mass General Cancer Center at Waltham, Waltham, MA
| | | | | | | | - Arielle Medford
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Annie Ma
- Massachusetts General Hospital, Boston, MA
| | | | | | | | - A John Iafrate
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jochen Lennerz
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ephraim Hochberg
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Seth A Wander
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Mass General/North Shore Cancer Center, Danvers, MA
| | - Beverly Moy
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Mass General Cancer Center at Waltham, Waltham, MA
| | - Steven J Isakoff
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Dejan Juric
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Deborah E Smith
- Mass General Cancer Center at Cooley Dickinson Hospital, Northampton, MA
| | - Barbara Civiello
- Mass General Cancer Center at Wentworth-Douglass Hospital, Dover, NH
| | - Therese Mulvey
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Amy Comander
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Mass General Cancer Center at Waltham, Waltham, MA
- Mass General Cancer Center at Newton Wellesley Hospital, Newton, MA
| | - Leif W Ellisen
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Joel H Schwartz
- Massachusetts General Hospital, Boston, MA
- Mass General/North Shore Cancer Center, Danvers, MA
- Mass General Cancer Center at Cooley Dickinson Hospital, Northampton, MA
| | - Aditya Bardia
- Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Mass General Cancer Center at Waltham, Waltham, MA
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Jacobson JO, Zerillo JA, Doolin J, Stuver SO, Revette A, Mulvey T. Uncovering the Risks of Anticancer Therapy Through Incident Report Analysis Using a Newly Developed Medical Oncology Incident Taxonomy. J Patient Saf 2023; 19:580-586. [PMID: 37922223 PMCID: PMC10662608 DOI: 10.1097/pts.0000000000001169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND Incident reporting systems were developed to identify possible and actual harm in healthcare facilities. They have the potential to capture important safety trends and to enable improvements that can mitigate the risk of future patient harm and suffering. We recently developed and validated a taxonomy specific for medical oncology designed to enhance the identification, tracking, and trending of incidents that may lead to patient harm. The current project was designed to test the ability of such a taxonomy to be applied across different organizations delivering medical oncology care and to identify specific risks that could result in future harm. METHODS We analyzed 309 randomly selected medical oncology-related incident reports from 3 different cancer centers that had been posted between January 2019 and December 2020. Each report was assigned up to 2 incident categories. We used a 2-step process to reconcile reviewer discrepancies. In a secondary analysis, each of the incidents was reviewed and recoded to identify events which may result in major or catastrophic harm. RESULTS Three hundred four incidents met criteria for inclusion. Three hundred incidents (98.7%) were successfully coded. Sixty-seven percent of incidents were encompassed by the following 4 of 21 categories: prescriber ordering (22%), nursing care (15%), pharmacy (14%), and relational/communication issues (15%). Of 297 evaluable incidents, 47% did not reach the patient, 44.7% reached the patient without harm, 7.7% caused minor injury, and 0.7% caused severe injury or death. Submission rates by physicians varied between the 3 sites accounting for 1.7%, 10.7%, and 16.1% of reports. Secondary analysis identified 9 distinct scenarios that may result in major or catastrophic patient harm. CONCLUSIONS A medical oncology-specific incident reporting taxonomy has the potential to increase our understanding of inherent risks and may lead to process improvements that improve patient safety.
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Affiliation(s)
| | | | - James Doolin
- Harvard Medical School
- Beth Israel Deaconess Medical Center
| | - Sherri O. Stuver
- From the Dana-Farber Cancer Institute
- Boston University School of Public Health
| | - Anna Revette
- From the Dana-Farber Cancer Institute
- Harvard T.H. Chan School of Public Health
| | - Therese Mulvey
- Harvard Medical School
- Mass General Cancer Center, Boston, Massachusetts
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Medford AJ, Scarpetti L, Niemierko A, Isakoff SJ, Moy B, Wander SA, Deluca E, Abraham E, Shin J, Schnipper L, Comander AE, Mulvey T, Spickard E, Kalashnikova E, Rodriguez A, Ellisen L, Bardia A, Spring LM. Abstract PD17-03: Cell-free DNA monitoring in a phase II study of adjuvant endocrine therapy with CDK 4/6 inhibitor ribociclib for localized HR+/HER2- breast cancer (LEADER). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd17-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: While adjuvant endocrine therapy (ET) reduces recurrence risk in hormone receptor-positive (HR+) breast cancer, many patients still experience disease recurrence. Adjuvant therapeutic advances are needed to improve outcomes. Meanwhile, monitoring for circulating tumor DNA (ctDNA) in the adjuvant setting may detect molecular residual disease and/or emergences of molecular recurrence from tumor dormancy. Cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors have shown efficacy in HR+/HER2- metastatic breast cancer, and abemaciclib is now approved for adjuvant use in high-risk HR+/HER2- breast cancer. Adjuvant clinical trials have evaluated upfront use of adjuvant CDK 4/6 inhibition; however, the optimal timing of adding a CDK 4/6 inhibitor for HR+/HER2- breast cancer remains unknown. We conducted a prospective phase II clinical trial to evaluate the addition of the CDK 4/6 inhibitor ribociclib in patients with at least one remaining year of adjuvant ET regardless of duration of ET prior to trial enrollment, and we prospectively collected plasma for ctDNA analysis. Methods: Eligible patients had Stage I-III HR+/HER2- breast cancer and had been on adjuvant ET (any number of years) with at least one year of treatment remaining. Patients were randomized to one of two ribociclib schedules: continuous (400 mg daily, 28-day cycle) or intermittent (600 mg daily days 1-21, 28-day cycle) for one year. Patients were concurrently treated with an aromatase inhibitor (plus GnRH agonist, if premenopausal). Time to recurrence was calculated using the Kaplan-Meier method. ctDNA monitoring was performed using the SignateraTM platform, a tumor-informed assay based on whole exome sequencing of the primary tumor for multiplex PCR-NGS ctDNA assay design with targeting of up to 16 single nucleotide variants. Plasma samples were collected at the start of ribociclib/ET and serially during follow-up visits. Results: Among 81 patients treated with adjuvant endocrine therapy and the CDK4/6 inhibitor ribociclib, 42 patients had samples suitable for ctDNA analysis: 3 (7%) had a single ctDNA test, 17 (40%) had 2 serial ctDNA tests, and 22 (52%) had 3 serial ctDNA tests. After a median follow-up of 20 months, 2 patients who received ribociclib (intermittent dosing) experienced disease recurrence with recurrence-free survival of 100% at 1 year from study entry and 97% (95% CI 88-99%) at 2 years. ctDNA was detected exclusively in the only 2 patients that experienced recurrence, with lead times of 7 months and 8 months prior to clinical recurrence. Both patients had no detectable ctDNA at the start of ribociclib/ET. One patient had detectable ctDNA [mean tumor molecules/mL (MTM/mL) = 0.1] while on ribociclib/ET for 5 months, after which she completed a full 12 months of treatment. One month after completing ribociclib/ET (8 months after ctDNA detection), she presented with metastases in the liver and bones. The second patient had 2 negative ctDNA tests at days 0 and 147 while receiving ribociclib/ET and became ctDNA positive (MTM/mL = 0.1) at day 350. She developed CNS-only metastatic disease 7 months after completing ribociclib/ET. Among the other 40 patients who did not have detectable ctDNA, none have experienced recurrence. Conclusions: Overall, only 2 patients had detectable ctDNA, and both patients developed recurrent metastatic disease after completion of ribociclib with ET. Notably, one of these patients developed CNS-only disease. While follow-up is early, the remaining patients did not have detectable ctDNA and have not developed recurrent disease. This study suggests monitoring for ctDNA may identify patients at increased risk for recurrence in the extended adjuvant period and potentially guide therapy escalation.
