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Jaiyesimi IA, Leighl NB, Ismaila N, Alluri K, Florez N, Gadgeel S, Masters G, Schenk EL, Schneider BJ, Sequist L, Singh N, Bazhenova L, Blanchard E, Freeman-Daily J, Furuya N, Halmos B, Azar IH, Kuruvilla S, Mullane M, Naidoo J, Reuss JE, Spigel DR, Owen DH, Patel JD. Therapy for Stage IV Non-Small Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2023.3. J Clin Oncol 2024; 42:e1-e22. [PMID: 38417091 DOI: 10.1200/jco.23.02744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/18/2024] [Indexed: 03/01/2024] Open
Abstract
PURPOSE To provide evidence-based recommendations for patients with stage IV non-small cell lung cancer with driver alterations. METHODS This ASCO living guideline offers continually updated recommendations based on an ongoing systematic review of randomized clinical trials (RCTs), with the latest time frame spanning February to October 2023. An Expert Panel of medical oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened. The literature search included systematic reviews, meta-analyses, and randomized controlled trials. Outcomes of interest include efficacy and safety. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS This guideline consolidates all previous updates and reflects the body of evidence informing this guideline topic. Eight new RCTs were identified in the latest search of the literature to date. RECOMMENDATIONS Evidence-based recommendations were updated to address first, second, and subsequent treatment options for patients based on targetable driver alterations.Additional information is available at www.asco.org/living-guidelines.
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Affiliation(s)
- Ishmael A Jaiyesimi
- Corewell Health William Beaumont University Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | - Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shirish Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, MI
| | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Erin L Schenk
- University of Colorado Anschutz Medical Center, Aurora, CO
| | | | | | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Naoki Furuya
- St Marianna University School of Medicine, Kawasaki, Japan
| | - Balazs Halmos
- Montefiore Einstein Center for Cancer Care, Bronx, NY
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2
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Jaiyesimi IA, Leighl NB, Ismaila N, Alluri K, Florez N, Gadgeel S, Masters G, Schenk EL, Schneider BJ, Sequist L, Singh N, Bazhenova L, Blanchard E, Freeman-Daily J, Furuya N, Halmos B, Azar IH, Kuruvilla S, Mullane M, Naidoo J, Reuss JE, Spigel DR, Owen DH, Patel JD. Therapy for Stage IV Non-Small Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2023.3. J Clin Oncol 2024; 42:e23-e43. [PMID: 38417098 DOI: 10.1200/jco.23.02746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 03/01/2024] Open
Abstract
PURPOSE To provide evidence-based recommendations for patients with stage IV non-small cell lung cancer (NSCLC) without driver alterations. METHODS This ASCO living guideline offers continually updated recommendations based on an ongoing systematic review of randomized clinical trials (RCTs), with the latest time frame spanning February to October 2023. An Expert Panel of medical oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened. The literature search included systematic reviews, meta-analyses, and randomized controlled trials. Outcomes of interest include efficacy and safety. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS This guideline consolidates all previous updates and reflects the body of evidence informing this guideline topic. Ten new RCTs were identified in the latest search of the literature to date. RECOMMENDATIONS Evidence-based recommendations were updated to address first, second, and subsequent treatment options for patients without driver alterations.Additional information is available at www.asco.org/living-guidelines.
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Affiliation(s)
- Ishmael A Jaiyesimi
- Corewell Health William Beaumont University Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | | | - Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Shirish Gadgeel
- Henry Ford Cancer Institute/Henry Ford Health System, Detroit, MI
| | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | - Erin L Schenk
- University of Colorado Anschutz Medical Center, Aurora, CO
| | | | | | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Naoki Furuya
- St Marianna University School of Medicine, Kawasaki, Japan
| | - Balazs Halmos
- Montefiore Einstein Center for Cancer Care, Bronx, NY
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3
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Owen DH, Jaiyesimi IA, Leighl NB, Ismaila N, Florez N, Puri S, Schenk EL, Schneider BJ, Patel JD. Therapy for Stage IV Non-Small Cell Lung Cancer With and Without Driver Alterations: ASCO Living Guideline Clinical Insights. JCO Oncol Pract 2024:OP2400177. [PMID: 38588478 DOI: 10.1200/op.24.00177] [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] [Received: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
| | - Ishmael A Jaiyesimi
- Corewell Health William Beaumont University Hospital, Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | - Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sonum Puri
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Erin L Schenk
- University of Colorado Anschutz Medical Center, Aurora, CO
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Qin A, Wells L, Malhotra B, Gadgeel S, Schneider BJ, Ramnath N, Rice JD, Kalemkerian GP. A Phase II Trial of Pevonedistat and Docetaxel in Patients With Previously Treated Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2024; 25:128-134. [PMID: 37977950 DOI: 10.1016/j.cllc.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Postimmunotherapy (IO) treatment options for stage IV non-small-cell lung cancer (NSCLC) remain limited. Docetaxel alone or in combination with ramucirumab remains a standard of care, but response rates and survival benefit are suboptimal. Cullin-RING ligases (CRL) catalyze degradation of tumor suppressor proteins and are overactivated in NSCLC. Neddylation, which is catalyzed by the NEDD8 activating enzyme (NAE), is required for the activation of CRLs. Pevonedistat, a first-in-class small molecule NAE inhibitor, exerted antitumor activity when combined with docetaxel in preclinical studies. METHODS We conducted a phase II, single-arm, investigator-initiated study evaluating the efficacy of pevonedistat plus docetaxel in patients with relapsed/refractory stage IV NSCLC. Patients received docetaxel 75 mg/m2 on day 1 and pevonedistat 25 mg/m2 on days 1, 3 and 5 of a 21-day cycle. The primary endpoint was objective response rate (ORR). RESULTS From March 5, 2018 to January 26, 2021, we enrolled 31 patients. The ORR was 22% (1 CR, 5 PR), median PFS was 4.1 months, and median OS was 13.2 months. The incidence of Grade ≥3 adverse events (AE) was 53% in patients (n = 30) who received at least 1 dose of both drugs, with the most frequent being neutropenia and AST/ALT elevation. One patient was taken off study for a Grade 4 transaminase elevation. There were no Grade 5 toxicities. CONCLUSION Our data suggest that the combination of docetaxel and pevonedistat is safe and exerts activity in patients with relapsed NSCLC. These encouraging results suggest that the neddylation pathway is an antitumor pathway that should be further studied.
