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Laslett NF, Park S, Masters GA, Biggs DD, Schneider CJ, Misleh JG, Suppiah K, Simpson PS, Grubbs S, Wozniak TF, Guarino M. Phase II study of carboplatin, pemetrexed, and bevacizumab in advanced nonsquamous non-small-cell lung cancer. Cancer Med 2018; 7:2969-2973. [PMID: 29905018 PMCID: PMC6051222 DOI: 10.1002/cam4.1569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/07/2022] Open
Abstract
Lung cancer remains the leading cause of cancer death throughout the world. Despite new chemotherapeutic, immunomodulating and molecularly targeted agents, patients with locally advanced or metastatic disease still have a poor prognosis. This trial looked to combine antiangiogenic therapy with a first‐line cytotoxic chemotherapy doublet, hoping to extend median progression‐free survival (PFS) while minimizing toxicity in patients with advanced nonsquamous non–small‐cell lung cancer (NSCLC). In this single institution, single‐arm study, 51 patients (age >18 yo) were followed from 2007 to 2012. Patients with stage IV nonsquamous NSCLC and patients with recurrent unresectable disease (nonradiation candidates) were eligible. Treatment consisted of carboplatin AUC 5 IV 30‐60 minutes, pemetrexed 500/mg2IV 10 minutes, bevacizumab 15 mg/kg IV (90 minutes 1st dose, 60 minutes 2nd dose, 30 minutes subsequent doses). Treatment was administered every 21 days and planned for 6 cycles, in the absence of disease progression or unacceptable toxicities. Growth factor support was not permitted prophylactically but allowed for toxicities, as were dose reductions. Maintenance treatment for those with stable disease or better consisted of Bevacizumab 15 mg/kg every 3 weeks for up to 1 year. Between November 2007 and March 2012, 51 patients were followed in the phase II trial of carboplatin, pemetrexed, and bevacizumab. Patients were enrolled over a 24‐month period. After the end of treatment visits, subjects were followed at least every 3 months for survival data. The median follow‐up period was 49 weeks (6 weeks to 178), and the median number of treatment cycles was 6 (range, 1‐6). Among the 50 patients assessable for response, median overall survival was 49 weeks (95% CI, 0‐62.7) with median PFS of 28 weeks (95% CI, 0‐132.4). A complete or partial response was seen in 28 (59.5%) patients. Grade 3‐4 treatment‐related adverse events occurred in 9 (17.6%) of 51 patients; the most common were thrombocytopenia (4 [7.8%]) and neutropenia (3 [5.9%]). Three (5.8%) of 51 patients were discontinued because of treatment‐related adverse events (grade 3 diarrhea, thrombocytopenia, dehydration, fatigue, and grade 4 respiratory distress), and 1 patient (1.9%) was found to be ineligible due to anticoagulation use. A novel 3‐drug combination for advanced nonsquamous NSCLC shows promising efficacy with modest toxicity.
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Affiliation(s)
- Nicole F Laslett
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - SuJung Park
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Gregory A Masters
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - David D Biggs
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Charles J Schneider
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Jamal G Misleh
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Kathir Suppiah
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Pamela S Simpson
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Stephen Grubbs
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Timothy F Wozniak
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Michael Guarino
- Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Newark, DE, USA
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Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky AM, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016; 387:849-56. [PMID: 26686957 PMCID: PMC4792688 DOI: 10.1016/s0140-6736(15)01168-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ductal carcinoma in situ is currently managed with excision, radiotherapy, and adjuvant hormone therapy, usually tamoxifen. We postulated that an aromatase inhibitor would be safer and more effective. We therefore undertook this trial to compare anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy. METHODS The double-blind, randomised, phase 3 National Surgical Adjuvant Breast and Bowel Project (NSABP) B-35 trial was done in 333 participating NSABP centres in the USA and Canada. Postmenopausal women with hormone-positive ductal carcinoma in situ treated by lumpectomy with clear resection margins and whole-breast irradiation were enrolled and randomly assigned (1:1) to receive either oral tamoxifen 20 mg per day (with matching placebo in place of anastrozole) or oral anastrozole 1 mg per day (with matching placebo in place of tamoxifen) for 5 years. Randomisation was stratified by age (<60 vs ≥60 years) and patients and investigators were masked to treatment allocation. The primary outcome was breast cancer-free interval, defined as time from randomisation to any breast cancer event (local, regional, or distant recurrence, or contralateral breast cancer, invasive disease, or ductal carcinoma in situ), analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00053898, and is complete. FINDINGS Between Jan 1, 2003, and June 15, 2006, 3104 eligible patients were enrolled and randomly assigned to the two treatment groups (1552 to tamoxifen and 1552 to anastrozole). As of Feb 28, 2015, follow-up information was available for 3083 patients for overall survival and 3077 for all other disease-free endpoints, with median follow-up of 9·0 years (IQR 8·2-10·0). In total, 212 breast cancer-free interval events occurred: 122 in the tamoxifen group and 90 in the anastrozole group (HR 0·73 [95% CI 0·56-0·96], p=0·0234). A significant time-by-treatment interaction (p=0·0410) became evident later in the study. There was also a significant interaction between treatment and age group (p=0·0379), showing that anastrozole is superior only in women younger than 60 years of age. Adverse events did not differ between the groups, except for thrombosis or embolism--a known side-effect of tamoxifen-for which there were 17 grade 4 or worse events in the tamoxifen group versus four in the anastrozole group. INTERPRETATION Compared with tamoxifen, anastrozole treatment provided a significant improvement in breast cancer-free interval, mainly in women younger than 60 years of age. This finding means that women will benefit from having a choice of effective agents for ductal carcinoma in situ. FUNDING US National Cancer Institute and AstraZeneca Pharmaceuticals LP.
