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Mansfield AS, Wei Z, Mehra R, Shaw AT, Lieu CH, Forde PM, Drilon AE, Mitchell EP, Wright JJ, Takebe N, Sharon E, Hovelson D, Tomlins S, Zeng J, Poorman K, Malik N, Gray RJ, Li S, McShane LM, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Conley BA, Arteaga CL, Harris LN, O’Dwyer PJ, Chen AP, Flaherty KT. Crizotinib in patients with tumors harboring ALK or ROS1 rearrangements in the NCI-MATCH trial. NPJ Precis Oncol 2022; 6:13. [PMID: 35233056 PMCID: PMC8888601 DOI: 10.1038/s41698-022-00256-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023] Open
Abstract
The NCI-MATCH was designed to characterize the efficacy of targeted therapies in histology-agnostic driver mutation-positive malignancies. Sub-protocols F and G were developed to evaluate the role of crizotinib in rare tumors that harbored either ALK or ROS1 rearrangements. Patients with malignancies that progressed following at least one prior systemic therapy were accrued to the NCI-MATCH for molecular profiling, and those with actionable ALK or ROS1 rearrangements were offered participation in sub-protocols F or G, respectively. There were five patients who enrolled on Arm F (ALK) and four patients on Arm G (ROS1). Few grade 3 or 4 toxicities were noted, including liver test abnormalities, and acute kidney injury. For sub-protocol F (ALK), the response rate was 50% (90% CI 9.8-90.2%) with one complete response among the 4 eligible patients. The median PFS was 3.8 months, and median OS was 4.3 months. For sub-protocol G (ROS1) the response rate was 25% (90% CI 1.3-75.1%). The median PFS was 4.3 months, and median OS 6.2 months. Data from 3 commercial vendors showed that the prevalence of ALK and ROS1 rearrangements in histologies other than non-small cell lung cancer and lymphoma was rare (0.1% and 0.4% respectively). We observed responses to crizotinib which met the primary endpoint for ALK fusions, albeit in a small number of patients. Despite the limited accrual, some of the patients with these oncogenic fusions can respond to crizotinib which may have a therapeutic role in this setting.
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Affiliation(s)
- A. S. Mansfield
- grid.66875.3a0000 0004 0459 167XDivision of Medical Oncology, Mayo Clinic, Rochester, MN USA
| | - Z. Wei
- grid.65499.370000 0001 2106 9910ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA USA
| | - R. Mehra
- grid.411024.20000 0001 2175 4264Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD USA
| | - A. T. Shaw
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | - C. H. Lieu
- grid.499234.10000 0004 0433 9255University of Colorado Cancer Center, Aurora, CO USA
| | - P. M. Forde
- grid.280502.d0000 0000 8741 3625Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD USA
| | - A. E. Drilon
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY USA
| | - E. P. Mitchell
- grid.412726.40000 0004 0442 8581Thomas Jefferson University Hospital, Philadelphia, PA USA
| | - J. J. Wright
- grid.48336.3a0000 0004 1936 8075Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | - N. Takebe
- grid.48336.3a0000 0004 1936 8075Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | - E. Sharon
- grid.48336.3a0000 0004 1936 8075Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | | | | | - J. Zeng
- grid.492659.50000 0004 0492 4462Caris Life Sciences, Irving, TX USA
| | - K. Poorman
- grid.492659.50000 0004 0492 4462Caris Life Sciences, Irving, TX USA
| | - N. Malik
- grid.511425.60000 0004 9346 3636Tempus, Chicago, IL USA
| | - R. J. Gray
- grid.65499.370000 0001 2106 9910ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA USA
| | - S. Li
- grid.65499.370000 0001 2106 9910ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA USA
| | - L. M. McShane
- grid.48336.3a0000 0004 1936 8075Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | - L. V. Rubinstein
- grid.48336.3a0000 0004 1936 8075Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | - D. Patton