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Affiliation(s)
- Angel Qin
- University of Michigan Rogel Cancer Center, Ann Arbor, MI.
| | - Leah Wells
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | | | | | | | - Nithya Ramnath
- University of Michigan Rogel Cancer Center, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - John D Rice
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
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Sperling G, Shatila M, Varatharajalu K, Lu Y, Altan M, Zhou Y, Zhao D, De Toni EN, Török HP, Schneider BJ, Khan A, Thomas AS, Zhang HC, Shafi MA, Wang Y. Pneumatosis intestinalis in cancer patients who received immune checkpoint inhibitors. J Cancer Res Clin Oncol 2023; 149:17597-17605. [PMID: 37917197 DOI: 10.1007/s00432-023-05461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Immune checkpoint inhibitor (ICI) therapy may give rise to immune-related adverse events (irAEs). Pneumatosis intestinalis (PI), or gas within the bowel wall, has very rarely been observed following ICI therapy, and its clinical significance is unclear. We described the clinical characteristics and outcomes of PI as a possible irAE in cancer patients. METHODS We retrospectively identified 12 adult cancer patients with radiologic evidence of PI within 1 year after ICI exposure during January 2010-January 2023. Clinical characteristics, treatment, and outcomes were evaluated. RESULTS The median age of our sample was 64 years. The most common cancer types were thoracic/head & neck and gastrointestinal. Eleven patients (92%) received anti-PD-1/L1 monotherapy, while 1 patient (8%) received a combination of anti-PD-1/L1 and anti-CTLA-4. PI occurred a median of 7 months after the first ICI dose. Half the patients (50%) were asymptomatic on diagnosis, and the most common presenting symptom was abdominal pain (42%). Six patients experienced complications, namely pneumoperitoneum (n = 6, 50%) and microperforation (n = 1, 8%), identified on imaging. Nine patients were treated with antibiotics and 3 patients were monitored conservatively. Nine patients (75%) resumed cancer treatment after PI. CONCLUSION PI may develop as an irAE. While half of cases were incidental radiologic findings, management with antibiotics as well as hospitalization for observation may still be appropriate. The decision to restart cancer therapy and possibly resume ICI therapy remains to be elucidated. Further large-scale studies may be warranted to clarify the association between PI and ICI therapy.
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Affiliation(s)
- Gabriel Sperling
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Malek Shatila
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Krishnavathan Varatharajalu
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Yang Lu
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yan Zhou
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dan Zhao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Enrico N De Toni
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Helga-Paula Török
- Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bryan J Schneider
- Department of Thoracic Medical Oncology, The University of Michigan, Ann Arbor, MI, USA
| | - Anam Khan
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Anusha S Thomas
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Hao Chi Zhang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Mehnaz A Shafi
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, TX, 77030, USA.
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6
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Iyengar P, All S, Berry MF, Boike TP, Bradfield L, Dingemans AMC, Feldman J, Gomez DR, Hesketh PJ, Jabbour SK, Jeter M, Josipovic M, Lievens Y, McDonald F, Perez BA, Ricardi U, Ruffini E, De Ruysscher D, Saeed H, Schneider BJ, Senan S, Widder J, Guckenberger M. Treatment of Oligometastatic Non-Small Cell Lung Cancer: An ASTRO/ESTRO Clinical Practice Guideline. Pract Radiat Oncol 2023; 13:393-412. [PMID: 37294262 DOI: 10.1016/j.prro.2023.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/07/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This joint guideline by American Society for Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) was initiated to review evidence and provide recommendations regarding the use of local therapy in the management of extracranial oligometastatic non-small cell lung cancer (NSCLC). Local therapy is defined as the comprehensive treatment of all known cancer-primary tumor, regional nodal metastases, and metastases-with definitive intent. METHODS ASTRO and ESTRO convened a task force to address 5 key questions focused on the use of local (radiation, surgery, other ablative methods) and systemic therapy in the management of oligometastatic NSCLC. The questions address clinical scenarios for using local therapy, sequencing and timing when integrating local with systemic therapies, radiation techniques critical for oligometastatic disease targeting and treatment delivery, and the role of local therapy for oligoprogression or recurrent disease. Recommendations were based on a systematic literature review and created using ASTRO guidelines methodology. RESULTS Based on the lack of significant randomized phase 3 trials, a patient-centered, multidisciplinary approach was strongly recommended for all decision-making regarding potential treatment. Integration of definitive local therapy was only relevant if technically feasible and clinically safe to all disease sites, defined as 5 or fewer distinct sites. Conditional recommendations were given for definitive local therapies in synchronous, metachronous, oligopersistent, and oligoprogressive conditions for extracranial disease. Radiation and surgery were the only primary definitive local therapy modalities recommended for use in the management of patients with oligometastatic disease, with indications provided for choosing one over the other. Sequencing recommendations were provided for systemic and local therapy integration. Finally, multiple recommendations were provided for the optimal technical use of hypofractionated radiation or stereotactic body radiation therapy as definitive local therapy, including dose and fractionation. CONCLUSIONS Presently, data regarding clinical benefits of local therapy on overall and other survival outcomes is still sparse for oligometastatic NSCLC. However, with rapidly evolving data being generated supporting local therapy in oligometastatic NSCLC, this guideline attempted to frame recommendations as a function of the quality of data available to make decisions in a multidisciplinary approach incorporating patient goals and tolerances.
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Affiliation(s)
- Puneeth Iyengar
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas.
| | - Sean All
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
| | - Thomas P Boike
- Department of Radiation Oncology, GenesisCare/MHP Radiation Oncology, Troy, Michigan
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Anne-Marie C Dingemans
- Department of Pulmonology, Erasmus Medical Center Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul J Hesketh
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Melenda Jeter
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Fiona McDonald
- Department of Radiation Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Bradford A Perez
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, Maastricht and Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Hina Saeed
- Department of Radiation Oncology, Baptist Health South Florida, Boca Raton, Florida
| | - Bryan J Schneider
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Owen DH, Singh N, Ismaila N, Masters G, Riely GJ, Robinson AG, Schneider BJ, Jaiyesimi IA. Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2023.2. J Clin Oncol 2023; 41:e63-e72. [PMID: 37433095 DOI: 10.1200/jco.23.01055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 07/13/2023] Open
Abstract
Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis; as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2). Updates are published regularly and can be found at https://ascopubs.org/nsclc-da-living-guideline.
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Affiliation(s)
| | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | | | | | | | - Ishmael A Jaiyesimi
- Corewell Health William Beaumont University Hospital Royal Oak and Oakland University William Beaumont School of Medicine, Rochester, MI
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8
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Pasternak AL, Seda R, Lipa J, McDevitt RL, Crysler OV, Swiecicki PL, Schneider BJ, Vanderwerff B, Henry NL, Krauss JC, Sahai V, Hertz DL. Confirmatory DPYD Testing in Patients Receiving Fluoropyrimidines who are Suspected DPYD Variant Carriers Based on a Genetic Data Repository. Clin Pharmacol Ther 2023. [PMID: 37163252 DOI: 10.1002/cpt.2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/05/2023] [Indexed: 05/11/2023]
Abstract
Using pharmacogenetics (PGx) to inform clinical decision making can benefit patients but clinical use of PGx testing has been limited. Existing genetics data obtained in the course of research could be used to identify patients who are suspected, but have not yet been confirmed, to carry clinically actionable genotypes, in whom confirmatory genetic testing could be conducted for highly efficient PGx implementation. Herein we demonstrate that it is regulatorily and technically feasible to implement PGx by identifying suspected carriers of actionable genotypes within an institutional genetics data repository and conduct confirmatory PGx testing immediately prior to that patient receiving the PGx-relevant drug, using a case study of DPYD testing prior to fluoropyrimidine chemotherapy. In two years since launching this program, ~3,000 suspected DPYD carriers have been passively monitored and one confirmed DPYD carrier was prevented from receiving unacceptably toxic fluoropyrimidine treatment, for minimal cost and effort. Now that we have demonstrated the feasibility of this strategy, we plan to transition to PGx panel testing and expand implementation to other genes and drugs for which the evidence of clinical benefit of PGx-informed treatment is high but PGx testing is not generally conducted. This highly efficient implementation process will maximize the clinical benefits of testing and could be explored at other institutions that have research-only genetic data repositories to expand the number of patients who benefit from PGx-informed treatment while we continue to work toward wide-scale adoption of PGx testing and implementation.