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MESH Headings
- Administration, Oral
- Age Factors
- Anastrozole
- Antineoplastic Agents, Hormonal/administration & dosage
- Antineoplastic Agents, Hormonal/adverse effects
- Antineoplastic Agents, Hormonal/therapeutic use
- Aromatase Inhibitors/administration & dosage
- Aromatase Inhibitors/adverse effects
- Aromatase Inhibitors/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Double-Blind Method
- Embolism/chemically induced
- Female
- Humans
- Mastectomy, Segmental
- Middle Aged
- Nitriles/administration & dosage
- Nitriles/adverse effects
- Nitriles/therapeutic use
- Postmenopause
- Tamoxifen/administration & dosage
- Tamoxifen/adverse effects
- Tamoxifen/therapeutic use
- Thrombosis/chemically induced
- Triazoles/administration & dosage
- Triazoles/adverse effects
- Triazoles/therapeutic use
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Affiliation(s)
- Richard G Margolese
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Jewish General Hospital, McGill University, Montreal, QC, Canada.
| | - Reena S Cecchini
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas B Julian
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
| | - Patricia A Ganz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; University of California, Los Angeles, CA, USA
| | - Joseph P Costantino
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura A Vallow
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Kathy S Albain
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; SWOG, San Antonio, TX, USA; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - Patrick W Whitworth
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; ALLIANCE/ACOSOG, Chicago, IL, USA; Nashville Breast Center, Nashville, TN, USA
| | - Mary E Cianfrocca
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; SWOG, San Antonio, TX, USA; ECOG/ACRIN, Philadelphia, PA, USA; Department of Hematology/Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Adam M Brufsky
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Hematology/Oncology, Magee Womens Hospital/University of Pittsburgh Department of Hematology/Oncology, Pittsburgh, PA, USA
| | - Howard M Gross
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Dayton Physicians LLC, Dayton, OH, USA
| | - Gamini S Soori
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Missouri Valley Cancer Consortium, Omaha, NE, USA
| | - Judith O Hopkins
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; SCOR NCORP, Winston Salem, NC, USA; Department of Hematology/Oncology, Forsyth Regional Cancer Center, Winston Salem, NC, USA
| | - Louis Fehrenbacher
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Medical Oncology, Kaiser Permanente Northern California Vallejo, CA, USA
| | - Keren Sturtz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Medical Oncology Colorado Cancer Research Program, Denver, CO, USA
| | - Timothy F Wozniak
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; CCOP, Christiana Care Health Systems, Newark, DE, USA
| | - Thomas E Seay
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Atlanta Regional Community Clinical Oncology Program, Atlanta, GA, USA
| | - Eleftherios P Mamounas
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; UF Health Cancer Center at Orlando Health, Orlando, FL, USA
| | - Norman Wolmark
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project (NSABP), Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
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Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky AM, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016; 387:857-65. [PMID: 26686960 PMCID: PMC4792658 DOI: 10.1016/s0140-6736(15)01169-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The NSABP B-35 trial compared 5 years of treatment with anastrozole versus tamoxifen for reducing subsequent occurrence of breast cancer in postmenopausal patients with ductal carcinoma in situ. This report assesses the effect of these drugs on quality of life and symptoms. METHODS The study was done at 333 hospitals in North America. Postmenopausal women with hormone-positive ductal carcinoma in situ treated by lumpectomy with clear resection margins and whole breast irradiation were randomly assigned to receive either tamoxifen (20 mg/day) or anastrazole (1 mg/day) for 5 years, stratified by age (<60 years vs ≥60 years). Patients and investigators were masked to treatment allocation. Patients completed questionnaires at baseline and every 6 months thereafter for 6 years. The primary outcomes were SF-12 physical and mental health component scale scores, and vasomotor symptoms (as per the BCPT symptom scale). Secondary outcomes were vaginal symptoms and sexual functioning. Exploratory outcomes were musculoskeletal pain, bladder symptoms, gynaecological symptoms, cognitive symptoms, weight problems, vitality, and depression. We did the analyses by intention to treat, including patients who completed questionnaires at baseline and at least once during follow-up. This study is registered with ClinicalTrials.gov, NCT00053898. FINDINGS Between Jan 6, 2003, and June 15, 2006, 3104 patients were enrolled in the study, of whom 1193 were included in the quality-of-life substudy: 601 assigned to tamoxifen and 592 assigned to anastrozole. We detected no significant difference between treatment groups for: physical health scores (mean severity score 46·72 for tamoxifen vs 45·85 for anastrozole; p=0·20), mental health scores (52·38 vs 51·48; p=0·38), energy and fatigue (58·34 vs 57·54; p=0·86), or symptoms of depression (6·19 vs 6·39; p=0·46) over 5 years. Vasomotor symptoms (1·33 vs 1·17; p=0·011), difficulty with bladder control (0·96 vs 0·80; p=0·0002), and gynaecological symptoms (0·29 vs 0·18; p<0·0001) were significantly more severe in the tamoxifen group than in the anastrozole group. Musculoskeletal pain (1·50 vs 1·72; p=0·0006) and vaginal symptoms (0·76 vs 0·86; p=0·035) were significantly worse in the anastrozole group than in the tamoxifen group. Sexual functioning did not differ significantly between the two treatments (43·65 vs 45·29; p=0·56). Younger age was significantly associated with more severe vasomotor symptoms (mean severity score 1·45 for age <60 years vs 0·65 for age ≥60 years; p=0·0006), vaginal symptoms (0·98 vs 0·65; p<0·0001), weight problems (1·32 vs 1·02; p<0·0001), and gynaecological symptoms (0·26 vs 0·22; p=0·014). INTERPRETATION Given the similar efficacy of tamoxifen and anastrozole for women older than age 60 years, decisions about treatment should be informed by the risk for serious adverse health effects and the symptoms associated with each drug. For women younger than 60 years old, treatment decisions might be driven by efficacy (favouring anastrozole); however, if the side-effects of anastrozole are intolerable, then switching to tamoxifen is a good alternative. FUNDING US National Cancer Institute, AstraZeneca Pharmaceuticals.