Citation Format: Arielle J. Medford, Lauren Scarpetti, Andrzej Niemierko, Steven J. Isakoff, Beverly Moy, Seth A. Wander, Elizabeth Deluca, Elizabeth Abraham, Jennifer Shin, Lowell Schnipper, Amy E. Comander, Therese Mulvey, Erik Spickard, Ekaterina Kalashnikova, Angel Rodriguez, Leif Ellisen, Aditya Bardia, Laura M. Spring. Cell-free DNA monitoring in a phase II study of adjuvant endocrine therapy with CDK 4/6 inhibitor ribociclib for localized HR+/HER2- breast cancer (LEADER) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD17-03.
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Affiliation(s)
- Arielle J. Medford
- 1Massachusetts General Hospital Cancer Center/Dana Farber Cancer Institute
| | | | | | | | | | - Seth A. Wander
- 6Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Therese Mulvey
- 12Massachusetts General Hospital North Shore Cancer Center
| | | | | | | | - Leif Ellisen
- 16Massachusetts General Hospital, Boston, Massachusetts
| | - Aditya Bardia
- 17Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Laura M. Spring
- 18Massachusetts General Hospital Cancer Center, Boston, MA, USA
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Tarantino P, Tayob N, Dang CT, Yardley D, Isakoff SJ, Valero V, Faggen M, Mulvey T, Bose R, Weckstein D, Wolff AC, Reeder-Hayes K, Rugo H, Ramaswamy B, Zuckerman D, Hart L, Gadi VK, Constantine M, Cheng K, Garrett AM, Marcom PK, Albain KS, DeFusco P, Tung N, Ardman B, Nanda R, Jankowitz RC, Rimawi M, Abramson V, Pohlmann PR, Van Poznak C, Forero-Torres A, Liu MC, Ruddy K, Zheng Y, Barroso-Sousa R, Waks A, DeMeo MK, DiLullo MK, Curigliano G, Burstein H, Partridge A, Winer E, Viale G, Hui W, Mittendorf EA, Schneider BP, Prat A, Krop I, Tolaney S. Abstract PD18-01: Adjuvant Trastuzumab Emtansine Versus Paclitaxel plus Trastuzumab for Stage I HER2+ Breast Cancer: 5-year results and correlative analyses from ATEMPT (TBCRC033). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd18-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: The ATEMPT trial primary analysis found that one year of adjuvant trastuzumab emtansine (T-DM1) achieved a 3-year iDFS of 97.8% for patients with stage I HER2+ breast cancer, but was not associated with fewer clinically relevant toxicities (CRTs) compared with paclitaxel and trastuzumab (TH). In this end-of-study analysis, we report 5-year survival outcomes and correlative analyses from the trial. Methods: Patients with stage I centrally confirmed HER2+ breast cancer were randomly assigned 3:1 to adjuvant T-DM1 for one year or TH and received T-DM1 3.6 mg/kg IV every 3 weeks for 17 cycles or paclitaxel 80 mg/m2 IV with weekly trastuzumab IV followed by trastuzumab for 9 months. The co-primary objectives were to compare the incidence of CRTs between the 2 arms and to evaluate iDFS in patients receiving T-DM1. To investigate proteomic correlates of recurrence, spatial proteomic analyses were performed on samples from 13 patients experiencing iDFS events (cases) and 24 matched controls using the NanoString GeoMx Digital Spatial Profiler. The impact of HER2 heterogeneity on outcomes was investigated among 17 cases and 51 matched controls by fluorescence in-situ hybridization (FISH). HER2 genetic heterogeneity was assessed by scrutinizing the whole tumor area and defined as the occurrence of HER2 gene amplification in >5% but < 50% invasive tumor cells. The risk of recurrence was evaluated centrally with the HER2DX genomic assay from 225 primary tumor samples. Germline whole genome sequencing (WGS) was conducted among 55 patients experiencing T-DM1-induced thrombocytopenia and/or bleeding and 55 matched controls to identify genomic correlates for this side effect. Results: A total of 497 patients who initiated protocol therapy were included in this analysis (383 T-DM1 and 114 TH). After a median follow up 5.8 years, among patients receiving T-DM1 there were a total of 11 iDFS events, with 3 distant recurrences. The 5-year iDFS for T-DM1 was 97.0% (95% CI, 95.3-98.8%), the 5-year recurrence-free interval (RFI) was 98.6% (95% CI: 97.4-99.8%) and the 5-year overall survival (OS) for T-DM1 was 97.8 % (95% CI, 96.3-99.3%). Although the study was not powered to evaluate the efficacy of TH, among the 114 patients receiving TH, a total of 9 iDFS events were observed, including 2 distant events; the 5-year iDFS with TH was 91.3% (95% CI: 86.0-96.9%), 5-year RFI was 93.3% (95% CI: 88.6-98.2%) and 5-year OS was 97.9% (95% CI: 95.2-100%). A total of 56 samples were evaluable for heterogeneity analyses, among which 14% (n=8) harbored HER2 genetic heterogeneity. Spatial proteomic analyses found that NF1 (adjusted p=0.72 × 10-6) and CTLA-4 (adjusted p=0.15 × 10-3) were significantly upregulated in primary samples from cases, while cleaved caspase 9, CD25, GITR, ICOS, p53 and PD-L2 were significantly upregulated in controls (all with adjusted p< 0.05). Germline WGS found that the top gene associations with thrombocytopenia and thrombocytopenia or bleeding were ALMS1 (p=0,19 × 10-3) and APBA3 (p=0,23 × 10-3), respectively, although none reaching the threshold for genome wide significance. rs62143195 and rs114169776 were the top single nucleotide polymorphisms associated with thrombocytopenia and thrombocytopenia or bleeding, respectively. Data on the impact of HER2 heterogeneity and of HER2DX score on survival outcomes will be presented. Conclusion: With longer follow-up, adjuvant T-DM1 confirmed outstanding long-term outcomes among patients with stage I HER2+ breast cancer, demonstrating a 5-year RFI of 98.6%. Spatial proteomic analyses identified a potential association between NF1 and CTLA-4 expression with recurrence. Details on the impact of HER2 heterogeneity and HER2DX assay on prognosis will be presented.
Citation Format: Paolo Tarantino, Nabihah Tayob, Chau T Dang, Denise Yardley, Steven J. Isakoff, Vicente Valero, Meredith Faggen, Therese Mulvey, Ron Bose, Douglas Weckstein, Antonio C. Wolff, Katherine Reeder-Hayes, Hope Rugo, Bhuvaneswari Ramaswamy, Dan Zuckerman, Lowell Hart, Vijayakrishna K. Gadi, Michael Constantine, Kit Cheng, Audrey Merrill Garrett, Paul K. Marcom, Kathy S. Albain, Patricia DeFusco, Nadine Tung, Blair Ardman, Rita Nanda, Rachel C. Jankowitz, Mothaffar Rimawi, Vandana Abramson, Paula R. Pohlmann, Catherine Van Poznak, Andres Forero-Torres, Minetta C. Liu, Kathryn Ruddy, Yue Zheng, Romualdo Barroso-Sousa, Adrienne Waks, Michelle K. DeMeo, Molly K. DiLullo, Giuseppe Curigliano, Harold Burstein, Ann Partridge, Eric Winer, Giuseppe Viale, Winnie Hui, Elizabeth A. Mittendorf, Bryan P. Schneider, Aleix Prat, Ian Krop, Sara Tolaney. Adjuvant Trastuzumab Emtansine Versus Paclitaxel plus Trastuzumab for Stage I HER2+ Breast Cancer: 5-year results and correlative analyses from ATEMPT (TBCRC033) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD18-01.