- grid.48336.3a0000 0004 1936 8075Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD USA
| | - P. M. Williams
- grid.418021.e0000 0004 0535 8394Frederick National Laboratory for Cancer Research, Frederick, MD USA
| | - S. R. Hamilton
- grid.410425.60000 0004 0421 8357City of Hope, Duarte, CA USA
| | - B. A. Conley
- grid.48336.3a0000 0004 1936 8075Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | - C. L. Arteaga
- grid.267313.20000 0000 9482 7121Simmons Cancer Center, University of Texas Southwestern, Dallas, TX USA
| | - L. N. Harris
- grid.48336.3a0000 0004 1936 8075Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | - P. J. O’Dwyer
- grid.25879.310000 0004 1936 8972University of Pennsylvania, Philadelphia, PA USA
| | - A. P. Chen
- grid.48336.3a0000 0004 1936 8075Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD USA
| | - K. T. Flaherty
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
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Mansfield AS, Każarnowicz A, Karaseva N, Sánchez A, De Boer R, Andric Z, Reck M, Atagi S, Lee JS, Garassino M, Liu SV, Horn L, Wen X, Quach C, Yu W, Kabbinavar F, Lam S, Morris S, Califano R. Safety and patient-reported outcomes of atezolizumab, carboplatin, and etoposide in extensive-stage small-cell lung cancer (IMpower133): a randomized phase I/III trial. Ann Oncol 2019; 31:310-317. [PMID: 31959349 DOI: 10.1016/j.annonc.2019.10.021] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/27/2019] [Accepted: 10/20/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The addition of atezolizumab to carboplatin and etoposide (CP/ET) significantly improved progression-free and overall survival for patients with extensive-stage small-cell lung cancer (ES-SCLC) in the IMpower133 study (NCT02763579). We have evaluated adverse events (AEs) and patient-reported outcomes in IMpower133 to assess the benefit-risk profile of this regimen. PATIENTS AND METHODS Patients received four 21-day cycles of CP/ET plus intravenous atezolizumab 1200 mg or placebo (induction phase), followed by atezolizumab or placebo (maintenance phase) until progression or loss of benefit. AEs were assessed and patient-reported outcomes were evaluated every 3 weeks during treatment using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (QLQ-C30) and QLQ-LC13. RESULTS Overall, 394 patients were assessable for safety in the induction phase and 318 in the maintenance phase. The frequency of AEs, grade 3-4 AEs, and serious AEs was similar between arms in both phases. Immune-related AEs were more frequent in the atezolizumab arm during both induction (28% versus 17%; leading to atezolizumab/placebo interruption 9% versus 5%, leading to withdrawal 4% versus 0%) and maintenance (26% versus 15%; leading to atezolizumab/placebo interruption, 3% versus 2%, leading to withdrawal 1% versus 1%), most commonly rash (induction 11% versus 9%, maintenance 14% versus 4%), and hypothyroidism (induction 4.0% versus 0%, maintenance 10% versus 1%). Changes in patient-reported treatment-related symptoms commonly associated with quality of life impairment were generally similar during induction and most of the maintenance phase. Patient-reported function and health-related quality of life (HRQoL) improved in both arms after initiating treatment, with more pronounced and persistent HRQoL improvements in the atezolizumab arm. CONCLUSIONS In patients with ES-SCLC, atezolizumab plus CP/ET has a comparable safety profile to placebo plus CP/ET, and the addition of atezolizumab did not adversely impact patient-reported HRQoL. These data demonstrate the positive benefit-risk profile of first-line atezolizumab plus CP/ET in ES-SCLC and further support this regimen as a new standard of care in this setting. CLINICAL TRIALS NUMBER NCT02763579.
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Affiliation(s)
- A S Mansfield
- Division of Medical Oncology, Mayo Clinic, Rochester, USA.