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Affiliation(s)
- Amy L Pasternak
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy
| | - Robinson Seda
- University of Michigan Data Office for Clinical and Translational Research, University of Michigan Medical School
| | - Joseph Lipa
- Health Information Technology & Services (HITS) at Michigan Medicine
| | | | - Oxana V Crysler
- University of Michigan Rogel Cancer Center
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Medical School
| | - Paul L Swiecicki
- University of Michigan Rogel Cancer Center
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Medical School
| | - Bryan J Schneider
- University of Michigan Rogel Cancer Center
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Medical School
| | - Brett Vanderwerff
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, United States, 48109-2029
| | - N Lynn Henry
- University of Michigan Rogel Cancer Center
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Medical School
| | - John C Krauss
- University of Michigan Rogel Cancer Center
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Medical School
| | - Vaibhav Sahai
- University of Michigan Rogel Cancer Center
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Medical School
| | - Daniel L Hertz
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy
- University of Michigan Rogel Cancer Center
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9
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Owen DH, Singh N, Ismaila N, Blanchard E, Celano P, Florez N, Jain D, Leighl NB, Mamdani H, Masters G, Moffitt PR, Naidoo J, Phillips T, Riely GJ, Robinson AG, Schenk E, Schneider BJ, Sequist L, Spigel DR, Jaiyesimi IA. Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline, Version 2022.2. J Clin Oncol 2023; 41:e1-e9. [PMID: 36534935 DOI: 10.1200/jco.22.02121] [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: 12/23/2022] Open
Abstract
Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See Appendix 1 (online only) for disclaimers and other important information. Updates are published regularly and can be found at https://ascopubs.org/nsclc-non-da-living-guideline.
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Affiliation(s)
| | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | - Natasha B Leighl
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Hirva Mamdani
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | | | | | | | | | - Andrew G Robinson
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Erin Schenk
- University of Colorado Anschutz Medical Center, Aurora, CO
| | | | | | | | - Ishmael A Jaiyesimi
- Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine, Royal Oak, MI
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10
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Owen DH, Singh N, Ismaila N, Blanchard E, Celano P, Florez N, Jain D, Leighl NB, Mamdani H, Masters G, Moffitt PR, Naidoo J, Phillips T, Riely GJ, Robinson AG, Schenk E, Schneider BJ, Sequist L, Spigel DR, Jaiyesimi IA. Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2022.2. J Clin Oncol 2023; 41:e10-e20. [PMID: 36534938 DOI: 10.1200/jco.22.02124] [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: 12/23/2022] Open
Abstract
Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual. ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines. Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See Appendix 1 (online only) for disclaimers and other important information. Updates are published regularly and can be found at https://ascopubs.org/nsclc-da-living-guideline.
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Affiliation(s)
| | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | - Natasha B Leighl
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Hirva Mamdani
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | | | | | | | | | - Andrew G Robinson
- Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Erin Schenk
- University of Colorado Anschutz Medical Center, Aurora, CO
| | | | | | | | - Ishmael A Jaiyesimi
- Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine, Royal Oak, MI
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11
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Swanson LA, Kassab I, Tsung I, Schneider BJ, Fontana RJ. Liver injury during durvalumab-based immunotherapy is associated with poorer patient survival: A retrospective analysis. Front Oncol 2022; 12:984940. [PMID: 36353563 PMCID: PMC9637844 DOI: 10.3389/fonc.2022.984940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/21/2022] [Indexed: 09/19/2023] Open
Abstract
Background Durvalumab is approved for the treatment of lung cancer, advanced biliary tract cancers, and is also being evaluated in many other solid organ tumors. The aim of our study is to define the incidence, etiology, and outcomes of liver injury in consecutive patients receiving durvalumab-based immunotherapy. Patients and methods Durvalumab treated patients between 1/2016 - 7/2020 were identified from the electronic medical record. Liver injury was defined as serum AST or ALT ≥ 5x upper limit of normal (ULN), ALP ≥ 2x ULN, bilirubin ≥ 2.5 mg/dl, or INR ≥ 1.5. Potential drug induced liver injury (DILI) cases were adjudicated using expert opinion scoring and confirmed with Roussel Uclaf Causality Assessment Method (RUCAM). Results Amongst 112 patients, 58 (52%) had non-small cell lung cancer, the median age was 65 years, and 60% were male. The 21 (19%) liver injury patients were significantly more likely to harbor hepatic metastases (52% vs 17%, p=<0.001), experience tumor progression (67% vs 32%, p=0.01) or die (48% vs 11%, p<0.001) during follow-up compared to the 91 without liver injury. Using multivariate regression analysis, the development of liver injury during treatment as well as baseline hepatic metastases were independently associated with mortality during follow-up. Six of the 21 (29%) liver injury cases were adjudicated as probable DILI with four attributed to durvalumab and two due to other drugs (paclitaxel, pembrolizumab). Durvalumab was permanently discontinued in two DILI patients, three received corticosteroids, and one was successfully rechallenged. Only one patient with DILI developed jaundice, and none required hospitalization. Liver biochemistries normalized in all 6 DILI cases, while they only normalized in 27% of the 15 non-DILI cases (p=0.002). The 6 DILI patients also had a trend towards improved survival compared to those with other causes of liver injury. Conclusion Liver injury was observed in 19% of durvalumab-treated patients and is associated with a greater likelihood of tumor progression and death during follow-up. The four durvalumab DILI cases were mild and self-limited, highlighting the importance of causality assessment to determine the cause of liver injury in oncology patients receiving immunotherapy.