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Affiliation(s)
- Paolo Tarantino
- 1Breast Oncology Program, Dana-Farber Cancer Institute; Harvard Medical School, Boston, Massachusetts
| | | | | | - Denise Yardley
- 4Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN, USA
| | | | - Vicente Valero
- 6Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Therese Mulvey
- 8Massachusetts General Hospital North Shore Cancer Center
| | - Ron Bose
- 9Washington University in St Louis School of Medicine
| | | | | | | | - Hope Rugo
- 13University of California San Francisco, San Francisco, CA
| | | | | | | | | | | | | | | | | | - Kathy S. Albain
- 22Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center
| | | | - Nadine Tung
- 24Beth Israel Deaconess Medical Center, Boston
| | | | - Rita Nanda
- 26University of Chicago, Chicago, Illinois
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giuseppe Viale
- 44European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
| | | | | | | | | | - Ian Krop
- 49Yale School of Medicine, New Haven, Connecticut
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Jacobson JO, Zerillo JA, Mulvey T, Stuver SO, Revette AC. Development of a taxonomy for characterising medical oncology-related patient safety and quality incidents: a novel approach. BMJ Open Qual 2022; 11:bmjoq-2022-001828. [PMID: 35793864 PMCID: PMC9260784 DOI: 10.1136/bmjoq-2022-001828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Joseph O Jacobson
- Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Ann Zerillo
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Therese Mulvey
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sherri O Stuver
- Quality and Patient Safety, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Anna C Revette
- Population Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Spring LM, Scarpetti L, Niemierko A, Isakoff SJ, Moy B, Wander SA, Smith E, Abraham E, Shin J, Patel JM, Comander A, Mulvey T, Bardia A. Abstract P1-14-02: Phase II study of adjuvant endocrine therapy with CDK 4/6 inhibitor, ribociclib, for localized ER+/HER2- breast cancer (LEADER, part 1). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-14-02] [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: CDK 4/6 inhibitors have demonstrated substantial efficacy in treating ER+/HER2- metastatic breast cancer. Therefore, there is great interest in exploring their ability to reduce recurrence risk in early breast cancer. However, conflicting results were observed in the large adjuvant phase 3 clinical trials investigating combination of endocrine therapy and CDK 4/6 inhibitor (PALLAS, MONARCH-E). While these adjuvant clinical trials evaluated upfront use of CDK 4/6 inhibitor, the optimal timing of adding CDK 4/6 inhibitor for HR+/HER2- breast cancer remains unknown. We conducted a prospective phase II clinical trial to evaluate the addition of a CDK 4/6 inhibitor, ribociclib, in patients who were already on adjuvant endocrine therapy. Methods: In part 1 of the clinical trial, eligibility included patients with localized stage I-III ER+ (≥ 10%), HER2- breast cancer; completed surgery; and were on adjuvant endocrine therapy (any number of years) with at least one year or more of treatment remaining. Patients were randomized to two different ribociclib schedules: continuous (400 mg daily of 28-day cycle; arm 1) or intermittent (600 mg daily on days 1-21 of 28-day cycle; arm 2) for one year. Patients were concurrently treated with an aromatase inhibitor (plus GnRH agonist if premenopausal). Tolerance was evaluated via CTCAE version 4.03 and proportion of subjects who discontinued CDK 4/6 treatment early. Stratification factors for statistical analysis included: disease stage (III vs lower), duration of prior endocrine therapy (within 2 years; 2-5 years vs > 5 years), and whether the patient received prior chemotherapy or not. Baseline characteristics and risk factors for recurrence and for early discontinuation were compared between the arms of the study using Pearson's chi-squared test. Actuarial analysis of time to recurrence was done using the Kaplan-Meier estimator. The primary objective of part 1 was to estimate adherence to ribociclib treatment in the adjuvant setting. Results: In total, 81 patients were enrolled between February 2018 and September 2019, and 25 (31%) discontinued ribociclib treatment early, with no significant difference between study arms. The most common grade 3 or greater adverse events (AEs) leading to study discontinuation were neutropenia (44%), alanine aminotransferase increase (28%), and aspartate aminotransferase increase (16%). Among patients who discontinued early, neutropenia was more frequent in the 600 mg arm, 9 of 12 patients (75%), versus 2 of 13 patients (15%) in the 400 mg arm. No patients discontinued early due to prolonged QTc. Ribociclib was dose reduced for 22 patients (27%), with no significant difference between study arms (p = 0.12). After a median follow-up of 20 months, two patients have experienced disease recurrence with recurrence-free survival of 100% at 1 year and 97% (95% CI 88-99%) at 2 years. Biomarker (ctDNA) results will be reported at the meeting. Conclusions: Results demonstrate that while serious AEs with one year of adjuvant ribociclib are low, a substantial number of patients discontinued adjuvant CDK 4/6 inhibitor within 1 year. Overall, with limited follow-up, only two patients had recurrent disease since completion of ribociclib treatment. Tolerability and identifying patient subsets who will most benefit need to be carefully considered with CDK 4/6 inhibitors in the adjuvant setting.
Citation Format: Laura M Spring, Lauren Scarpetti, Andrzej Niemierko, Steven J Isakoff, Beverly Moy, Seth A Wander, Elisabeth Smith, Elizabeth Abraham, Jennifer Shin, Jaymin M Patel, Amy Comander, Therese Mulvey, Aditya Bardia. Phase II study of adjuvant endocrine therapy with CDK 4/6 inhibitor, ribociclib, for localized ER+/HER2- breast cancer (LEADER, part 1) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-14-02.
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8
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Tolaney SM, Tayob N, Dang C, Yardley DA, Isakoff SJ, Valero V, Faggen M, Mulvey T, Bose R, Hu J, Weckstein D, Wolff AC, Reeder-Hayes K, Rugo HS, Ramaswamy B, Zuckerman D, Hart L, Gadi VK, Constantine M, Cheng K, Briccetti F, Schneider B, Garrett AM, Marcom K, Albain K, DeFusco P, Tung N, Ardman B, Nanda R, Jankowitz RC, Rimawi M, Abramson V, Pohlmann PR, Van Poznak C, Forero-Torres A, Liu M, Ruddy K, Zheng Y, Rosenberg SM, Gelber RD, Trippa L, Barry W, DeMeo M, Burstein H, Partridge A, Winer EP, Krop I. Adjuvant Trastuzumab Emtansine Versus Paclitaxel in Combination With Trastuzumab for Stage I HER2-Positive Breast Cancer (ATEMPT): A Randomized Clinical Trial. J Clin Oncol 2021; 39:2375-2385. [PMID: 34077270 DOI: 10.1200/jco.20.03398] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [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
PURPOSE The ATEMPT trial was designed to determine if treatment with trastuzumab emtansine (T-DM1) caused less toxicity than paclitaxel plus trastuzumab (TH) and yielded clinically acceptable invasive disease-free survival (iDFS) among patients with stage I human epidermal growth factor receptor 2-positive (HER2+) breast cancer (BC). METHODS Patients with stage I centrally confirmed HER2+ BC were randomly assigned 3:1 to T-DM1 or TH and received T-DM1 3.6 mg/kg IV every 3 weeks for 17 cycles or T 80 mg/m2 IV with H once every week × 12 weeks (4 mg/kg load →2 mg/kg), followed by H × 39 weeks (6 mg/kg once every 3 weeks). The co-primary objectives were to compare the incidence of clinically relevant toxicities (CRTs) in patients treated with T-DM1 versus TH and to evaluate iDFS in patients receiving T-DM1. RESULTS The analysis population includes all 497 patients who initiated protocol therapy (383 T-DM1 and 114 TH). CRTs were experienced by 46% of patients on T-DM1 and 47% of patients on TH (P = .83). The 3-year iDFS for T-DM1 was 97.8% (95% CI, 96.3 to 99.3), which rejected the null hypothesis (P < .0001). Serially collected patient-reported outcomes indicated that patients treated with T-DM1 had less neuropathy and alopecia and better work productivity compared with patients on TH. CONCLUSION Among patients with stage I HER2+ BC, one year of adjuvant T-DM1 was associated with excellent 3-year iDFS, but was not associated with fewer CRT compared with TH.