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Affiliation(s)
- Patricia A Ganz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; University of California, Los Angeles, CA, USA.
| | - Reena S Cecchini
- NRG Oncology, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas B Julian
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
| | - Richard G Margolese
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; The Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Joseph P Costantino
- NRG Oncology, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Laura A Vallow
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Kathy S Albain
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Southwest Oncology Group, San Antonio, TX, USA; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Chicago, IL, USA
| | - Patrick W Whitworth
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Alliance for Clinical Trials in Oncology/American College of Surgeons Oncology Group, Chicago, IL, USA; Nashville Breast Center, Nashville, TN, USA
| | - Mary E Cianfrocca
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Southwest Oncology Group, San Antonio, TX, USA; Eastern Cooperative Oncology Group/American College of Radiology Imaging Network, Philadelphia, PA, USA; Department of Hematology/Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Adam M Brufsky
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Hematology/Oncology, Magee Womens Hospital/University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard M Gross
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Dayton Physicians, Dayton, OH, USA
| | - Gamini S Soori
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Missouri Valley Cancer Consortium, Omaha, NE, USA
| | - Judith O Hopkins
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Southeast Clinical Oncology Research Consortium National Cancer Institute Community Oncology Research Program, Winston Salem, NC, USA; Department of Hematology/Oncology, Forsyth Regional Cancer Center, Winston Salem, NC, USA
| | - Louis Fehrenbacher
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Medical Oncology, Kaiser Permanente, Northern California Vallejo, CA, USA
| | - Keren Sturtz
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Medical Oncology Colorado Cancer Research Program, Denver, CO, USA
| | - Timothy F Wozniak
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Community Clinical Oncology Program, Christiana Care Health Systems, Wilmington, DE, USA
| | - Thomas E Seay
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Atlanta Regional Community Clinical Oncology Program, Atlanta, GA, USA
| | - Eleftherios P Mamounas
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; UF Health Cancer Center at Orlando Health, Orlando, FL, USA
| | - Norman Wolmark
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA, USA; Department of Surgical Oncology, Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA, USA
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Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Abstract S6-04: Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The clinical results of NSABP B-35, phase III trial comparing 1 mg/day A to 20 mg/day tam, each given for 5 years, were reported at ASCO 2015. B-35 demonstrated a statistically significant benefit in breast cancer free interval for women assigned to A, primarily in women <60 years. A secondary endpoint of B-35 was quality of life (QOL) and symptom (SX) outcomes in the two treatment groups. The primary hypotheses of the PRO study were that there would be no differences in QOL between the two treatments, and that patients receiving A would report higher rates of hot flashes compared to patients receiving tam. Other SX comparisons were secondary endpoints.
Methods
QOL and SX were assessed at baseline (prior to randomization), and every 6 months thereafter for 5 years of treatment and in the following 12 months. QOL was measured with the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS). SX were measured with selected scales from the BCPT symptom-checklist, and other standardized instruments. Stratification was by age (<60 v ≥60) as in the main trial. Study hypotheses and endpoints were examined by comparing PROs in the two treatment arms using a mixed model for repeated measures analysis with adjustment for the baseline scores, time point and age category, using an intention-to-treat principle and including only patients who completed the baseline and at least one follow-up questionnaire. Patients with protocol events were censored. Only data through 60 months are reported here. The accrual goal for the sub-study was 1,150 consecutive patients.
Results
Between January 6, 2003 and June 15, 2006, a total of 3,104 patients were entered and randomly assigned to NSABP Protocol B-35. Accrual to the PRO study of B-35 closed on December 28, 2004, at which time 1,275 patients were entered, with 1,193 patients included in this analysis. There were no medical or demographic differences between patients assigned to A or tam in the PRO sub-study, and they reflected the characteristics of the parent trial. Adherence to data collection across the 60 months was 87%. There were no significant differences in QOL outcomes by treatment for the PCS (p=0.16) or the MCS (p=0.38). SX subscales: hot flash scale was greater in tam group and this difference varied over time (p=0.001); musculoskeletal pain was significantly greater in A group for time points 6-24 months (all p<.001); vaginal problems were greater in A group (p=0.03). Hot flash and vaginal problems were significantly worse in women <60 years. Additional SX outcomes (depression, fatigue, sexual function) will be reported at presentation.
Conclusion
In this large, double-blind, placebo-controlled trial comparing A to tam in patients with DCIS, there was no significant difference in QOL between the two treatments. However, there were important treatment differences in SX outcomes, which should be considered as part of treatment decision-making discussions, along with the clinical breast cancer outcome results.
Support: CA-180868, 180822, 189867, 196067, 114732; AstraZeneca Pharmaceuticals LP.
Citation Format: Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S6-04.