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Affiliation(s)
- Linnea A. Swanson
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ihab Kassab
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Irene Tsung
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Bryan J. Schneider
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Robert J. Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States
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12
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Singh N, Temin S, Baker S, Blanchard E, Brahmer JR, Celano P, Duma N, Ellis PM, Elkins IB, Haddad RY, Hesketh PJ, Jain D, Johnson DH, Leighl NB, Mamdani H, Masters G, Moffitt PR, Phillips T, Riely GJ, Robinson AG, Rosell R, Schiller JH, Schneider BJ, Spigel DR, Jaiyesimi IA. Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO Living Guideline. J Clin Oncol 2022; 40:3310-3322. [PMID: 35816666 DOI: 10.1200/jco.22.00824] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations updating the 2021 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. METHODS ASCO updated recommendations on the basis of an ongoing systematic review of randomized control trials from 2020 to 2021. RESULTS This guideline update reflects changes in evidence since the previous update. Two studies provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS For patients with an anaplastic lymphoma kinase rearrangement, a performance status (PS) of 0-2, and previously untreated NSCLC, clinicians should offer alectinib or brigatinib or lorlatinib. For patients with an anaplastic lymphoma kinase rearrangement, a PS of 0-2, and previously untreated NSCLC, if alectinib, brigatinib, or lorlatinib are not available, clinicians should offer ceritinib or crizotinib. For patients with a RET rearrangement, a PS of 0-2, and previously untreated NSCLC, clinicians may offer selpercatinib or pralsetinib. In second line, for patients with a RET rearrangement who have not received RET-targeted therapy, clinicians may offer selpercatinib or pralsetinib.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
- Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Julie R Brahmer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | | | | | | | | | | | | | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Hirva Mamdani
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | | | | | | | | | - Rafael Rosell
- Catalan Institute of Oncology, Barcelona, Catulunia, Spain
| | | | | | | | - Ishmael A Jaiyesimi
- Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine, Royal Oak, MI
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13
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Singh N, Temin S, Baker S, Blanchard E, Brahmer JR, Celano P, Duma N, Ellis PM, Elkins IB, Haddad RY, Hesketh PJ, Jain D, Johnson DH, Leighl NB, Mamdani H, Masters G, Moffitt PR, Phillips T, Riely GJ, Robinson AG, Rosell R, Schiller JH, Schneider BJ, Spigel DR, Jaiyesimi IA. Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline. J Clin Oncol 2022; 40:3323-3343. [PMID: 35816668 DOI: 10.1200/jco.22.00825] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations updating the 2020 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer without driver alterations. METHODS ASCO updated recommendations on the basis of an ongoing systematic review of randomized clinical trials from 2018 to 2021. RESULTS This guideline update reflects changes in evidence since the previous update. Five randomized clinical trials provide the evidence base. Outcomes of interest include efficacy and safety. RECOMMENDATIONS In addition to 2020 options for patients with high programmed death ligand-1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%), nonsquamous cell carcinoma (non-SCC), and performance status (PS) 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression (TPS ≥ 50%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilumumab alone or nivolumab and ipilimumab plus chemotherapy. With negative (0%) and low positive PD-L1 expression (TPS 1%-49%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or nivolumab and ipilimumab plus chemotherapy. With high PD-L1 expression, SCC, and PS 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression, squamous cell carcinoma (SCC), and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With negative and low positive PD-L1 expression, SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With non-SCC who received an immune checkpoint inhibitor and chemotherapy as first-line therapy, clinicians may offer second-line paclitaxel plus bevacizumab. With non-SCC, who received chemotherapy with or without bevacizumab and immune checkpoint inhibitor therapy, clinicians should offer the options of third-line single-agent pemetrexed, docetaxel, or paclitaxel plus bevacizumab.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
- Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Julie R Brahmer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | | | | | | | | | | | | | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Hirva Mamdani
- Karmanos Cancer Institute/Wayne State University, Detroit, MI
| | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
| | | | | | | | | | - Rafael Rosell
- Catalan Institute of Oncology, Barcelona, Catalonia, Spain
| | | | | | | | - Ishmael A Jaiyesimi
- Beaumont Health Royal Oak and Oakland University William Beaumont School of Medicine, Royal Oak, MI
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14
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Qin A, Lima F, Bell S, Kalemkerian GP, Schneider BJ, Ramnath N, Lew M, Krishnan S, Mohammed S, Rao A, Frankel TL. Cellular engagement and interaction in the tumor microenvironment predict non-response to PD-1/PD-L1 inhibitors in metastatic non-small cell lung cancer. Sci Rep 2022; 12:9054. [PMID: 35641540 PMCID: PMC9156701 DOI: 10.1038/s41598-022-13236-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) with anti-PD-1/PD-L1 agents have improved the survival of patients with metastatic non-small cell lung cancer (mNSCLC). Tumor PD-L1 expression is an imperfect biomarker as it does not capture the complex interactions between constituents of the tumor microenvironment (TME). Using multiplex fluorescent immunohistochemistry (mfIHC), we modeled the TME to study the influence of cellular distribution and engagement on response to ICI in mNSCLC. We performed mfIHC on pretreatment tissue from patients with mNSCLC who received ICI. We used primary antibodies against CD3, CD8, CD163, PD-L1, pancytokeratin, and FOXP3; simple and complex phenotyping as well as spatial analyses was performed. We analyzed 68 distinct samples from 52 patients with mNSCLC. Patients were 39–79 years old (median 67); 44% were male and 75% had adenocarcinoma histology. The most used ICI was atezolizumab (48%). The percentage of PD-L1 positive epithelial tumor cells (EC), degree of cytotoxic T lymphocyte (CTL) engagement with EC, and degree of CTL engagement with helper T lymphocytes (HTL) were significantly lower in non-responders versus responders (p = 0.0163, p = 0.0026 and p = 0.0006, respectively). The combination of these 3 characteristics generated the best sensitivity and specificity to predict non-response to ICI and was also associated with shortened overall survival (p = 0.0271). The combination of low CTL engagement with EC and HTL along with low expression of EC PD-L1 represents a state of impaired endogenous immune reactivity. Together, they more precisely identified non-responders to ICI compared to PD-L1 alone and illustrate the importance of cellular interactions in the TME.
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Affiliation(s)
- Angel Qin
- Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Fatima Lima
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA
| | | | - Gregory P Kalemkerian
- Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Bryan J Schneider
- Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Nithya Ramnath
- Department of Internal Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI, USA.,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Madelyn Lew
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Santhoshi Krishnan
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Shariq Mohammed
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Timothy L Frankel
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA. .,VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
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15
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Schneider BJ, Chang AC. ASO Perspectives: Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer: Never Stop Questioning. Ann Surg Oncol 2022; 29:2735-2738. [PMID: 35182309 DOI: 10.1245/s10434-021-11276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022]
Abstract
This ASO perspective reviews the findings of a randomized placebo-controlled, clinical trial evaluating adjuvant nivolumab in esophageal or gastroesophageal junction carcinoma, reported recently by the Checkmate 577 investigators. The use of postoperative immunotherapy represents a significant paradigm shift for managing patients who have had limited evidence-based treatment options after completing neoadjuvant chemoradiation followed by resection for these aggressive malignancies.