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Affiliation(s)
- Sara M Tolaney
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Denise A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | | | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ron Bose
- Washington University, St Louis, MO
| | - Jiani Hu
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | - Dan Zuckerman
- St Luke's Mountain States Tumor Institute, Boise, ID
| | - Lowell Hart
- Wake Forest Baptist Health, Winston-Salem, NC
| | - Vijayakrishna K Gadi
- University of Washington, Seattle, WA. Currently at University of Illinois at Chicago, Chicago, IL
| | | | - Kit Cheng
- North Shore-LIJ Cancer Institute, Lake Success, NY
| | | | | | | | | | | | | | - Nadine Tung
- Harvard Medical School, Boston, MA.,Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | - Mothaffar Rimawi
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | | | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | | | | | | | - Yue Zheng
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Richard D Gelber
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Lorenzo Trippa
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | - Harold Burstein
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ann Partridge
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Eric P Winer
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
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9
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Wander SA, Han HS, Zangardi ML, Niemierko A, Mariotti V, Kim LSL, Xi J, Pandey A, Dunne S, Nasrazadani A, Kambadakone A, Stein C, Lloyd MR, Yuen M, Spring LM, Juric D, Kuter I, Sanidas I, Moy B, Mulvey T, Vidula N, Dyson NJ, Ellisen LW, Isakoff S, Wagle N, Brufsky A, Kalinsky K, Ma CX, O'Shaughnessy J, Bardia A. Clinical Outcomes With Abemaciclib After Prior CDK4/6 Inhibitor Progression in Breast Cancer: A Multicenter Experience. J Natl Compr Canc Netw 2021:1-8. [PMID: 33761455 DOI: 10.6004/jnccn.2020.7662] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inhibitors of cyclin-dependent kinases 4 and 6 (CDK4/6i) are widely used as first-line therapy for hormone receptor-positive metastatic breast cancer (HR+ MBC). Although abemaciclib monotherapy is also FDA-approved for treatment of disease progression on endocrine therapy, there is limited insight into the clinical activity of abemaciclib after progression on prior CDK4/6i. PATIENTS AND METHODS We identified patients with HR+ MBC from 6 cancer centers in the United States who received abemaciclib after disease progression on prior CDK4/6i, and abstracted clinical features, outcomes, toxicity, and predictive biomarkers. RESULTS In the multicenter cohort, abemaciclib was well tolerated after a prior course of CDK4/6i (palbociclib)-based therapy; a minority of patients discontinued abemaciclib because of toxicity without progression (9.2%). After progression on palbociclib, most patients (71.3%) received nonsequential therapy with abemaciclib (with ≥1 intervening non-CDK4/6i regimens), with most receiving abemaciclib with an antiestrogen agent (fulvestrant, 47.1%; aromatase inhibitor, 27.6%), and the remainder receiving abemaciclib monotherapy (19.5%). Median progression-free survival for abemaciclib in this population was 5.3 months and median overall survival was 17.2 months, notably similar to results obtained in the MONARCH-1 study of abemaciclib monotherapy in heavily pretreated HR+/HER2-negative CDK4/6i-naïve patients. A total of 36.8% of patients received abemaciclib for ≥6 months. There was no relationship between the duration of clinical benefit while on palbociclib and the subsequent duration of treatment with abemaciclib. RB1, ERBB2, and CCNE1 alterations were noted among patients with rapid progression on abemaciclib. CONCLUSIONS A subset of patients with HR+ MBC continue to derive clinical benefit from abemaciclib after progression on prior palbociclib. These results highlight the need for future studies to confirm molecular predictors of cross-resistance to CDK4/6i therapy and to better characterize the utility of abemaciclib after disease progression on prior CDK4/6i.
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Affiliation(s)
- Seth A Wander
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Hyo S Han
- 3Moffitt Cancer Center, Tampa, Florida
| | | | - Andrzej Niemierko
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | | | - Leslie S L Kim
- 4Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas
| | - Jing Xi
- 5Washington University, St. Louis, Missouri
| | | | - Siobhan Dunne
- 4Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas
| | | | - Avinash Kambadakone
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Casey Stein
- 1Massachusetts General Hospital Cancer Center, and
| | | | - Megan Yuen
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Laura M Spring
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Dejan Juric
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Irene Kuter
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Ioannis Sanidas
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Beverly Moy
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Therese Mulvey
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Neelima Vidula
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Nicholas J Dyson
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Leif W Ellisen
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Steven Isakoff
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
| | - Nikhil Wagle
- 2Harvard Medical School, Boston, Massachusetts
- 7Dana-Farber Cancer Institute, and
- 8Broad Institute of MIT and Harvard, Boston, Massachusetts; and
| | - Adam Brufsky
- 6University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin Kalinsky
- 9Columbia University Irving Medical Center, New York, New York
| | | | - Joyce O'Shaughnessy
- 4Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas
| | - Aditya Bardia
- 1Massachusetts General Hospital Cancer Center, and
- 2Harvard Medical School, Boston, Massachusetts
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Spring LM, Tolaney SM, Desai N, Comander A, Mulvey T, Krop IE, Winer EP, Mittendorf EA, Ellisen LW, Bardia A. Abstract OT-03-06: Phase 2 study of response-guided neoadjuvant sacituzumab govitecan (IMMU-132) in patients with localized triple-negative breast cancer (NeoSTAR). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-03-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Optimizing treatments for triple negative breast cancer (TNBC) in the localized breast cancer setting is key to preventing metastatic recurrences and reducing mortality from this devastating disease. Sacituzumab Govitecan (SG), a novel antibody-drug conjugate in which the topoisomerase 1 inhibitor SN-38 (the active metabolite of irinotecan) is coupled to a humanized monoclonal antibody targeting the tumor antigen Trop-2, was granted FDA accelerated approval in April 2020 for treatment of patients with metastatic TNBC. The NeoSTAR clinical trial is evaluating SG in the neoadjuvant setting for patients with localized TNBC. Trial design: This is a single arm phase II study of neoadjuvant SG in patients with localized TNBC. SG will be administered via an IV infusion on Days 1, 8 of each 21-day cycle at a starting dose of 10 mg/kg for 4 cycles. After 4 cycles, patients who have biopsy-proven residual disease will have the option to receive additional standard neoadjuvant therapy at the discretion of the treating physician and subsequently proceed to surgery. Those with a complete response on imaging may proceed directly to surgery. A baseline research biopsy prior to initiation of study therapy is required as well as tissue collection following treatment with SG (either at surgery or via biopsy prior to additional neoadjuvant therapy). Eligibility criteria: Patients ≥ 18 years of age with previously untreated primary TNBC as determined by the local institution according to ASCO/CAP criteria will be enrolled. Patients must either have a primary tumor >1 cm measured by imaging (cT1c-T4), or be node positive. An ECOG performance score of 0 or 1, and adequate bone marrow, hepatic, and renal function is required. Specific aims: The primary objective is to assess the pathological complete response (pCR) rate in breast and lymph nodes (ypT0/isN0) with SG. Secondary objectives include assessment of radiological response rate, evaluation of the safety and tolerability of SG (CTCAE v5.0), disease-free survival (DFS), and quality of life (EORTC QLQ-C30). Exploratory objectives include assessment of potential predictive biomarkers, including Trop-2 expression, DNA damage response markers and immunological markers, as well as changes in cell free DNA with SG. Statistical methods: The primary analysis is based on the estimated pCR rate with SG and will be provided as a proportion (with two-sided 95% confidence interval). Accounting for up to a 14% drop out rate, a sample size of 43 patients will provide 80% power to exclude a lower limit of pCR of 20% (alpha 0.05, two-sided test). DFS will be analyzed using Kaplan-Meier methods and descriptive statistics. Target Accrual: 50 patients. Contact: Dr. Laura Spring (LSpring@mgh.harvard.edu) Clinicaltrials.gov #: NCT04230109
Citation Format: Laura M. Spring, Sara M. Tolaney, Neelam Desai, Amy Comander, Therese Mulvey, Ian E. Krop, Eric P. Winer, Elizabeth A. Mittendorf, Leif W. Ellisen, Aditya Bardia. Phase 2 study of response-guided neoadjuvant sacituzumab govitecan (IMMU-132) in patients with localized triple-negative breast cancer (NeoSTAR) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-03-06.