| | - A Każarnowicz
- Department of Oncology, Tuberculosis and Lung Disease Hospital, Olsztyn, Poland
| | - N Karaseva
- City Clinical Oncology Dispensary, St Petersburg, Russia
| | - A Sánchez
- Department of Medical Oncology, Hospital Universitario "Virgen del Rocio", Seville, Spain
| | - R De Boer
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Z Andric
- Department of Medical Oncology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - M Reck
- Department of Thoracic Oncology, German Center for Lung Research (DZL), Großhansdorf, Germany
| | - S Atagi
- Department of Thoracic Oncology, Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - J-S Lee
- Division of Hematology-Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - M Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S V Liu
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - L Horn
- Thoracic Oncology Program, Vanderbilt University Medical Center, Nashville, USA
| | - X Wen
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - C Quach
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - W Yu
- Biometrics, Genentech, Inc., South San Francisco, USA
| | - F Kabbinavar
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - S Lam
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - S Morris
- Global PD Medical Affairs (Oncology), F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - R Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, and Division of Cancer Sciences, University of Manchester, Manchester, UK
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Mansfield AS, Tafur AJ. Predictors of active cancer thromboembolic outcomes: validation of the Khorana score among patients with lung cancer: reply. J Thromb Haemost 2017; 15:591-592. [PMID: 27992093 DOI: 10.1111/jth.13592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A S Mansfield
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - A J Tafur
- Department of Medicine, Division of Cardiology - Vascular Medicine Program, NorthShore University Health System, Evanston, IL, USA
- School of Medicine, University of Chicago, Chicago, IL, USA
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Mansfield AS, Murphy SJ, Harris FR, Robinson SI, Marks RS, Johnson SH, Smadbeck JB, Halling GC, Yi ES, Wigle D, Vasmatzis G, Jen J. Chromoplectic TPM3-ALK rearrangement in a patient with inflammatory myofibroblastic tumor who responded to ceritinib after progression on crizotinib. Ann Oncol 2016; 27:2111-2117. [PMID: 27742657 PMCID: PMC5091324 DOI: 10.1093/annonc/mdw405] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/11/2016] [Indexed: 01/17/2023] Open
Abstract
Ceritinib resulted in a significant, durable response of a metastatic inflammatory myofibroblastic tumor (IMT) after failure of crizotinib. A chromoplectic TPM3–ALK rearrangement involving many known oncogenes was found in the residual IMT. Ceritinib may be useful for patients with IMT after failure of crizotinib, and chromoplexy may have a role in the oncogenesis or treatment resistance of IMTs. Background Inflammatory myofibroblastic tumors (IMTs) are rare sarcomas that can occur at any age. Surgical resection is the primary treatment for patients with localized disease; however, these tumors frequently recur. Less commonly, patients with IMTs develop or present with metastatic disease. There is no standard of care for these patients and traditional cytotoxic therapy is largely ineffective. Most IMTs are associated with oncogenic ALK, ROS1 or PDGFRβ fusions and may benefit from targeted therapy. Patient and methods We sought to understand the genomic abnormalities of a patient who presented for management of metastatic IMT after progression of disease on crizotinib and a significant and durable partial response to the more potent ALK inhibitor ceritinib. Results The residual IMT was resected based on the recommendations of a multidisciplinary tumor sarcoma tumor board and analyzed by whole-genome mate pair sequencing. Analysis of the residual, resected tumor identified a chromoplectic TPM3–ALK rearrangement that involved many other known oncogenes and was confirmed by rtPCR. Conclusions In our analysis of the treatment-resistant, residual IMT, we identified a complex pattern of genetic rearrangements consistent with chromoplexy. Although it is difficult to know for certain if these chromoplectic rearrangements preceded treatment, their presence suggests that chromoplexy has a role in the oncogenesis of IMTs. Furthermore, this patient's remarkable response suggests that ceritinib should be considered as an option after progression on crizotinib for patients with metastatic or unresectable IMT and ALK mutations.
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Affiliation(s)
- A S Mansfield
- Division of Medical Oncology, Department of Oncology
| | - S J Murphy
- Biomarker Discovery Program, Center of Individualized Medicine, Department of Molecular Medicine
| | - F R Harris
- Biomarker Discovery Program, Center of Individualized Medicine, Department of Molecular Medicine
| | - S I Robinson
- Division of Medical Oncology, Department of Oncology
| | - R S Marks
- Division of Medical Oncology, Department of Oncology
| | - S H Johnson
- Biomarker Discovery Program, Center of Individualized Medicine, Department of Molecular Medicine
| | - J B Smadbeck
- Biomarker Discovery Program, Center of Individualized Medicine, Department of Molecular Medicine
| | - G C Halling
- Biomarker Discovery Program, Center of Individualized Medicine, Department of Molecular Medicine
| | - E S Yi
- Department of Laboratory Medicine and Pathology
| | | | - G Vasmatzis
- Biomarker Discovery Program, Center of Individualized Medicine, Department of Molecular Medicine
| | - J Jen
- Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology.,Medical Genome Facility.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, USA
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Mansfield AS, Aubry MC, Moser JC, Harrington SM, Dronca RS, Park SS, Dong H. Temporal and spatial discordance of programmed cell death-ligand 1 expression and lymphocyte tumor infiltration between paired primary lesions and brain metastases in lung cancer. Ann Oncol 2016; 27:1953-8. [PMID: 27502709 PMCID: PMC5035793 DOI: 10.1093/annonc/mdw289] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/18/2016] [Indexed: 12/26/2022] Open
Abstract
The tumor microenvironments of paired primary lung cancers and brain metastases are significantly different, such that many of the metastases lose PD-L1 expression, lymphocyte infiltration or both with greater discrepancies over time. The spatial and temporal heterogeneity of PD-L1 expression may limit its use as a tissue-based predictive biomarker in lung cancer. Background The dynamics of PD-L1 expression may limit its use as a tissue-based predictive biomarker. We sought to expand our understanding of the dynamics of PD-L1 expression and tumor-infiltrating lymphocytes (TILs) in patients with lung cancer-related brain metastases. Experimental design Paired primary lung cancers and brain metastases were identified and assessed for PD-L1 and CD3 expression by immunohistochemistry. Lesions with 5% or greater PD-L1 expression were considered positive. Agreement statistics and the χ2 or Fisher's exact test were used for analysis. Results We analyzed 146 paired lesions from 73 cases. There was disagreement of tumor cell PD-L1 expression in 10 cases (14%, κ = 0.71), and disagreement of TIL PD-L1 expression in 19 cases (26%, κ = 0.38). Most paired lesions with discordant tumor cell expression of PD-L1 were obtained 6 or more months apart. When specimens were categorized using a proposed tumor microenvironment categorization scheme based on PD-L1 expression and TILs, there were significant changes in the classifications because many of the brain metastases lacked either PD-L1 expression, tumor lymphocyte infiltration or both even when they were present in the primary lung cancer specimens (P = 0.009). Conclusions We identified that there are significant differences between the tumor microenvironment of paired primary lung cancers and brain metastases. When physicians decide to treat patients with lung cancer with a PD-1 or PD-L1 inhibitor, they must do so in the context of the spatial and temporal heterogeneity of the tumor microenvironment.
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Affiliation(s)
- A S Mansfield
- Division of Medical Oncology, Departments of Oncology
| | | | | | | | - R S Dronca
- Division of Medical Oncology, Departments of Oncology
| | - S S Park
- Radiation Oncology, Mayo Clinic, Rochester, USA
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Mansfield AS, Dong H. Implications of Programmed Cell Death 1 Ligand 1 Heterogeneity in the Selection of Patients With Non-Small Cell Lung Cancer to Receive Immunotherapy. Clin Pharmacol Ther 2016; 100:220-2. [PMID: 26916808 DOI: 10.1002/cpt.360] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 11/08/2022]
Abstract
The use of programmed cell death 1 ligand 1 (PD-L1) as a predictive biomarker to select patients to receive programmed cell death 1 (PD-1) or PD-L1 inhibitors in non-small cell lung cancer (NSCLC) is limited by the definitions of positivity, interassay agreement, and intra- and intertumoral heterogeneity of expression. Although PD-L1 expression enriches for responses, the lack of expression does not exclude clinical benefit.
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Affiliation(s)
- A S Mansfield
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - H Dong
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Tafur AJ, Dale G, Cherry M, Wren JD, Mansfield AS, Comp P, Rathbun S, Stoner JA. Prospective evaluation of protein C and factor VIII in prediction of cancer-associated thrombosis. Thromb Res 2015; 136:1120-5. [PMID: 26475410 PMCID: PMC4679511 DOI: 10.1016/j.thromres.2015.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/02/2015] [Accepted: 10/04/2015] [Indexed: 12/12/2022]
Abstract
Venous thromboembolism (VTE) is a preventable disease, yet it is one of the leading causes of death among patients with cancer. Improving risk stratification mechanisms will allow us to personalize thrombo-prophylaxis strategies. We sought to evaluate Collagen and Thrombin Activated Platelets (COAT-platelets) as well as protein C and factor VIII as biomarkers predictive of cancer-associated thrombosis in a prospective cohort of patients with cancer. Protein C was selected as a candidate based on bioinformatics prediction. Blood samples were collected before chemotherapy. All specimen processing was blinded to clinical data. Surveillance and adjudication of the main outcome of VTE was performed for up to 1 year. We used Cox proportional hazard regression to measure the association of biomarkers and incident events using SAS 9.2 for all statistical analysis. Death was modeled as a competing event. Among 241 patients followed for an average of 10.4 months, 15% died and 13% developed a VTE. COAT-platelets were not predictive of VTE. Low levels of pre-chemotherapy protein C (<118%) (HR 2.5; 95% CI 1.1-5.5) and high baseline factor VIII (>261% I) (HR 3.0; 95% CI 1.1-8.0) were predictive of VTE after adjusting for age, Khorana prediction risk, metastatic disease and D dimer. In addition, low protein C was predictive of overall mortality independent of age, metastatic disease and functional status (HR 2.8; 95% CI 1.3-6.0). Addition of these biomarkers to cancer-VTE risk prediction models may add to risk stratification and patient selection to optimize thrombo-prophylaxis.