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Affiliation(s)
- Bryan J Schneider
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andrew C Chang
- Department of Surgery, University of Michigan, TC2120/5344, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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16
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Fecher LA, Bishu S, Fontana RJ, Hayek SS, Schneider BJ. The Role of Tissue Biopsy in the Management of Immune Checkpoint Inhibitor Toxicity. J Natl Compr Canc Netw 2022; 20:417-425. [PMID: 35390763 DOI: 10.6004/jnccn.2022.7011] [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] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
Immune checkpoint inhibitors have revolutionized the treatment of cancer and are now omnipresent. However, immune-related adverse events can present with varying phenotypes and timing, which can pose diagnostic and therapeutic challenges for the treating oncologist as well as subspecialty consultants. Biopsies of affected organs may provide insight into biologic mechanisms as well as potentially guide management in certain circumstances.
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Affiliation(s)
| | | | | | - Salim S Hayek
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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17
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Thompson JA, Schneider BJ, Brahmer J, Achufusi A, Armand P, Berkenstock MK, Bhatia S, Budde LE, Chokshi S, Davies M, Elshoury A, Gesthalter Y, Hegde A, Jain M, Kaffenberger BH, Lechner MG, Li T, Marr A, McGettigan S, McPherson J, Medina T, Mohindra NA, Olszanski AJ, Oluwole O, Patel SP, Patil P, Reddy S, Ryder M, Santomasso B, Shofer S, Sosman JA, Wang Y, Zaha VG, Lyons M, Dwyer M, Hang L. Management of Immunotherapy-Related Toxicities, Version 1.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:387-405. [PMID: 35390769 DOI: 10.6004/jnccn.2022.0020] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions, consisting of medical and hematologic oncologists with expertise across a wide range of disease sites, and experts from the areas of dermatology, gastroenterology, endocrinology, neurooncology, nephrology, cardio-oncology, ophthalmology, pulmonary medicine, and oncology nursing. The content featured in this issue is an excerpt of the recommendations for managing toxicities related to CAR T-cell therapies and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to immune checkpoint inhibitors, visit NCCN.org.
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Affiliation(s)
- John A Thompson
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Julie Brahmer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | - Saurin Chokshi
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | | | | | | | | | - Benjamin H Kaffenberger
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Nisha A Mohindra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Pradnya Patil
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Vlad G Zaha
- UT Southwestern Simmons Comprehensive Cancer Center; and
| | | | | | - Lisa Hang
- National Comprehensive Cancer Network
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18
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Schneider BJ, Lacchetti C, Bollin K. Management of the Top 10 Most Common Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy. JCO Oncol Pract 2022; 18:431-444. [DOI: 10.1200/op.21.00776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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19
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Schneider BJ, Naidoo J, Santomasso BD, Lacchetti C, Adkins S, Anadkat M, Atkins MB, Brassil KJ, Caterino JM, Chau I, Davies MJ, Ernstoff MS, Fecher L, Ghosh M, Jaiyesimi I, Mammen JS, Naing A, Nastoupil LJ, Phillips T, Porter LD, Reichner CA, Seigel C, Song JM, Spira A, Suarez-Almazor M, Swami U, Thompson JA, Vikas P, Wang Y, Weber JS, Funchain P, Bollin K. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update. J Clin Oncol 2021; 39:4073-4126. [PMID: 34724392 DOI: 10.1200/jco.21.01440] [Citation(s) in RCA: 488] [Impact Index Per Article: 162.7] [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 To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with immune checkpoint inhibitor (ICPi) therapy. METHODS A multidisciplinary panel of medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to update the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 through 2021. RESULTS A total of 175 studies met the eligibility criteria of the systematic review and were pertinent to the development of the recommendations. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to the organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, except for some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert ≤ grade 1. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids. Corticosteroids should be tapered over the course of at least 4-6 weeks. Some refractory cases may require other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, except for endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | - Jarushka Naidoo
- Beaumont Hospital, Dublin, Ireland.,Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | | | | | | | | | - Ian Chau
- Royal Marsden Hospital and Institute of Cancer Research, London & Surrey, Sutton, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Umang Swami
- Huntsman Cancer Institute-University of Utah, Salt Lake City, UT
| | - John A Thompson
- Seattle Cancer Care Alliance, University of Washington/Fred Hutchinson, Seattle, WA
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20
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Santomasso BD, Nastoupil LJ, Adkins S, Lacchetti C, Schneider BJ, Anadkat M, Atkins MB, Brassil KJ, Caterino JM, Chau I, Davies MJ, Ernstoff MS, Fecher L, Funchain P, Jaiyesimi I, Mammen JS, Naidoo J, Naing A, Phillips T, Porter LD, Reichner CA, Seigel C, Song JM, Spira A, Suarez-Almazor M, Swami U, Thompson JA, Vikas P, Wang Y, Weber JS, Bollin K, Ghosh M. Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline. J Clin Oncol 2021; 39:3978-3992. [PMID: 34724386 DOI: 10.1200/jco.21.01992] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events (irAEs) in patients treated with chimeric antigen receptor (CAR) T-cell therapy. METHODS A multidisciplinary panel of medical oncology, neurology, hematology, emergency medicine, nursing, trialists, and advocacy experts was convened to develop the guideline. Guideline development involved a systematic literature review and an informal consensus process. The systematic review focused on evidence published from 2017 to 2021. RESULTS The systematic review identified 35 eligible publications. Because of the paucity of high-quality evidence, recommendations are based on expert consensus. RECOMMENDATIONS The multidisciplinary team issued recommendations to aid in the recognition, workup, evaluation, and management of the most common CAR T-cell-related toxicities, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, B-cell aplasia, cytopenias, and infections. Management of short-term toxicities associated with CAR T cells begins with supportive care for most patients, but may require pharmacologic interventions for those without adequate response. Management of patients with prolonged or severe CAR T-cell-associated cytokine release syndrome includes treatment with tocilizumab with or without a corticosteroid. On the basis of the potential for rapid decline, patients with moderate to severe immune effector cell-associated neurotoxicity syndrome should be managed with corticosteroids and supportive care.Additional information is available at www.asco.org/supportive-care-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ian Chau
- Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom
| | | | | | | | | | | | | | - Jarushka Naidoo
- Beaumont Hospital, Dublin, Ireland and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | | | | | | | | | | | | | | | | | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - John A Thompson
- Seattle Cancer Care Alliance, University of Washington/Fred Hutchinson, Seattle, WA
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21
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Thompson JA, Schneider BJ, Brahmer J, Andrews S, Armand P, Bhatia S, Budde LE, Costa L, Davies M, Dunnington D, Ernstoff MS, Frigault M, Kaffenberger BH, Lunning M, McGettigan S, McPherson J, Mohindra NA, Naidoo J, Olszanski AJ, Oluwole O, Patel SP, Pennell N, Reddy S, Ryder M, Santomasso B, Shofer S, Sosman JA, Wang Y, Weight RM, Johnson-Chilla A, Zuccarino-Catania G, Engh A. NCCN Guidelines Insights: Management of Immunotherapy-Related Toxicities, Version 1.2020. J Natl Compr Canc Netw 2021; 18:230-241. [PMID: 32135517 DOI: 10.6004/jnccn.2020.0012] [Citation(s) in RCA: 231] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The NCCN Guidelines for Management of Immunotherapy-Related Toxicities provide interdisciplinary guidance on the management of immune-related adverse events (irAEs) resulting from cancer immunotherapy. These NCCN Guidelines Insights describe symptoms that may be caused by an irAE and should trigger further investigation, and summarize the NCCN Management of Immunotherapy-Related Toxicities Panel discussions for the 2020 update to the guidelines regarding immune checkpoint inhibitor-related diarrhea/colitis and cardiovascular irAEs.