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Affiliation(s)
- PA Ganz
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - RS Cecchini
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TB Julian
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - RG Margolese
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - JP Costantino
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - LA Vallow
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - KS Albain
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - PW Whitworth
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - ME Cianfrocca
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - A Brufsky
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - HM Gross
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - GS Soori
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - JO Hopkins
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - L Fehrenbacher
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - K Sturtz
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TF Wozniak
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TE Seay
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - EP Mamounas
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - N Wolmark
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
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Allegra CJ, Yothers G, O'Connell MJ, Beart RW, Wozniak TF, Pitot HC, Shields AF, Landry JC, Ryan DP, Arora A, Evans LS, Bahary N, Soori G, Eakle JF, Robertson JM, Moore DF, Mullane MR, Marchello BT, Ward PJ, Sharif S, Roh MS, Wolmark N. Neoadjuvant 5-FU or Capecitabine Plus Radiation With or Without Oxaliplatin in Rectal Cancer Patients: A Phase III Randomized Clinical Trial. J Natl Cancer Inst 2015; 107:djv248. [PMID: 26374429 DOI: 10.1093/jnci/djv248] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 08/05/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND National Surgical Adjuvant Breast and Bowel Project R-04 was designed to determine whether the oral fluoropyrimidine capecitabine could be substituted for continuous infusion 5-FU in the curative setting of stage II/III rectal cancer during neoadjuvant radiation therapy and whether the addition of oxaliplatin could further enhance the activity of fluoropyrimidine-sensitized radiation. METHODS Patients with clinical stage II or III rectal cancer undergoing preoperative radiation were randomly assigned to one of four chemotherapy regimens in a 2x2 design: CVI 5-FU or oral capecitabine with or without oxaliplatin. The primary endpoint was local-regional tumor control. Time-to-event endpoint distributions were estimated using the Kaplan-Meier method. Hazard ratios were estimated from Cox proportional hazard models. All statistical tests were two-sided. RESULTS Among 1608 randomized patients there were no statistically significant differences between regimens using 5-FU vs capecitabine in three-year local-regional tumor event rates (11.2% vs 11.8%), 5-year DFS (66.4% vs 67.7%), or 5-year OS (79.9% vs 80.8%); or for oxaliplatin vs no oxaliplatin for the three endpoints of local-regional events, DFS, and OS (11.2% vs 12.1%, 69.2% vs 64.2%, and 81.3% vs 79.0%). The addition of oxaliplatin was associated with statistically significantly more overall and grade 3-4 diarrhea (P < .0001). Three-year rates of local-regional recurrence among patients who underwent R0 resection ranged from 3.1 to 5.1% depending on the study arm. CONCLUSIONS Continuous infusion 5-FU produced outcomes for local-regional control, DFS, and OS similar to those obtained with oral capecitabine combined with radiation. This study establishes capecitabine as a standard of care in the pre-operative rectal setting. Oxaliplatin did not improve the local-regional failure rate, DFS, or OS for any patient risk group but did add considerable toxicity.
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Affiliation(s)
- Carmen J Allegra
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW).
| | - Greg Yothers
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Michael J O'Connell
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Robert W Beart
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Timothy F Wozniak
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Henry C Pitot
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Anthony F Shields
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Jerome C Landry
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - David P Ryan
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Amit Arora
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Lisa S Evans
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Nathan Bahary
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Gamini Soori
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Janice F Eakle
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - John M Robertson
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Dennis F Moore
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Michael R Mullane
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Benjamin T Marchello
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Patrick J Ward
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Saima Sharif
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Mark S Roh
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
| | - Norman Wolmark