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Affiliation(s)
| | | | - Neelam Desai
- 3Beth Israel Deaconess Medical Center, Boston, MA
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van Seventer EE, Fish MG, Fosbenner K, Kanter K, Mojtahed A, Allen JN, Blaszkowsky L, Clark JW, Dubois J, Franses JW, Giantonio BJ, Goyal L, Klempner SJ, Roeland EJ, Ryan DP, Weekes CD, Mulvey T, El-Jawahri A, Horick N, Corcoran RB, Parikh AR, Nipp RD. Associations of baseline patient-reported outcomes with treatment outcomes in advanced gastrointestinal cancer. Cancer 2020; 127:619-627. [PMID: 33170962 DOI: 10.1002/cncr.33315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) assessing quality of life (QOL) and symptom burden correlate with clinical outcomes in patients with cancer. However, to the authors' knowledge, data regarding associations between PROs and treatment response are lacking. METHODS The authors prospectively approached consecutive patients with advanced gastrointestinal cancer who were initiating a new treatment. Prior to treatment, patients reported their QOL (Functional Assessment of Cancer Therapy-General [FACT-G], 4 subscales: Functional, Physical, Emotional, Social; higher scores indicate better QOL) and symptom burden (Edmonton Symptom Assessment System [ESAS], Patient Health Questionnaire-4 [PHQ-4]; higher scores represent greater symptoms). Regression models were used to examine associations of baseline PROs with treatment response (clinical benefit or progressive disease [PD] at time of first scan), healthcare utilization, and survival. RESULTS From May 2019 to April 2020, a total of 112 patients with advanced gastrointestinal cancer were enrolled. For treatment response, 64.3% had CB and 35.7% had PD. Higher baseline ESAS-Physical (odds ratio, 1.04; P = .027) and lower FACT-G Functional (odds ratio, 0.92; P = .038) scores were associated with PD. Higher ESAS-Physical (hazard ratio [HR], 1.03; P = .044) and lower FACT-G Total (HR, 0.96; P = .005), FACT-G Physical (HR, 0.89; P < .001), and FACT-G Functional (HR, 0.87; P < .001) scores were associated with a greater hospitalization risk. Lower FACT-G Total (HR, 0.96; P = .009) and FACT-G Emotional (HR, 0.86; P = .012) scores as well as higher ESAS-Total (HR, 1.03; P = .014) and ESAS-Physical (HR, 1.04; P = .032) scores were associated with worse survival. CONCLUSIONS Baseline PROs are associated with treatment response in patients with advanced gastrointestinal cancer, namely physical symptoms and functional QOL, in addition to health care use and survival. The findings of the current study support the association between PROs and important clinical outcomes, including the novel finding of treatment response.
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Affiliation(s)
- Emily E van Seventer
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Madeleine G Fish
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Kathryn Fosbenner
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Katie Kanter
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill N Allen
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lawrence Blaszkowsky
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey W Clark
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jon Dubois
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Joseph W Franses
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Bruce J Giantonio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lipika Goyal
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Samuel J Klempner
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Eric J Roeland
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - David P Ryan
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Colin D Weekes
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Therese Mulvey
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Nora Horick
- Department of Statistics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan B Corcoran
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Aparna R Parikh
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts
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Sinaiko AD, Barnett ML, Gaye M, Soriano M, Mulvey T, Hochberg E. Association of Peer Comparison Emails With Electronic Health Record Documentation of Cancer Stage by Oncologists. JAMA Netw Open 2020; 3:e2015935. [PMID: 33021649 PMCID: PMC7539129 DOI: 10.1001/jamanetworkopen.2020.15935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Systematically capturing cancer stage is essential for any serious effort by health systems to monitor outcomes and quality of care in oncology. However, oncologists do not routinely record cancer stage in machine-readable structured fields in electronic health records (EHRs). OBJECTIVE To evaluate whether a peer comparison email intervention that communicates an oncologist's performance on documenting cancer stage relative to that of peer physicians was associated with increased likelihood that stage was documented in the EHR. DESIGN, SETTING, AND PARTICIPANTS This 12-month, randomized quality improvement pilot study aimed to increase oncologist staging documentation in the EHR. The pilot study was performed at Massachusetts General Hospital Cancer Center from October 1, 2018, to September 30, 2019. Participants included 56 oncologists across 3 practice sites who treated patients in the ambulatory setting and focused on diseases that use standardized staging systems. Data were analyzed from July 2, 2019, to March 5, 2020. INTERVENTIONS Peer comparison intervention with as many as 3 emails to oncologists during 6 months that displayed the oncologist's staging documentation rate relative to all oncologists in the study sample. MAIN OUTCOMES AND MEASURES The primary outcome was patient-level documentation of cancer stage, defined as the likelihood that a patient's stage of disease was documented in the EHR after the patient's first (eg, index) ambulatory visit during the pilot period. RESULTS Among the 56 oncologists participating (32 men [57%]), receipt of emails with peer comparison data was associated with increased likelihood of documentation of cancer stage using the structured field in the EHR (23.2% vs 13.0% of patient index visits). In adjusted analyses, this difference represented an increase of 9.0 (95% CI, 4.4-13.5) percentage points (P = .002) in the probability that a patient's cancer stage was documented, a relative increase of 69% compared with oncologists who did not receive peer comparison emails. The association increased with each email that was sent, ranging from a nonsignificant 4.0 (95% CI, -0.8 to 8.8) percentage points (P = .09) after the first email to a statistically significant 11.2 (95% CI, 4.9-17.4) percentage points (P = .003) after the third email . The association was concentrated among an oncologist's new patients (increase of 11.8 [95% CI, 6.2-17.4] percentage points; P = .001) compared with established patients (increase of 1.6 [95% CI, -2.9 to 6.1] percentage points; P = .44) and persisted for 7 months after the email communications stopped. CONCLUSIONS AND RELEVANCE In a quality improvement pilot trial, peer comparison emails were associated with a substantial increase in oncologist use of the structured field in the EHR to document stage of disease.