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Affiliation(s)
- John A Thompson
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Julie Brahmer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | | | | | - Benjamin H Kaffenberger
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | - Nisha A Mohindra
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Jarushka Naidoo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | - Nathan Pennell
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Jeffrey A Sosman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
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22
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Shah MA, Almhanna K, Iqbal S, Thakkar P, Schneider BJ, Yantiss R, Wu Y, Futamura E, Port JL, Spinelli C, Sarkar S, Christos PJ, Brar G, Betel D, Sanfilippo NJ, Altorki NK. Multicenter, randomized phase II study of neoadjuvant pembrolizumab plus chemotherapy and chemoradiotherapy in esophageal adenocarcinoma (EAC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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
4005 Background: Recent transformative studies in the treatment of EAC support adjuvant nivolumab for patients with residual disease following neoadjuvant chemoradiotherapy (CRT) (Checkmate 577) and pembrolizumab (P) with chemotherapy in untreated metastatic disease (Keynote 590). We hypothesized that pre-operative P combined with CRT can further improve outcomes in patients with locally advanced EAC. Methods: Patients with cT3-4Nx or T2N1 M0 EAC or gastroesophageal junction (GEJ) adenocarcinoma eligible for curative surgery were randomized (1:1) to receive either full-dose paclitaxel (T)/ carboplatin (C) or T/C + P induction therapy. All patients then received CRT with weekly T/C, RT 41.4Gy in 23 fractions, and P every 3 weeks. Following resection, patients received P for one year. The primary endpoint is rate of major pathologic response (MPR), defined as pathologic complete response or near complete response ( < 10% residual cancer), with 80% power and 0.1 one-sided significance level to detect the difference between a MPR proportion of 30% (historical control) and an alternative hypothesis of 47% (with preoperative P). Tissue was collected for tumor immune microenvironment (TIME) analysis including bulk and single cell RNA(scRNA) expression analysis, DNA sequencing, and flow cytometry. Results: From 8/4/17 to 10/26/20, 40 patients were enrolled: median age 68 [38-81], male 32, esophagus/GEJ type I (n = 16), GEJ II/III (n = 24). CRT was well tolerated, with no grade 3-4 adverse events attributed to P. Notable toxicity included grade 3-4 pneumonitis (13%), anastomotic leak (13%), infection (35%). In 31 evaluable patients to date, the MPR rate was 50.0% (95% CI, 32.7%-67.3%). 1-yr disease free survival was 100% for patients with MPR vs. 31.8% without MPR, p = 0.002. Esophageal/GEJ type I cancers had a significantly higher MPR rate when compared with GEJ type II/III (76.9% vs 37.5%, p = 0.03). scRNA seq on > 100,000 tumor cells revealed EAC/GEJ type I had higher infiltration of activated dendritic cells (p = 0.12), whereas GEJ tumors have significantly higher infiltration of activated B cells (p = 0.02). Conclusions: The addition of P to preoperative CRT for EAC is safe and associated with a significantly higher MPR rate compared to historical data. We found MPR to be significantly enriched in EAC/GEJ type I tumors compared with GEJ II/III, associated with important differences in the baseline tumor immune microenvironment. Clinical trial information: NCT02998268.
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Affiliation(s)
| | | | - Syma Iqbal
- USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Prashant Thakkar
- Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | | | | | - Yiru Wu
- Lifespan Cancer Institute, Providence, RI
| | | | | | | | | | - Paul J. Christos
- Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY
| | | | - Doron Betel
- Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
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23
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Qin A, Zhao S, Miah A, Wei L, Patel S, Johns A, Grogan M, Bertino EM, He K, Shields PG, Kalemkerian GP, Gadgeel SM, Ramnath N, Schneider BJ, Hassan KA, Szerlip N, Chopra Z, Journey S, Waninger J, Spakowicz D, Carbone DP, Presley CJ, Otterson GA, Green MD, Owen DH. Bone Metastases, Skeletal-Related Events, and Survival in Patients With Metastatic Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors. J Natl Compr Canc Netw 2021; 19:915-921. [PMID: 33878726 DOI: 10.6004/jnccn.2020.7668] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bone metastases and skeletal-related events (SREs) are a frequent cause of morbidity in patients with metastatic non-small cell lung cancer (mNSCLC). Data are limited on bone metastases and SREs in patients with mNSCLC treated using immune checkpoint inhibitors (ICIs), and on the efficacy of bone-modifying agents (BMAs) in this setting. Here we report the incidence, impact on survival, risk factors for bone metastases and SREs, and impact of BMAs in patients with mNSCLC treated with ICIs in a multi-institutional cohort. PATIENTS AND METHODS We conducted a retrospective study of patients with mNSCLC treated with ICIs at 2 tertiary care centers from 2014 through 2017. Overall survival (OS) was compared between patients with and without baseline bone metastases using a log-rank test. A Cox regression model was used to evaluate the association between OS and the presence of bone metastases at ICI initiation, controlling for other confounding factors. RESULTS We identified a cohort of 330 patients who had received ICIs for metastatic disease. Median patient age was 63 years, most patients were treated in the second line or beyond (n=259; 78%), and nivolumab was the most common ICI (n=211; 64%). Median OS was 10 months (95% CI, 8.4-12.0). In our cohort, 124 patients (38%) had baseline bone metastases, and 43 (13%) developed SREs during or after ICI treatment. Patients with bone metastases had a higher hazard of death after controlling for performance status, histology, line of therapy, and disease burden (hazard ratio, 1.57; 95% CI, 1.19-2.08; P=.001). Use of BMAs was not associated with OS or a decreased risk of SREs. CONCLUSIONS Presence of bone metastases at baseline was associated with a worse prognosis for patients with mNSCLC treated with ICI after controlling for multiple clinical characteristics. Use of BMAs was not associated with reduced SREs or a difference in survival.