- NRG Oncology/National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA (CJA, GY, MJO, RWB, TFW, HCP, AFS, JCL, DPR, AA, LSE, NB, GS, JFE, JMR, DFMJr, MRM, BTM, PJW, SS, MSR, NW); Department of Medicine, University of Florida Health, Gainesville, FL (CJA); NRG Oncology and the University of Pittsburgh Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA (GY); Glendale Memorial Hospital, Glendale, CA (RWB); CCOP Christiana Care Health Systems, Newark, DE (TFW); Mayo Clinic, Rochester, MN and the ALLIANCE, Boston, MA (HCP); Wayne State University, Karmanos Cancer Institute, Detroit, MI and SWOG, San Antonio, TX (AFS); Emory University, Department of Radiation Oncology, Atlanta, GA and ECOG/ACRIN, Rochester, MN (JCL); Massachusetts General Hospital Cancer Center and the ALLIANCE, Boston, MA (DPR); Kaiser Permanente, Fremont, CA (AA); Novant Health Forsyth Medical Center, Winston-Salem, NC (LSE); University of Pittsburgh, Pittsburgh, PA (NB); Missouri Valley Cancer Consortium CCOP, Omaha, NE (GS); Florida Cancer Specialists, Fort Myers, FL (JFE); Beaumont Hospital System, Royal Oak, MI (JMR); Cancer Center of Kansas, Wichita, KS (DFMJr); Stroger Hospital Chicago MU-NCORP, Chicago, IL (MRM); Montana Cancer Consortium, Billings, MT (BTM); Oncology and Hematology Care, Cincinnati, OH (PJW); UF Health Cancer Center, Orlando FL (MSR); Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA (NW)
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Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow L, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Primary results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) versus tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.18_suppl.lba500] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA500 Background: The primary endpoint of NSABP B-35, a phase III trial comparing 1 mg/day anastrozole to 20 mg/day tamoxifen, each given for 5 years, was breast cancer-free interval (BCFI), defined as the time from randomization to any breast cancer (BC) event including local, regional, or distant recurrence or contralateral disease, invasive or DCIS. Methods: Postmenopausal women with ER-receptor or PgR-receptor positive (by IHC analysis) DCIS and no invasive BC who had undergone a lumpectomy with clear resection margins were randomly assigned to receive either 20 mg/day tam or 1 mg/day A (blinded) for 5 years. Stratification was by age (<60 v ≥60). Results: From 1/6/2003 to 6/15/2006, 3,104 pts were entered and randomized (1552 in groups tam and A each). As of 2/28/15, follow-up information was available on 3,083 pts for OS and on 3,077 pts for all other disease-free endpoints, with mean time of follow-up of 8.6 years. There were 198 BCFI events, 114 in the tam group and 84 in the A group (HR, 0.73; p=0.03). 10-year point estimates for BCFI were 89.2% for tam and 93.5% for A. A significant time-by-treatment interaction (p=0.02) indicated that the effect was not evident until later in the study. There was a significant interaction between treatment and age group (p=0.04); benefit of A is only in women <60 years old. As to secondary endpoints, there were 495 DFS events, 260 in the tam group and 235 in the A group (HR, 0.89; p=0.21). 10-year point estimates for DFS were 77.9% for tam and 82.7% for A. There were 186 deaths, 88 in the tam group and 98 in the A group (HR, 1.11; p=0.48). 10-year point estimates for OS were 92.1% for tam, 92.5% for A. There were 8 deaths due to breast cancer in the tam group and 5 in the A group. There were 63 cases of invasive breast cancer in the tam group and 39 in the A group (HR, 0.61; p=0.02). There was a non-significant trend for a reduction in breast second primary cancers with A (HR, 0.68; p=0.07). Conclusions: Anastrozole provided a significant improvement compared to tamoxifen for BCFI, which was seen later in the study, primarily in women <60 years. Support: CA12027, 37377, 69651, 69974; 180868, 180822, 189867 196067, 114732; AstraZeneca Pharmaceuticals LP. Clinical trial information: NCT00053898.
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Affiliation(s)
- Richard G. Margolese
- NRG Oncology/NSABP, and The Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | - Thomas B. Julian
- NRG Oncology/NSABP, and The Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA
| | - Patricia A. Ganz
- NRG Oncology/NSABP, and the University of California, Los Angeles, Los Angeles, CA
| | | | - Laura Vallow
- NRG Oncology/NSABP, ALLIANCE/NCCRT, and Mayo Clinic, Jacksonville, FL, Jacksonville, FL
| | - Kathy S. Albain
- NRG Oncology/NSABP, SWOG, and Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Pat W. Whitworth
- NRG Oncology/NSABP, ALLIANCE/ACOSOG, and Nashville Breast Center, Nashville, TN
| | | | - Adam Brufsky
- NRG Oncology/NSABP, and Magee Women's Hospital, Pittsburgh, PA
| | - Howard M. Gross
- NRG Oncology/NSABP, and Hem and Onc Div of Dayton Physicians LLC, Dayton, OH
| | - Gamini S. Soori
- NRG Oncology/NSABP, and Nebraska Cancer Specialists, Omaha, NE
| | - Judith O. Hopkins
- NRG Oncology/NSABP, and SCOR NCORP and the Forsyth Regional Cancer Center, Winston Salem, NC
| | - Louis Fehrenbacher
- NRG Oncology/NSABP, and Kaiser Permanente Northern California, Novato, CA
| | | | - Timothy F. Wozniak
- NRG Oncology/NSABP, and CCOP, Christiana Care Health Systems, Newark, DE
| | - Thomas E. Seay
- NRG Oncology/NSABP, and the Atlanta Regional Community Clinical Oncology Program, Atlanta, GA
| | | | - Norman Wolmark
- NRG Oncology/NSABP, and the Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA
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7
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Margolese RG, Cecchini RS, Julian TB, Ganz PA, Costantino JP, Vallow L, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Primary results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) versus tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.lba500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Richard G. Margolese
- NRG Oncology/NSABP, and The Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | - Thomas B. Julian
- NRG Oncology/NSABP, and The Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA
| | - Patricia A. Ganz
- NRG Oncology/NSABP, and the University of California, Los Angeles, Los Angeles, CA
| | | | - Laura Vallow
- NRG Oncology/NSABP, ALLIANCE/NCCRT, and Mayo Clinic, Jacksonville, FL, Jacksonville, FL
| | - Kathy S. Albain
- NRG Oncology/NSABP, SWOG, and Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Pat W. Whitworth
- NRG Oncology/NSABP, ALLIANCE/ACOSOG, and Nashville Breast Center, Nashville, TN
| | | | - Adam Brufsky