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Affiliation(s)
- Anna D. Sinaiko
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marema Gaye
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Therese Mulvey
- Division of Hematology and Oncology, Department of Medicine, General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ephraim Hochberg
- Division of Hematology and Oncology, Department of Medicine, General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
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13
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Partridge A, Zheng Y, Rosenberg S, Gelber R, Gelber S, Barry W, Dang C, Yardley D, Isakoff S, Valero V, Faggen M, Mulvey T, Bose R, Weckstein D, Wolff A, Reeder-Hayes K, Rugo H, Ramaswamy B, Zuckerman D, Hart L, Gadi V, Constantine M, Cheng K, Briccetti F, Schneider B, Garrett M, Marcom PK, Albain K, Defusco P, Tung N, Ardman B, Nanda R, Jankowitz R, DeMeo M, Burstein H, Winer EP, Krop I, Tolaney S. Abstract PD10-02: Patient reported outcomes from the adjuvant trastuzumab emtansine (T-DM1) vs. paclitaxel + trastuzumab (TH) (ATEMPT) trial (TBCRC 033). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-pd10-02] [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
Purpose: The ATEMPT trial sought to determine if adjuvant T-DM1 (every 3 wks for 1 yr) for Stage I HER2 positive breast cancer is better tolerated than TH (paclitaxel weekly x 12 wks with 1 yr of trastuzumab). Here we compare patient-reported outcomes (PROs) including quality of life (QOL), specific symptoms, and work productivity between the two treatments over time. Patients and Methods: English-speaking patients were randomized (3:1) to T-DM1 or TH, and completed PRO assessments at baseline (day 1), 3 wks, 12 wks, and 6, 12, and 18 mos after initiation of treatment. Surveys included the FACT-B, Patient-Neurotoxicity Questionnaire (PNQ), Rotterdam Symptom Checklist (RSCL), Alopecia Patient Assessment, and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP). Results: 469/497 (94%) patients (363 on T-DM1, 106 on TH) completed surveys at any timepoint, ranging from 100% at baseline to 79% at 18 mos. Median age was 56 yrs (range 23-85). There were different patterns of deterioration and recovery seen over time in each group for QOL and other relevant symptoms. Compared with the T-DM1 group, the TH group had significantly lower mean total FACT-B scores, indicating poorer QOL from baseline to 12 weeks (p<0.001 for each timepoint); mean scores were similar between the groups at 6 and 12 mos, and significantly worse again in the TH group at 18 mos. The greatest mean change from baseline, and lowest FACT-B scores overall were reported in the TH group at 12 weeks. Moderate to severe sensory neuropathy was 8% at 12 weeks for patients receiving T-DM1 and reached its highest level of 15% by 18 mos. In comparison, moderate to severe sensory neuropathy was 35% at 12 weeks and 26% at 18 mos for patients on TH (p<0.001 at 12 weeks and p=0.018 at 18 mos). Hair loss at week 12 was 13% on T-DM1 compared to 77% on TH (p<0.001). Mean physical symptom distress was greater for TH at baseline, 3 and 12 weeks, and greater for T-DM1 at 1 year, with greatest symptom distress reported by the TH group at 12 weeks. Psychological distress was greatest for both groups at enrollment, though significantly greater with TH than T-DM1 at baseline, 12 weeks and 18 mos (groups were similar at 6 and 12 mos). There was limited impact on activity level impairment in both groups. Rates of employment were lowest for the TH group at 12 weeks (49% TH vs. 61% T-DM1, p=0.074) with significant differences seen at 3 and 12 weeks for percent work time missed due to health treatment, percent impairment while working, percent overall work impairment, and percent activity impairment, all favoring T-DM1. Conclusion: PROs differ between patients with Stage I HER2 positive breast cancer treated with T-DM1 vs. TH. T-DM1 treated patients had better QOL, less neuropathy and hair loss, and better work productivity, particularly during the first 12 weeks of treatment, and importantly, differences persist with longer-term follow-up.
Citation Format: Ann Partridge, Yue Zheng, Shoshana Rosenberg, Richard Gelber, Shari Gelber, William Barry, Chau Dang, Denise Yardley, Steven Isakoff, Vicente Valero, Meredith Faggen, Therese Mulvey, Ron Bose, Douglas Weckstein, Antonio Wolff, Katherine Reeder-Hayes, Hope Rugo, Bhuvaneswari Ramaswamy, Dan Zuckerman, Lowell Hart, Vijayakrishna Gadi, Michael Constantine, Kit Cheng, Frederick Briccetti, Bryan Schneider, Merrill Garrett, P. Kelly Marcom, Kathy Albain, Patricia Defusco, Nadine Tung, Blair Ardman, Rita Nanda, Rachel Jankowitz, Michelle DeMeo, Harold Burstein, Eric P. Winer, Ian Krop, Sara Tolaney. Patient reported outcomes from the adjuvant trastuzumab emtansine (T-DM1) vs. paclitaxel + trastuzumab (TH) (ATEMPT) trial (TBCRC 033) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr PD10-02.
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Affiliation(s)
| | - Yue Zheng
- 1Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | - Chau Dang
- 2Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Ron Bose
- 6Washington University School of Medicine, St. Louis, MO
| | | | | | | | - Hope Rugo
- 9Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA
| | | | - Dan Zuckerman
- 11St. Luke's Mountain States Tumor Institute, Boise, ID
| | - Lowell Hart
- 12Florida Cancer Specialists and Wake Forest School of Medicine, Ft. Meyers, FL
| | | | | | - Kit Cheng
- 13Northwell Health, Lake Success, NY
| | | | - Bryan Schneider
- 14Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Kathy Albain
- 17Loyola University Stritch School of Medicine, Chicago, IL
| | | | - Nadine Tung
- 19Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | | | | | | | - Ian Krop
- 1Dana-Farber Cancer Institute, Boston, MA
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Mayer EL, DeMichele A, Rugo HS, Miller K, Waks AG, Come SE, Mulvey T, Jeselsohn R, Overmoyer B, Guo H, Barry WT, Huang Bartlett C, Koehler M, Winer EP, Burstein HJ. A phase II feasibility study of palbociclib in combination with adjuvant endocrine therapy for hormone receptor-positive invasive breast carcinoma. Ann Oncol 2019; 30:1514-1520. [PMID: 31250880 DOI: 10.1093/annonc/mdz198] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The CDK4/6 inhibitor palbociclib prolongs progression-free survival in hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer when combined with endocrine therapy. This phase II trial was designed to determine the feasibility of adjuvant palbociclib and endocrine therapy for early breast cancer. PATIENTS AND METHODS Eligible patients with HR+/HER2- stage II-III breast cancer received 2 years of palbociclib at 125 mg daily, 3 weeks on/1 week off, with endocrine therapy. The primary end point was discontinuation from palbociclib due to toxicity, non-adherence, or events related to tolerability. A discontinuation rate of 48% or higher would indicate the treatment duration of 2 years was not feasible, and was evaluated under a binomial test using a one-sided α = 0.025. RESULTS Overall, 162 patients initiated palbociclib; over half had stage III disease (52%) and most received prior chemotherapy (80%). A total of 102 patients (63%) completed 2 years of palbociclib; 50 patients discontinued early for protocol-related reasons (31%, 95% CI 24% to 39%, P = 0.001), and 10 discontinued due to protocol-unrelated reasons. The cumulative incidence of protocol-related discontinuation was 21% (95% CI 14% to 27%) at 12 months from start of treatment. Rates of palbociclib-related toxicity were congruent with the metastatic experience, and there were no cases of febrile neutropenia. Ninety-one patients (56%) required at least one dose reduction. CONCLUSION Adjuvant palbociclib is feasible in early breast cancer, with a high proportion of patients able to complete 2 years of therapy. The safety profile in the adjuvant setting mirrors that observed in metastatic disease, with approximately half of the patients requiring dose-modification. As extended duration adjuvant palbociclib appears feasible and tolerable for most patients, randomized phase III trials are evaluating clinical benefit in this population. CLINICALTRIALS.GOV REGISTRATION NCT02040857.
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Affiliation(s)
- E L Mayer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston.
| | - A DeMichele
- Division of Hematology and Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia
| | - H S Rugo
- Division of Hematology and Medical Oncology, University of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco
| | - K Miller
- Division of Hematology/Oncology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis
| | - A G Waks
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S E Come
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston
| | - T Mulvey
- Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston
| | - R Jeselsohn
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - B Overmoyer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - H Guo
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston
| | - W T Barry
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston
| | | | | | - E P Winer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - H J Burstein
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
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Mayer EL, DeMichele AM, Guo H, Miller KD, Rugo HS, Schneider B, Waks AG, Come SE, Mulvey T, Huang Bartlett C, Koehler M, Barry W, Winer EP, Burstein HJ. Abstract PD5-06: Adjuvant palbociclib plus endocrine therapy for hormone receptor positive/HER2 negative breast cancer: A phase II feasibility study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd5-06] [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 CDK4/6 inhibitor palbociclib (P) combined with endocrine therapy (ET) prolongs progression-free survival in previously untreated and treated hormone receptor positive/HER2 negative (HR+/HER2-) metastatic breast cancer (MBC). The most common toxicity with P is neutropenia, typically non-cumulative and uncomplicated. Given observed benefits of P in metastatic BC, this single arm phase II trial was designed to determine the feasibility and toxicity of combination adjuvant P and ET for HR+/HER2- early BC (EBC).