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Affiliation(s)
- Angel Qin
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Sandipkumar Patel
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Andrew Johns
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | | | | | - Kai He
- Division of Medical Oncology, and
| | | | | | - Shirish M Gadgeel
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.,Division of Hematology and Oncology, Henry Ford Cancer Center, Detroit, Michigan
| | - Nithya Ramnath
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Bryan J Schneider
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Khaled A Hassan
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio; and
| | | | | | | | | | | | | | | | | | - Michael D Green
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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24
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Daly ME, Ismaila N, Decker RH, Higgins K, Owen D, Saxena A, Franklin GE, Donaldson D, Schneider BJ. Radiation Therapy for Small-Cell Lung Cancer: ASCO Guideline Endorsement of an ASTRO Guideline. J Clin Oncol 2021; 39:931-939. [DOI: 10.1200/jco.20.03364] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on radiation therapy (RT) for small-cell lung cancer (SCLC). Because of the relevance of this topic to ASCO membership, ASCO reviewed the guideline, applying a set of procedures and policies used to critically examine guidelines developed by other organizations. METHODS The ASTRO guideline on RT for SCLC was reviewed for developmental rigor by methodologists. Then, an ASCO Expert Panel reviewed the content and the recommendations. RESULTS The ASCO Expert Panel determined that the recommendations from ASTRO guideline on RT for SCLC, published in June 2020, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed ASTRO guideline on RT for SCLC with a few discussion points. RECOMMENDATIONS Recommendations addressed thoracic radiotherapy for limited-stage SCLC, role of stereotactic body radiotherapy in stage I or II node-negative SCLC, prophylactic cranial radiotherapy, and thoracic consolidation for extensive-stage SCLC. Additional information is available at www.asco.org/thoracic-cancer-guidelines .
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25
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Hanna NH, Robinson AG, Temin S, Baker S, Brahmer JR, Ellis PM, Gaspar LE, Haddad RY, Hesketh PJ, Jain D, Jaiyesimi I, Johnson DH, Leighl NB, Moffitt PR, Phillips T, Riely GJ, Rosell R, Schiller JH, Schneider BJ, Singh N, Spigel DR, Tashbar J, Masters G. Therapy for Stage IV Non-Small-Cell Lung Cancer With Driver Alterations: ASCO and OH (CCO) Joint Guideline Update. J Clin Oncol 2021; 39:1040-1091. [PMID: 33591844 DOI: 10.1200/jco.20.03570] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) with driver alterations. A guideline update for systemic therapy for patients with stage IV NSCLC without driver alterations was published separately. METHODS The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel updated recommendations based on a systematic review of randomized controlled trials (RCTs) from December 2015 to January 2020 and meeting abstracts from ASCO 2020. RESULTS This guideline update reflects changes in evidence since the previous update. Twenty-seven RCTs, 26 observational studies, and one meta-analysis provide the evidence base (total 54). Outcomes of interest included efficacy and safety. Additional literature suggested by the Expert Panel is discussed. RECOMMENDATIONS All patients with nonsquamous NSCLC should have the results of testing for potentially targetable mutations (alterations) before implementing therapy for advanced lung cancer, regardless of smoking status recommendations, when possible, following other existing high-quality testing guidelines. Most patients should receive targeted therapy for these alterations: Targeted therapies against ROS-1 fusions, BRAF V600e mutations, RET fusions, MET exon 14 skipping mutations, and NTRK fusions should be offered to patients, either as initial or second-line therapy when not given in the first-line setting. New or revised recommendations include the following: Osimertinib is the optimal first-line treatment for patients with activating epidermal growth factor receptor mutations (exon 19 deletion, exon 21 L858R, and exon 20 T790M); alectinib or brigatinib is the optimal first-line treatment for patients with anaplastic lymphoma kinase fusions. For the first time, to our knowledge, the guideline includes recommendations regarding RET, MET, and NTRK alterations. Chemotherapy is still an option at most stages.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
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Affiliation(s)
- Nasser H Hanna
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Andrew G Robinson
- Kingston General Hospital, School of Medicine, Queen's University, ON, Canada
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | - Laurie E Gaspar
- University of Colorado School of Medicine, Denver, CO.,Banner MDA Cancer Center, Greeley, CO
| | | | | | | | | | | | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Rafael Rosell
- Catalan Institute of Oncology, Barcelona, Catalonia, Spain
| | | | | | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
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26
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Zeinali M, Huang W, Lee M, Nadhan A, Mathur A, Hedman C, Lin E, Harouaka R, Wicha MS, Zhao L, Palanisamy N, Hafner M, Reddy R, Kalemkerian GP, Schneider BJ, Hassan KA, Ramnath N, Nagrath S. Abstract B45: High-throughput label-free isolation and expansion of circulating tumor cells (CTCs) from non-small cell lung cancer (NSCLC) patients for personalized treatments. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.liqbiop20-b45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Circulating tumor cell (CTC) clusters are emerging as clinically significant harbingers of metastases in solid organ cancers. Prior to engaging these CTC clusters in animal models of metastases, it is imperative for technology to identify them with high sensitivity. These clusters often present heterogeneous surface markers, and current methods for isolation of clusters may fall short.
Methods: We have applied the inertial microfluidic Labyrinth device for high-throughput, biomarker-independent, size-based isolation of CTCs and CTC clusters from patients with metastatic non-small cell lung cancer (NSCLC).
Results: Using the Labyrinth device, CTCs (PanCK+/DAPI+/CD45-) were isolated from metastatic NSCLC patients (n=25). Heterogeneous CTC populations were detected, including CTCs expressing epithelial (EpCAM), mesenchymal (vimentin), or both markers. CTCs were isolated from 100% of patients (417±1023 CTCs/mL), and CTCs that were EpCAM negative were significantly higher in numbers than EpCAM+ CTCs. Cell clusters of ≥2 CTCs were observed in 96% of patients, of which 75% were negative for EpCAM. Patients with higher number of CTC clusters than single CTCs had worse progression-free survival (PFS) (p=0.05). Recovered CTCs from patients with RET, ROS1, and ALK-rearranged tumors revealed identical genetic aberrations as the primary tumor for each gene using FISH analysis. We have successfully expanded the recovered CTCs from 2 patients and screened for therapeutic targeting. We have found that TPX-0005 might be effective in these patients and would direct them to a clinical trial using this compound.
Conclusions: The label-free Labyrinth device demonstrated the capability of collecting recovered CTCs from the device using a continuous processing technique while in a suspension state. This advantage opens the opportunities not only for CTC expansion off-chip, but also for ex vivo drug testing to direct patient-specific therapies.
Citation Format: Mina Zeinali, Wei Huang, Maggie Lee, Arthi Nadhan, Anvya Mathur, Casey Hedman, Eric Lin, Ramdane Harouaka, Max S. Wicha, Lili Zhao, Nallasivam Palanisamy, Mathias Hafner, Rishindra Reddy, Gregory P. Kalemkerian, Bryan J. Schneider, Khaled A. Hassan, Nithya Ramnath, Sunitha Nagrath. High-throughput label-free isolation and expansion of circulating tumor cells (CTCs) from non-small cell lung cancer (NSCLC) patients for personalized treatments [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr B45.