- NRG Oncology/NSABP, and Magee Women's Hospital, Pittsburgh, PA
| | - Howard M. Gross
- NRG Oncology/NSABP, and Hem and Onc Div of Dayton Physicians LLC, Dayton, OH
| | - Gamini S. Soori
- NRG Oncology/NSABP, and Nebraska Cancer Specialists, Omaha, NE
| | - Judith O. Hopkins
- NRG Oncology/NSABP, and SCOR NCORP and the Forsyth Regional Cancer Center, Winston Salem, NC
| | - Louis Fehrenbacher
- NRG Oncology/NSABP, and Kaiser Permanente Northern California, Novato, CA
| | | | - Timothy F. Wozniak
- NRG Oncology/NSABP, and CCOP, Christiana Care Health Systems, Newark, DE
| | - Thomas E. Seay
- NRG Oncology/NSABP, and the Atlanta Regional Community Clinical Oncology Program, Atlanta, GA
| | | | - Norman Wolmark
- NRG Oncology/NSABP, and the Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA
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O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, Pitot HC, Shields AF, Landry JC, Ryan DP, Parda DS, Mohiuddin M, Arora A, Evans LS, Bahary N, Soori GS, Eakle J, Robertson JM, Moore DF, Mullane MR, Marchello BT, Ward PJ, Wozniak TF, Roh MS, Yothers G, Wolmark N. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from National Surgical Adjuvant Breast and Bowel Project trial R-04. J Clin Oncol 2014; 32:1927-34. [PMID: 24799484 DOI: 10.1200/jco.2013.53.7753] [Citation(s) in RCA: 300] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The optimal chemotherapy regimen administered concurrently with preoperative radiation therapy (RT) for patients with rectal cancer is unknown. National Surgical Adjuvant Breast and Bowel Project trial R-04 compared four chemotherapy regimens administered concomitantly with RT. PATIENTS AND METHODS Patients with clinical stage II or III rectal cancer who were undergoing preoperative RT (45 Gy in 25 fractions over 5 weeks plus a boost of 5.4 Gy to 10.8 Gy in three to six daily fractions) were randomly assigned to one of the following chemotherapy regimens: continuous intravenous infusional fluorouracil (CVI FU; 225 mg/m(2), 5 days per week), with or without intravenous oxaliplatin (50 mg/m(2) once per week for 5 weeks) or oral capecitabine (825 mg/m(2) twice per day, 5 days per week), with or without oxaliplatin (50 mg/m(2) once per week for 5 weeks). Before random assignment, the surgeon indicated whether the patient was eligible for sphincter-sparing surgery based on clinical staging. The surgical end points were complete pathologic response (pCR), sphincter-sparing surgery, and surgical downstaging (conversion to sphincter-sparing surgery). RESULTS From September 2004 to August 2010, 1,608 patients were randomly assigned. No significant differences in the rates of pCR, sphincter-sparing surgery, or surgical downstaging were identified between the CVI FU and capecitabine regimens or between the two regimens with or without oxaliplatin. Patients treated with oxaliplatin experienced significantly more grade 3 or 4 diarrhea (P < .001). CONCLUSION Administering capecitabine with preoperative RT achieved similar rates of pCR, sphincter-sparing surgery, and surgical downstaging compared with CVI FU. Adding oxaliplatin did not improve surgical outcomes but added significant toxicity. The definitive analysis of local tumor control, disease-free survival, and overall survival will be performed when the protocol-specified number of events has occurred.
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Affiliation(s)
- Michael J O'Connell
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Linda H Colangelo
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Robert W Beart
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Nicholas J Petrelli
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Carmen J Allegra
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Saima Sharif
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Henry C Pitot
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Anthony F Shields
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Jerome C Landry
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - David P Ryan
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - David S Parda
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Mohammed Mohiuddin
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Amit Arora
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Lisa S Evans
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Nathan Bahary
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Gamini S Soori
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Janice Eakle
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - John M Robertson
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Dennis F Moore
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Michael R Mullane
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Benjamin T Marchello
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Patrick J Ward
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Timothy F Wozniak
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Mark S Roh
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Greg Yothers
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
| | - Norman Wolmark