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Affiliation(s)
- A J Tafur
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States.
| | - G Dale
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States
| | - M Cherry
- Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States
| | - J D Wren
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, United States
| | - A S Mansfield
- Department of Oncology, Division of Medical Oncology, Mayo Clinic Rochester, United States
| | - P Comp
- Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States
| | - S Rathbun
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States
| | - J A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, United States
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Mansfield AS, Tafur AJ, Vulih D, Smith GL, Harris PJ, Ivy SP. Severe hepatic dysfunction is associated with venous thromboembolic events in phase 1 clinical trials. Thromb Res 2015; 136:1169-73. [PMID: 26493604 DOI: 10.1016/j.thromres.2015.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Venous thromboembolic events (VTEs) are a significant cause of death in patients with cancer. The incidence of VTE is not well characterized in early phase clinical trials of novel antineoplastic agents, or in hepatic dysfunction studies designed for patients with varying degrees of liver test abnormalities. We compared the incidences of VTE in phase 1 clinical trials (P1CTs) and hepatic dysfunction trials (HDCTs) sponsored by the Cancer Therapy Evaluation Program of the National Cancer Institute (NCI) of the United States. MATERIALS & METHODS We reviewed individual patient records of 1841 subjects for symptomatic VTE diagnosed while on study: 1328 subjects on 42 P1CTs, and 513 subjects on 9 HDCTs. The NCI's Organ Dysfunction Working Group definitions were used to categorize patients. The incidences of VTEs between patients were compared by the Chi square test. Confounders were evaluated with the Cochran-Mantel-Haenszel method. RESULTS & CONCLUSIONS There were 43 VTEs identified among all subjects (2.3%). There were significantly more VTE observed in the subjects on P1CTs (n=38, 2.9%) than in the subjects on HDCTs (n=5, 1.0%; RR 0.341, 95% 0.13-0.86, p=0.015). For patients on HDCTs, those with severe dysfunction had a high incidence of VTE (RR 10.5 (1.12-93.6), p=0.021) that remained significant in a multivariate model. VTEs were observed less frequently in patients who were enrolled in HDCT than those who were enrolled in P1CT; however, patients with severe hepatic dysfunction were more likely to experience VTE. Severe liver test abnormalities may not be protective against VTE in patients with malignancies receiving chemotherapy.
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Affiliation(s)
- A S Mansfield
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - A J Tafur
- Vascular Medicine, Northshore University Health System, 2650 Ridge Avenue, Evanston, IL 60201, USA.
| | - D Vulih
- Theradex, 4365 Route 1 South, Princeton, NJ 08540, USA.
| | - G L Smith
- Clinical Trials Monitoring Branch, Cancer Therapy Evaluation Program, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
| | - P J Harris
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
| | - S P Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892, USA.