Methods:
Eligible patients (pts) had HR+/HER2- stage II (not T2N0)-III EBC, with prior completion of 3-24 mo of ET (either AI or tamoxifen) without significant adverse events (AE). Pts received P at 125 mg daily, 3 wk on/1 wk off in a 28d cycle, plus continuous ET, for planned duration 2 yrs. Pts were removed from study for toxicity, non-adherence, or other events related to tolerability; pts who recurred or completed 2 yrs of therapy were censored for the primary endpoint. The primary objective was to evaluate the treatment discontinuation rate at 2 yrs; a rate of >50%, would indicated a non-feasible treatment duration (null hypothesis). Discontinuation rates at 2 yrs are estimated by Kaplan Meier with 95% confidence bands. A sample size of 160 pts provided 92% power to reject the null hypothesis using a one-sided alpha = 0.025 if the true rate of discontinuation is <33.3%, and accounting for a censoring rate of up to 20% over the 2 yrs. Secondary endpoints include toxicity, adherence, QOL, and pharmacogenomics.
Results:
Between 3/2014 and 11/2015, 162 pts initiated P; the majority had stage III EBC (52%) and received prior chemotherapy (63%). As of 05/2017, 120 (74%) have completed at least 1 yr of P + ET, and 50 (31%) have completed 2 yrs of P + ET. Early discontinuation of protocol treatment was reported for 59 pts (36%), including 49 events (30%) related to protocol-mandated (9%) and non-mandated (21%) tolerability. The cumulative rate of all discontinuations was 15.1% at 6 mos, 20.9% at 12 mos and 27.8% at 18 mos. Half of all non-mandated discontinuations occurred within the first 6 mos of initiation of therapy, and the rate decreased with greater provider and pt education. Median duration of pts still on treatment is 20 mos (inter-quartile range: 18 to 21 mos). The rate of grade 3/4 neutropenia was 77%, with 0 cases of febrile neutropenia. Other common all-grade P-related AE > 20% included fatigue 65%, alopecia 25%, mucositis 24%, and anemia 24%. 32% of pts required one dose reduction, 16% required two. There have been 2 BC recurrence events and 1 chemotherapy-related AML. Updated data for the primary analysis of feasibility and tolerability, as well as pharmacogenomics, QOL, and adherence, will be presented.
Conclusions:
In this single arm phase II trial, the majority of pts have completed at least 1 year of adjuvant P + ET therapy, with no new toxicity signals. Non-protocol discontinuations have decreased with education. Updated results for the primary analysis will be presented. As in the MBC setting, extended duration palbociclib appears feasible and tolerable for most pts. The efficacy of 2 years of P and ET will be addressed by the phase III PALLAS trial (NCT NCT02513394).
Citation Format: Mayer EL, DeMichele AM, Guo H, Miller KD, Rugo HS, Schneider B, Waks AG, Come SE, Mulvey T, Huang Bartlett C, Koehler M, Barry W, Winer EP, Burstein HJ. Adjuvant palbociclib plus endocrine therapy for hormone receptor positive/HER2 negative breast cancer: A phase II feasibility study [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 PD5-06.
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Affiliation(s)
- EL Mayer
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - AM DeMichele
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - H Guo
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - KD Miller
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - HS Rugo
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - B Schneider
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - AG Waks
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - SE Come
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - T Mulvey
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - C Huang Bartlett
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - M Koehler
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - W Barry
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - HJ Burstein
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
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Schnipper LE, Davidson NE, Wollins DS, Blayney DW, Dicker AP, Ganz PA, Hoverman JR, Langdon R, Lyman GH, Meropol NJ, Mulvey T, Newcomer L, Peppercorn J, Polite B, Raghavan D, Rossi G, Saltz L, Schrag D, Smith TJ, Yu PP, Hudis CA, Vose JM, Schilsky RL. Updating the American Society of Clinical Oncology Value Framework: Revisions and Reflections in Response to Comments Received. J Clin Oncol 2016; 34:2925-34. [DOI: 10.1200/jco.2016.68.2518] [Citation(s) in RCA: 435] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Lowell E. Schnipper
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Nancy E. Davidson
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Dana S. Wollins
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Douglas W. Blayney
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Adam P. Dicker
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Patricia A. Ganz
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - J. Russell Hoverman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Robert Langdon
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Gary H. Lyman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Neal J. Meropol
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Therese Mulvey
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Lee Newcomer
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Jeffrey Peppercorn
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Blase Polite
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Derek Raghavan
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Gregory Rossi
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Leonard Saltz
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Deborah Schrag
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Thomas J. Smith
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Peter P. Yu
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Clifford A. Hudis
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Julie M. Vose
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
| | - Richard L. Schilsky
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Therese Mulvey and Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins and Richard L. Schilsky, American Society of Clinical
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Schnipper LE, Davidson NE, Wollins DS, Tyne C, Blayney DW, Blum D, Dicker AP, Ganz PA, Hoverman JR, Langdon R, Lyman GH, Meropol NJ, Mulvey T, Newcomer L, Peppercorn J, Polite B, Raghavan D, Rossi G, Saltz L, Schrag D, Smith TJ, Yu PP, Hudis CA, Schilsky RL, American Society of Clinical Oncology. American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options. J Clin Oncol 2015; 33:2563-77. [PMID: 26101248 PMCID: PMC5015427 DOI: 10.1200/jco.2015.61.6706] [Citation(s) in RCA: 687] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Lowell E Schnipper
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD.
| | - Nancy E Davidson
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Dana S Wollins
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Courtney Tyne
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Douglas W Blayney
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Diane Blum
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Adam P Dicker
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Patricia A Ganz
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - J Russell Hoverman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Robert Langdon
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Gary H Lyman
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Neal J Meropol
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Therese Mulvey
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Lee Newcomer
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Jeffrey Peppercorn
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Blase Polite
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Derek Raghavan
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Gregory Rossi
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Leonard Saltz
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Deborah Schrag
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Thomas J Smith
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Peter P Yu
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Clifford A Hudis
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Richard L Schilsky
- Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Harvard Medical School; Jeffrey Peppercorn, Massachusetts General Hospital; Deborah Schrag, Dana-Farber Cancer Institute, Boston; Therese Mulvey, Southcoast Centers for Cancer Care, Fall River, MA; Nancy E. Davidson, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center Cancer Center, Pittsburgh; Adam P. Dicker, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Dana S. Wollins, Courtney Tyne, and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria, VA; Douglas W. Blayney, Stanford University Medical Center, Stanford; Patricia A. Ganz, Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles; Peter P. Yu, Palo Alto Medical Foundation, Palo Alto, CA; Diane Blum, National Executive Service Corps; Leonard Saltz and Clifford A. Hudis, Memorial Sloan Kettering Cancer Center, New York, NY; J. Russell Hoverman, Texas Oncology, Dallas, TX; Robert Langdon, Nebraska Cancer Specialists, Omaha, NE; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Neal J. Meropol, University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH; Lee Newcomer, UnitedHealthcare, Minneapolis, MN; Blase Polite, University of Chicago Medicine, Chicago, IL; Derek Raghavan, Levine Cancer Institute, Charlotte, NC; Gregory Rossi, AstraZeneca, Macclesfield, Cheshire, United Kingdom; and Thomas J. Smith, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
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Smith GC, Zhang ZY, Mulvey T, Petersen N, Lach S, Xiu P, Phillips A, Han W, Wang MW, Shepherd PR. Clozapine directly increases insulin and glucagon secretion from islets: implications for impairment of glucose tolerance. Schizophr Res 2014; 157:128-33. [PMID: 24906220 DOI: 10.1016/j.schres.2014.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 04/04/2014] [Accepted: 05/03/2014] [Indexed: 01/31/2023]
Abstract
Second generation antipsychotics cause derangements in glucose metabolism that are often interpreted as insulin resistance. In previous studies we have shown that this is not classical insulin resistance but the drugs were actually inducing a hyperglycaemic state associated with elevated hepatic glucose output (HGO) and increased levels of glucagon and insulin. However, it remains unclear whether these effects are directly elicited by drug actions in the liver and pancreas, or whether they are indirectly mediated. Here we investigated if clozapine is capable of inducing insulin resistance in the liver or enhancing insulin and glucagon secretion from the pancreas. It was observed that insulin signalling was elevated in livers from animals treated with clozapine indicating there was no insulin resistance in the early steps of insulin signalling. To explore whether the defects arise at later stages of insulin action we used an isolated perfused liver system. In this model, clozapine had no direct effect on insulin's counter regulatory effect on epinephrine-induced HGO. In isolated mouse islets clozapine significantly increased glucose-stimulated insulin secretion while simultaneously blocking glucose-induced reductions in glucagon secretion. We also show that the non-peptidic glucagon receptor like peptide-1 (GLP-1) receptor agonist Boc5 was able to overcome the inhibitory effects of clozapine on glucose metabolism. Taken together these results suggest that clozapine does not have any direct effect on glucose metabolism in the liver but it simultaneously stimulates insulin and glucagon secretion, a situation that would allow for the concurrent presence of high glucose and high insulin levels in treated animals.