- Michael J. O'Connell, Linda H. Colangelo, Robert W. Beart, Nicholas J. Petrelli, Carmen J. Allegra, Saima Sharif, Henry C. Pitot, Anthony F. Shields, David S. Parda, Mohammed Mohiuddin, Amit Arora, Lisa S. Evans, Nathan Bahary, Gamini S. Soori, Janice Eakle, John M. Robertson, Dennis F. Moore Jr, Michael R. Mullane, Benjamin T. Marchello, Patrick J. Ward, Timothy F. Wozniak, Mark S. Roh, Greg Yothers, Norman Wolmark, National Surgical Adjuvant Breast and Bowel Project Operations and Biostatistical Centers; David S. Parda, Norman Wolmark, Allegheny Cancer Center at Allegheny General Hospital; Nathan Bahary, University of Pittsburgh Medical Center and University of Pittsburgh Cancer Institute, Pittsburgh, PA; Robert W. Beart, Colorectal Surgery Institute, Glendale Memorial Hospital, Glendale; Amit Arora, Kaiser Permanente Hayward, Hayward, CA; Nicholas J. Petrelli, Timothy F. Wozniak, Helen F. Graham Cancer Center at Christiana Care Health Service, Newark, DE; Carmen J. Allegra, University of Florida, Gainesville; Janice Eakle, Florida Cancer Specialists, Sarasota; Mark S. Roh, MD Anderson Cancer Center Orlando Health, Orlando, FL; Henry C. Pitot, Mayo Clinic, Rochester, MN; Anthony F. Shields, Karmanos Cancer Institute/Southwest Oncology Group, Detroit; John M. Robertson, Beaumont Hospital System, Royal Oak, MI; Jerome C. Landry, Eastern Cooperative Oncology Group/Emory University, Winship Cancer Institute, Atlanta, GA; David P. Ryan, Massachusetts General Hospital Cancer Center, Boston, MA; Lisa S. Evans, Community Clinical Oncology Program, Southeast CCC Novant Health Derrick L. Davis Forsyth Medical Center, Winston-Salem, NC; Gamini S. Soori, Missouri Valley Cancer Consortium Community Clinical Oncology Program, Omaha, NE; Dennis Moore Jr, Community Clinical Oncology Program, Wichita/St Francis Regional Medical Center/Via Christi Regional Medical Center, Wichita, KS; Michael R. Mullane, Minority-Based Community Clinical Oncology Program John H. Stroger Jr Hospital
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Ganz PA, Lopa SH, Yothers G, Ko CY, Arora A, Atkins JN, Bahary N, Soori GS, Robertson JM, Eakle JF, Marchello BT, Wozniak TF, Wolmark N. Comparative effectiveness of sphincter-sparing surgery (SSS) versus abdomino-perineal resection (APR) in rectal cancer: Patient-reported outcomes (PROs) from NSABP R-04. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3545 Background: R-04 is a trial of pre-surgical RT and either capecitabine or 5-FU with or without oxaliplatin in patients (Pts) with resectable rectal cancer. PROs were measured before treatment, post-RT, and 1 yr post-op. We compare PROs at 1 yr by type of surgery with hypothesis that APR Pts would have worse quality of life (QOL). Methods: Pts completed the FACT-C and EORTC-CR38 at all times. Baseline and 1 yr were compared within groups (SSS and APR) with paired t-test, and between groups at 1 yr, with adjustment for covariates of age, gender, clinical stage, baseline score, and surgery intent in a general linear model. These secondary/exploratory hypotheses were significant if p < 0.05. Results: 1,608Pts were randomized and 1405 completed baseline QOL form after consent, prior to treatment. 1,003 completed QOL form 1 yr post-op: 6 were ineligible, 10 did not have surgery, leaving 987 Pts. 615 had SSS and 372 had APR. 66.6% were male, 61.5% stage II, and almost all had post-surgical adjuvant chemotherapy. SSS Pts were significantly younger (60.3% vs. 53.5% < 59 yr, p=0.04). FACT-C total and subscale scores were not significantly different by surgery type at 1 yr, with only minimal decline from baseline in both groups. For SSS Pts, EORTC-CR38 scores significantly worsened for body image, sexual function, sexual enjoyment (all p <0.0001), while future perspective improved (p<0.0001) at 1 yr from baseline. All symptom subscales except weight loss and micturition showed worsened symptoms (GI tract, chemo side effects, defecation problems, sexual problems) all p < 0.0001 at 1 yr from baseline. Compared to APR Pts, SSS had less severe functional problems and symptoms, especially in sexual enjoyment, weight loss, GI symptoms, and body image, all significant. Conclusions: Contrary to prediction, there were no significant differences in FACT-C scores for SSS vs. APR. Symptoms and functional problems were detected by the EORTC-CR38, reflecting expected differences. The largest differences between the surgical treatments were for GI symptoms and body image. Information from these PROs may be useful in counseling Pts anticipating surgery for rectal cancer.
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Affiliation(s)
- Patricia A. Ganz
- University of California, Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Samia H. Lopa
- NSABP and the NSABP Biostatistical Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Greg Yothers
- NSABP Biostatistical Center and University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Clifford Y. Ko
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Amit Arora
- Kaiser Permanente Medical Center, Hayward, CA
| | - James Norman Atkins
- National Surgical Adjuvant Breast and Bowel Project and SCCC-CCOP, Goldboro, NC
| | - Nathan Bahary
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | | | | | - Norman Wolmark
- National Surgical Adjuvant Breast and Bowel Project and Allegheny Cancer Center at Allegheny General Hospital, Pittsburgh, PA
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Guarino MJ, Masters GA, Biggs D, Schneider C, Misleh JG, Simpson PS, Suppiah K, Wozniak TF, Grubbs SS. Phase II trial of carboplatin, pemetrexed, and bevacizumab in metastatic nonsquamous (NSC) lung cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18122 Background: The trial was designed to examine PFS, OS and toxicities of a novel 3 drug combination in advanced NSC lung cancer. The first patient was entered 3/08 and the last in 5/11. Methods: Treatment consisted of Carboplatin AUC 5,Pemetrexed %00mg/m2, Bevacizumab 15mg/kg q21d x 6 cycles; then Bev maintenaince q3wk for up to one year. Eligibile pts. had metastatic non-squamous NSC lung ca, EGOG 0-1, first line Rx. Fifty patients were entered, all available for response and toxicity analysis: 26 M, median age 64, 45 white. Results: 52% RR by RECIST (2% CR, 50% PR); 26% SD. Median PFS 24 wks; median overall survival will be in excess of 49 weeks. 62% of patients received all planned 6 cycles and went on to maintenance. Treatment was out-patient and well tolerated with modest toxicities, including 2 DVT's, one PE, one TIA and one episode of F+N Conclusions: The 3 drug combination of Carboplatin, Pemetrxed and Bevacizumab for met NSC lung cancer is effective and well tolerated; and is a resonable choice of Rx for patients with non-squamous tumors hoping to avoid more neurotoxic or myelotoxic options.