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Meretoja TJ, Heikkilä PS, Mansfield AS, Cserni G, Ambrozay E, Boross G, Zgajnar J, Perhavec A, Gazic B, Arisio R, Tvedskov TF, Jensen MB, Leidenius MHK. A predictive tool to estimate the risk of axillary metastases in breast cancer patients with negative axillary ultrasound. Ann Surg Oncol 2014; 21:2229-36. [PMID: 24664623 DOI: 10.1245/s10434-014-3617-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sentinel node biopsy (SNB) is the "gold standard" in axillary staging in clinically node-negative breast cancer patients. However, axillary treatment is undergoing a paradigm shift and studies are being conducted on whether SNB may be omitted in low-risk patients. The purpose of this study was to evaluate the risk factors for axillary metastases in breast cancer patients with negative preoperative axillary ultrasound. METHODS A total of 1,395 consecutive patients with invasive breast cancer and SNB formed the original patient series. A univariate analysis was conducted to assess risk factors for axillary metastases. Binary logistic regression analysis was conducted to form a predictive model based on the risk factors. The predictive model was first validated internally in a patient series of 566 further patients and then externally in a patient series of 2,463 patients from four other centers. All statistical tests were two-sided. RESULTS A total of 426 of the 1,395 (30.5 %) patients in the original patient series had axillary lymph node metastases. Histological size (P < 0.001), multifocality (P < 0.001), lymphovascular invasion (P < 0.001), and palpability of the primary tumor (P < 0.001) were included in the predictive model. Internal validation of the model produced an area under the receiver operating characteristics curve (AUC) of 0.731 and external validation an AUC of 0.79. CONCLUSIONS We present a predictive model to assess the patient-specific probability of axillary lymph node metastases in patients with clinically node-negative breast cancer. The model performs well in internal and external validation. The model needs to be validated in each center before application to clinical use.
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Affiliation(s)
- T J Meretoja
- Breast Surgery Unit, Helsinki University Central Hospital, Helsinki, Finland,
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Mansfield AS, Nevala WK, Dronca RS, Leontovich AA, Shuster L, Markovic SN. Normal ageing is associated with an increase in Th2 cells, MCP-1 (CCL1) and RANTES (CCL5), with differences in sCD40L and PDGF-AA between sexes. Clin Exp Immunol 2013; 170:186-93. [PMID: 23039889 DOI: 10.1111/j.1365-2249.2012.04644.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We have observed T helper type 2 (Th2) polarization of systemic immunity in patients with metastatic malignant melanoma. We hypothesized that similar changes in systemic immunity occur with ageing and may be permissive for the development of melanoma. We analysed the peripheral blood of 389 healthy blood donors. All subjects were profiled for peripheral blood T cell and B cell subsets, and 58 of these subjects were profiled for antigen-specific cytotoxic T cell subsets [cytomegalovirus (CMV), influenza and melanoma antigen recognized by T cells 1 (MART-1)]. Ninety-five separate healthy subjects underwent profiling of 42 plasma cytokines. Ageing was associated positively with CD4(+) CD294(+) Th2 cells, and associated negatively with CD3(+) T cells, cytotoxic T cells and T helper cells. Ageing was also associated negatively with CMV-, influenza- and MART-1-specific naive and CD8(+) T cells. There were significant increases in plasma monocyte chemotactic protein 1 (MCP-1) (CCL1) and regulated upon activation normal T cell expressed and secreted (RANTES) (CCL5) with age. We observed differences in cytokine profiles between males and females; specifically, women had higher levels of sCD40L and PDGF-AA. In summary, we demonstrated in healthy blood donors that ageing was associated with an increase in cellular Th2 bias and a decline in total numbers of T cells. Additionally, there was an increase in MCP-1 and RANTES with ageing. Women had higher levels of sCD40L and PDGF-AA than men.
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Affiliation(s)
- A S Mansfield
- Departments of Oncology Medicine, Division of Hematology Immunology Biomedical Statistics and Informatics Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic Rochester, MN 55905, USA
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Mansfield AS, Sakai Y, Walsh FJ, Wiktor AE, Sukov WR, Dogan A, Jenkins RB. Abstract PD02-05: Comparison of fluorescence in situ hybridization (FISH) and dual-ISH (D-ISH) in the determination of HER2 status. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd02-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The appropriate assessment of HER2 amplification status is critical to determining which patients should receive HER2-directed therapy. An alternative to FISH is D-ISH (Ventana Medical Systems Tucson, Arizona) which utilizes chromogenic HER2 and chromosome 17 probes. Both FISH and D-ISH utilize formalin-fixed, paraffin-embedded (FFPE) human breast cancer tissue specimens. D-ISH has two principle advantages over FISH: it can be visualized using light microscopy and after analysis the specimens can be archived.