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Affiliation(s)
- G C Smith
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand; Department of Pharmacology, University of New South Wales, NSW, Australia
| | - Z Y Zhang
- The National Centre for Drug Screening and the CAS Key Laboratory of Receptor Research, Shanghai, Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - T Mulvey
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - N Petersen
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore; Hubrecht Institute for Development Biology and Stem Cell Research, Utrecht, The Netherlands
| | - S Lach
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - P Xiu
- Department of General Surgery, Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - A Phillips
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - W Han
- Singapore Bioimaging Consortium, Agency for Science, Technology and Research (A*STAR), Singapore
| | - M-W Wang
- The National Centre for Drug Screening and the CAS Key Laboratory of Receptor Research, Shanghai, Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China.
| | - P R Shepherd
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand; The Maurice Wilkins Centre, Auckland, New Zealand.
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Whiting L, Danaher RN, Ruggiero K, Lee CC, Chaussade C, Mulvey T, Phillips A, Loomes KM. D-chiro-inositol attenuates epinephrine-stimulated hepatic glucose output in the isolated perfused liver independently of insulin. Horm Metab Res 2013; 45:394-7. [PMID: 23225249 DOI: 10.1055/s-0032-1330016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
D-chiro-Inositol (DCI) is a cyclic sugar alcohol that evokes both antidiabetic and insulin sensitizing effects. Pharmacological administration of DCI has been shown to lower blood glucose in rat models of diabetes mellitus and enhance insulin sensitivity in humans with polycystic ovary syndrome (PCOS). We hypothesised that the antidiabetic effects of DCI could be due to inhibition of hepatic glucose output (HGO). To test this hypothesis, we perfused isolated rat livers either with buffer, myo-inositol, DCI, or insulin, and investigated their respective effects on the stimulation of HGO by epinephrine. We found that perfusion with 200 μM DCI attenuated epinephrine-stimulated HGO by 35% over 30 min as compared to the buffer control perfusion (p=0.05). By comparison, perfusion with 1 nM insulin attenuated epinephrine-stimulated HGO by 57% (p<0.0001). The glucose-lowering effects by DCI occurred independently of insulin and were specific to the DCI stereoisomer as 200 μM myo-inositol had no effect. These findings suggest that DCI could evoke its antidiabetic effects in vivo by inhibition of HGO. Further identification of the protein targets involved could open up new avenues to regulate hyperglycaemia with wider implications for the treatment of hepatic insulin resistance in PCOS.
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Affiliation(s)
- L Whiting
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
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Mulvey T. History of Electron Microscopy in Switzerland. Edited by John R. Guenter. J Microsc 2011. [DOI: 10.1111/j.1365-2818.1991.tb03176.x] [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: 11/28/2022]
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Mulvey T. [Not Available]. J Oncol Pract 2005; 1:82-3. [PMID: 20871688 DOI: 10.1200/jop.2005.1.3.82] [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: 11/20/2022] Open
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Abstract
The objectives of this study were to determine the local effects of transforming growth factor-beta1 (TGF-beta1) on mammary epithelial and stromal cell proliferation and expression of the TGF-beta1 responsive genes c-myc and fibronectin. A single slow-release plastic pellet containing 5 microg of TGF-beta1 and 20 mg of BSA was implanted in the parenchyma of the right rear quarter of the mammary gland of 9-mo-old prepubertal heifers. A control pellet containing 20 mg of BSA was implanted in the left rear quarter of each heifer. All heifers were treated with bromodeoxyuridine (BrdU) at 4, 12.5, and 22 h after the pellets were implanted to label proliferating cells. Two hours after the last BrdU injection, the animals were euthanatized, and their mammary glands were recovered. Proliferation of mammary stromal cells was significantly higher in TGF-beta1-treated quarters than in BSA-treated, control quarters (3.5 vs. 1.8% BrdU-positive cells). This result coincided with a lack of significant effect of TGF-beta1 on proliferation of mammary epithelial cells and apoptosis. By quantitative reverse transcriptase-polymerase chain reaction, we found that c-myc gene expression was unchanged after TGF-beta1 treatment, but fibronectin gene expression was increased 3-fold in TGF-beta1-treated quarters compared with BSA-treated, control quarters. Thus, we concluded that TGF-beta1 selectively acts on the stromal compartment of the bovine mammary gland by increasing cell proliferation and gene expression of the extracellular matrix protein fibronectin.
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Affiliation(s)
- S Musters
- Department of Animal Science, University of Vermont, Burlington 05405, USA
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Mulvey T. Conference on Electron Probe Microanalysis, Reading, September 1963: Recent advances in the instrumentation and technique of electron probe microanalysis. ACTA ACUST UNITED AC 2002. [DOI: 10.1088/0950-7671/41/2/401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
Depression is underdiagnosed and undertreated by nonpsychiatric practitioners. Research suggests improvement is needed in the recognition and treatment of depressive disorders by primary care physicians. This study was undertaken to better understand internists' ability to recognize depressive disorders, choice of appropriate medications, dosage, and treatment patterns. Questionnaires were distributed to 45 internal medicine attendings, 45 internal medicine housestaff, and 32 adult psychiatry residents. Each questionnaire contained four vignettes: major depressive disorder (MDD), MDD with melancholic features, MDD with atypical features, and MDD with psychotic features. Eleven questions per case covered diagnoses, management, and treatment. Data analysis with intragroup comparisons on 20 internal medicine attendings, 33 internal medicine housestaff, and 32 psychiatry residents suggested that many internal medicine attendings and housestaff had difficulty in recognizing major depression and its subtypes. Although the findings indicated that internists would initiate pharmacological treatment, they frequently made incorrect or questionable pharmacological choices. Psychiatric referral or consultation was often endorsed. Our findings among internists are consistent with previous research examining other primary care physicians suggesting that depression is underdiagnosed and undertreated.
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Affiliation(s)
- J V Penn
- Brown University Department of Psychiatry and Human Behavior, East Providence, R.I. 02915, USA
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Mulvey T. Anatomy and pathology of the shoulder complex. Orthop Nurs 1988; 7:23-8. [PMID: 3387126 DOI: 10.1097/00006416-198805000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Mulvey T. Points: Support for families bereaved by cot death. West J Med 1978. [DOI: 10.1136/bmj.2.6131.209-c] [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: 11/03/2022]
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Abstract
Scherzer's general expression of 1937 for the spiral distortion coefficient of electron lenses is used to calculate the spiral distortion of the rectangular-field model for the axial flux density distribution in magnetic projector lenses. The results show why it is difficult to correct the spiral distortion produced by conventional lenses. On the other hand, corresponding calculations for single-polepiece projector lenses indicate that the employment of such lenses could lead to a significant improvement of the projector stage of the electron microscope, especially that of the high voltage electron microscope.
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Mulvey T. Report on EMAG75, a conference on developments in electron microscopy and analysis organised by the Electron Microscopy and Analysis Group of the Institute of Physics at the University of Bristol, UK, on the 8th-11th September 1975. Ultramicroscopy 1976; 1:263-5. [PMID: 1028194 DOI: 10.1016/0304-3991(76)90040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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