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Affiliation(s)
| | | | - David Biggs
- Helen F. Graham Cancer Center, Christiana Care, Newark, DE
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Fleishman SB, Khan H, Homel P, Suhail MF, Strebel-Amrhein R, Mohammad F, Mahajan D, Rosenwald V, Guarino MJ, Mirzoyev T, Wozniak TF, Suppiah K. Testosterone Levels and Quality of Life in Diverse Male Patients With Cancers Unrelated to Androgens. J Clin Oncol 2010; 28:5054-60. [DOI: 10.1200/jco.2010.30.3818] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Symptoms secondary to hormonal changes significantly impact quality of life (QoL) in patients with cancer. This cross-sectional study examines prevalence of hypogonadism and its correlation with QoL and sexual dysfunction. Patients and Methods We collected blood and medical histories from 428 male patients with non–testosterone-related cancer at three cancer centers. Serum was analyzed for total testosterone (TT), free testosterone (FT), bioavailable testosterone (BAT), and sex hormone binding globulin (SHBG). The Functional Assessment of Cancer Therapy-Prostate (FACT-P) QoL questionnaire measured physical, social, emotional, and functional domains as well as sexual function. Exclusion criteria were prostate, testicular, or male breast cancer; known hypogonadism; and HIV. Results Mean and median TTs were 337.46 and 310 ng/dL, respectively. The mean age of patients was 62.05 years. The crude prevalence of hypogonadism (ie, TT < 300 ng/dL) was 48%, and mean TT in hypogonadal patients was 176 ng/dL. The prevalences that were based on FT (ie, hypogonadal < 52 pg/dL) and BAT (ie, hypogonadal < 95 ng/dL) were 78% and 66%, respectively. The mean FT and BAT values in hypogonadal patients were 25 pg/dL and 45 ng/dL, respectively. Hypogonadal patients had decreased total QoL scores on FACT-P (P = .01) and decreased three-item sexual function subset (P = .003). Conclusion The prevalence of hypogonadism was unexpectedly high. Measurement of FT or BAT detected a higher prevalence than TT alone, which confirmed previous studies. Correlation of T with FACT-P showed significant reduction of both overall QoL and sexual function for hypogonadal men. BAT and FT levels showed a stronger correlation than TT with overall FACT-P and subscales. The prevalence of symptomatic hypogonadism in male patients with cancer exceeds that found in comparable studies in noncancer populations.
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Affiliation(s)
- Stewart B. Fleishman
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Hina Khan
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Peter Homel
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Mohammad F. Suhail
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Rotraud Strebel-Amrhein
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Farhan Mohammad
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Divya Mahajan
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Victoria Rosenwald
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Michael J. Guarino
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Tahir Mirzoyev
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Timothy F. Wozniak
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
| | - Kathiresan Suppiah
- From the Continuum Cancer Centers of New York, Beth Israel Medical Center and St Luke's-Roosevelt Hospital, New York, NY; and the Helen F. Graham Cancer Center, Newark, DE
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Kindler HL, Niedzwiecki D, Hollis D, Sutherland S, Schrag D, Hurwitz H, Innocenti F, Mulcahy MF, O'Reilly E, Wozniak TF, Picus J, Bhargava P, Mayer RJ, Schilsky RL, Goldberg RM. Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol 2010; 28:3617-22. [PMID: 20606091 DOI: 10.1200/jco.2010.28.1386] [Citation(s) in RCA: 645] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The combination of gemcitabine plus bevacizumab produced a 21% response rate and a median survival of 8.8 months in a multicenter phase II trial in patients with metastatic pancreatic cancer. These encouraging data led Cancer and Leukemia Group B (CALGB) to conduct a double-blind, placebo-controlled, randomized phase III trial of gemcitabine/bevacizumab versus gemcitabine/placebo in advanced pancreatic cancer patients. PATIENTS AND METHODS Eligible patients had no prior therapy for advanced disease, Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2, no tumor invasion of adjacent organs, and no increased bleeding risk. The primary end point was overall survival. Patients were stratified by performance status, extent of disease, and prior radiotherapy. Patients received gemcitabine at 1,000 mg/m(2) over 30 minutes on days 1, 8, and 15 every 28 days and bevacizumab at 10 mg/kg or placebo on days 1 and 15 every 28 days. RESULTS Between June 2004 and April 2006, 602 patients were enrolled onto the study and 535 were treated. Median overall survival was 5.8 months for gemcitabine/bevacizumab and 5.9 months for gemcitabine/placebo (P = .95). Median progression-free survival was 3.8 and 2.9 months, respectively (P = .07). Overall response rates were 13% and 10%, respectively. Patients with a performance status of 0, 1, and 2 survived a median of 7.9, 4.8, and 2.4 months, respectively. The only statistically significant differences in grades 3 and 4 toxicity occurred for hypertension (10% v 3%; P < .001) and proteinuria (5% v 1%; P = .002); venous thrombosis grade > or = 3 was equivalent in both arms (14% and 15%, respectively). CONCLUSION The addition of bevacizumab to gemcitabine does not improve survival in advanced pancreatic cancer patients.
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Affiliation(s)
- Hedy Lee Kindler
- University of Chicago Cancer Research Center, Chicago, IL 60637-1470, USA.
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Mitchell ML, Filippone MD, Wozniak TF. Metastatic carcinomatous cirrhosis and hepatic hemosiderosis in a patient heterozygous for the H63D genotype. Arch Pathol Lab Med 2001; 125:1084-7. [PMID: 11473464 DOI: 10.5858/2001-125-1084-mccahh] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 38-year-old woman had a mastectomy for infiltrating ductal carcinoma of the breast 3 years before her last admission and had received chemotherapy for known liver metastases. She developed the rapid onset of liver failure with portal hypertension and died in a hospice. Autopsy revealed macronodular cirrhosis of the liver secondary to metastatic carcinoma of the breast with associated florid fibrosis. This rare lesion, previously called metastatic carcinomatous cirrhosis, was also found, in this case, to have marked hepatic hemosiderosis, and analysis of the patient's DNA showed heterozygosity for the H63D genotype. The possibility of cirrhosis-associated hemosiderosis secondary to an iron metabolism abnormality associated with the H63D mutation of the HFE gene is proposed. Computed tomographic scans showed the development of cirrhosis during the 3-month period before the patient's last admission and suggested the possibility of a postnecrotic type origin.
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Affiliation(s)
- M L Mitchell
- Department of Pathology and Laboratory Medicine, Christiana Hospital, Newark, DE 19718, USA.
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Wozniak TF, Eppes PG, Wilson CT. Drugs can reduce the incidence of breast cancer: now what? Del Med J 1999; 71:387-9. [PMID: 10584440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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