Methods: We tested 250 samples with FISH and with D-ISH. Fifty specimens were controls: 25 cases with no HER2 or CEP17anomaly and 25 cases with HER2 amplification. There were also 200 test subjects of 50 cases each of chromosome 17 aneusomy, HER2 deletion (HER2/CEP17 ratio <0.8), HER2 duplication (HER2/CEP17 ratio 1.3–1.8), and equivocal results (HER2/CEP17 ratios between 1.8 and 2.2). FISH (Abbott Molecular) and D-ISH analysis were performed using methods described in the appropriate clinical kit package inserts, with the following exception: Four cases with CEP17 and HER2 co-amplification were also included and for FISH analysis these cases were reflexed to the use of chromosome 17 control probe (D17S122).
Results: Four samples failed testing by D-ISH. There was a 63% (155/246) concordance between FISH and D-ISH by anomaly (aneusomy, duplication, deletion, etc.) and an 83% concordance by amplification status (non-amplified, equivocal, and amplified). D-ISH detected 18 (62%) of F-ISH-amplified cases. D-ISH resulted in lower estimates of HER2/CEP17 ratios than FISH, and many cases that were equivocal by FISH were normal by D-ISH. D-ISH did not detect HER2 amplification in any of the four HER2 and CEP17 co-amplified cases.
Conclusions: We observed a lower concordance rate between FISH and D-ISH than the ∼95% rate in the D-ISH package insert. This lower concordance rate is likely a result of how this study was designed: it was biased toward common chromosome 17 anomalies and difficult specimens. Such specimens comprise about 60% of our current clinical HER2 biomarker practice. D-ISH may underestimate the HER2/CEP17 ratio, or FISH may overestimate this ratio. D-ISH also does not reliably detect HER2 amplification when the centromere of chromosome 17 is also co-amplifed. Compared to FISH, in this study cohort D-ISH had a significant false negative rate for the detection of HER2 amplification.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD02-05.
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Winter JM, Narang AK, Mansfield AS, Herman JM, Cameron JL, Laheru D, Eckhauser FE, Olson M, Miller RC, Andersen DK. Resectable pancreatic small cell carcinoma: The experience of two institutions and review of the literature. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.333] [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
333 Background: Primary pancreatic small cell carcinoma (SCC) is rare, with just over 30 cases reported in the literature. Only 7 of these patients underwent surgical resection with a median survival of 6 months. Prognosis of SCC is therefore considered to be poor, and the role of adjuvant therapy is uncertain. Here we report two institutions' experience with resectable pancreatic SCC. Methods: Six patients with pancreatic SCC at the Johns Hopkins Hospital (4 patients) and the Mayo Clinic (2 patients) were identified from prospectively collected pancreatic cancer databases and re-reviewed by pathology. All six patients underwent a pancreaticoduodenectomy. Clinicopathologic data was analyzed, and the literature on pancreatic SCC was reviewed. Results: Median age at diagnosis was 50 years (range 27-60). Half of the patients were male, and half were known smokers. All six masses were limited to the pancreatic head. Median tumor size was 3 cm, and all cases had positive lymph nodes except for one patient who only had five nodes sampled. There was no perioperative mortality, although three patients had postoperative complications. All six patients received adjuvant chemotherapy therapy, five of whom were given cisplatin and etoposide. Of these five patients, three were known to have received radiation, while the remaining two had a plan for radiation at an outside facility. Median survival was 20 months with a range of 9-173 months. The patient who lived for 9 months received chemotherapy only, while the patient who lived for 173 months was given chemoradiation with cisplatin and etoposide and represents the longest reported survival time from pancreatic SCC to date. Conclusions: Pancreatic SCC is an extremely rare form of cancer with a poor prognosis. Patients in this surgical series showed improved survival rates when compared to prior experiences with both resected and unresectable cases. Cisplatin and etoposide appears to be the preferred chemotherapy regimen, although its efficacy remains uncertain, as does the role of combined modality treatment with radiation. No significant financial relationships to disclose.
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Affiliation(s)
- J. M. Winter
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - A. K. Narang
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - A. S. Mansfield
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - J. M. Herman
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - J. L. Cameron
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - D. Laheru
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - F. E. Eckhauser
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - M. Olson
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - R. C. Miller
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
| | - D. K. Andersen
- Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD; Mayo Clinic, Rochester, MN; Johns Hopkins University School of Medicine, Baltimore, MD
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Mansfield AS, Grotz T, Jakub JW, Flotte T, Erickson L, Markovic S. Changes in regional immunity and metastasis in melanoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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