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Affiliation(s)
| | - Wei Huang
- 1University of Michigan, Ann Arbor, MI,
| | | | | | | | | | - Eric Lin
- 1University of Michigan, Ann Arbor, MI,
| | | | | | - Lili Zhao
- 1University of Michigan, Ann Arbor, MI,
| | | | - Mathias Hafner
- 2Institute for Medical Technology of Heidelberg University, Mannheim, Germany
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Mamdani H, Schneider BJ, Kasi PM, Abushahin LI, Birdas TJ, Kesler K, Burney H, Perkins S, Jalal SI. Durvalumab following multimodality therapy for locally advanced esophageal and GEJ adenocarcinoma: Updated survival and early translational results from Big Ten Cancer Research Consortium Study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4572 Background: Concurrent chemoradiation(CRT) followed by esophagectomy is a standard of care for locally advanced esophageal(LA-EAC) and GEJ adenocarcinoma. Approximately 50% of patients(pts) experience disease relapse within the 1st yr after treatment(tx) completion. Immune checkpoint inhibitors have activity in metastatic PD-L1 positive EAC. Preclinical studies have shown radiation +/- chemotherapy upregulates PD-1/PD-L1 pathway. Methods: We conducted a phase II trial evaluating safety and efficacy of PD-L1 inhibitor durvalumab(durva) in pts with LA-EAC and GEJ adenocarcinoma who had residual disease in surgical specimen after neoadjuvant CRT and R0 resection. Pts received durva 1500mg IV every 4 weeks for up to 1yr. Results: Initially 24 pts were enrolled, study was expanded to enroll additional 13 pts. Median age: 61yrs (range, 43-73). 31 received carbo/paclitaxel and 6 received cis/5-FU concurrently with RT. 24(64.9%) pts had positive lymph nodes(LN) at the time of surgery following CRT: N3(n = 3,8.1%), N2(n = 10, 27%), N1(n = 11,29.7%).17 pts relapsed: 11 on tx, 6 had late relapses. 3/5 late relapses were locoregional and were re-treated with chemo-RT. Remaining relapses were systemic with lung and LN being the most common sites. 2 of 3 pts who developed grade 3 irAEs are alive and disease free at 17 and 23 mo. RFS/OS:1 yr- 79.2%/95.5%, 2yr-55.5%/67.4%. 20/37 pts have HER-2 status available: 5/6 HER2 positive pts had disease relapse, 1 is undergoing tx. Molecular profiling is available on 8 relapsed pts: all were microsatellite stable with low TMB and PD-L1 < 10% CPS. Mutations in DNA repair genes ( ARID1A, ATM, ATR, CHEK2), and PIK3CA E542K were more prevalent among late relapsing pts. Circulating tumor cells (CTCs) analysis is available for 10/37 pts. 4/5 pts where CTCs increased from C1 to C4 had disease relapse. Molecular profiling of the remaining pts and correlation of PD-L1 expression, TMB, specific genes mutations, CTCs, and Immunoscore with outcomes with durva is being evaluated will be presented at the meeting. Conclusions: Adjuvant durva following trimodality therapy for LA-EAC and GEJ adenocarcinoma improved 1-yr RFS to 79.2% compared to historical rate of 50%.2-yr RFS and OS data are encouraging in this high risk pt population. HER-2 positivity may be associated with lack of benefit from durva. Mutations in DNA repair genes are prevalent in pts with delayed relapse. Rise in CTCs during durva tx may be an early marker of disease relapse. Clinical trial information: NCT02639065 .
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Affiliation(s)
| | | | | | | | | | | | | | - Susan Perkins
- Indiana University Health Simon Cancer Center, Indianapolis, IN
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28
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Simone CB, Bogart JA, Cabrera AR, Daly ME, DeNunzio NJ, Detterbeck F, Faivre-Finn C, Gatschet N, Gore E, Jabbour SK, Kruser TJ, Schneider BJ, Slotman B, Turrisi A, Wu AJ, Zeng J, Rosenzweig KE. Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:158-173. [PMID: 32222430 PMCID: PMC10915746 DOI: 10.1016/j.prro.2020.02.009] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Several sentinel phase III randomized trials have recently been published challenging traditional radiation therapy (RT) practices for small cell lung cancer (SCLC). This American Society for Radiation Oncology guideline reviews the evidence for thoracic RT and prophylactic cranial irradiation (PCI) for both limited-stage (LS) and extensive-stage (ES) SCLC. METHODS The American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications, dose fractionation, techniques and timing of thoracic RT for LS-SCLC, the role of stereotactic body radiation therapy (SBRT) compared with conventional RT in stage I or II node negative SCLC, PCI for LS-SCLC and ES-SCLC, and thoracic consolidation for ES-SCLC. Recommendations were based on a systematic literature review and created using a consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS The task force strongly recommends definitive thoracic RT administered once or twice daily early in the course of treatment for LS-SCLC. Adjuvant RT is conditionally recommended in surgically resected patients with positive margins or nodal metastases. Involved field RT delivered using conformal advanced treatment modalities to postchemotherapy volumes is also strongly recommended. For patients with stage I or II node negative disease, SBRT or conventional fractionation is strongly recommended, and chemotherapy should be delivered before or after SBRT. In LS-SCLC, PCI is strongly recommended for stage II or III patients who responded to chemoradiation, conditionally not recommended for stage I patients, and should be a shared decision for patients at higher risk of neurocognitive toxicities. In ES-SCLC, radiation oncologist consultation for consideration of PCI versus magnetic resonance surveillance is strongly recommended. Lastly, the use of thoracic RT is strongly recommended in select patients with ES-SCLC after chemotherapy treatment, including a conditional recommendation in those responding to chemotherapy and immunotherapy. CONCLUSIONS RT plays a vital role in both LS-SCLC and ES-SCLC. These guidelines inform best clinical practices for local therapy in SCLC.
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Affiliation(s)
| | - Jeffrey A Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
| | - Alvin R Cabrera
- Department of Radiation Oncology, Kaiser Permanente, Seattle, WA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis, Sacramento, CA
| | - Nicholas J DeNunzio
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - Corinne Faivre-Finn
- Division of Cancer Science, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers University, New Brunswick, NJ
| | - Tim J Kruser
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL
| | - Bryan J Schneider
- Department of Medical Oncology, University of Michigan, Ann Arbor, MI
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Andrew Turrisi
- Department of Radiation Oncology, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington, Seattle, WA
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Shah MA, Oliver TK, Peterson DE, Einhaus K, Schneider BJ, Denduluri N, Chavez-MacGregor M. ASCO Clinical Practice Guideline Endorsements and Adaptations. J Clin Oncol 2020; 38:834-840. [DOI: 10.1200/jco.19.02839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ASCO engages in the endorsement and adaptation of clinical practice guidelines to recognize the high-quality work of other guideline-developing organizations, to avoid duplication of effort, and to offer harmonized recommendations across guideline development groups. ASCO develops guidelines in accordance with the principles of the National Academy of Medicine and Council of Medical Specialty Societies. Guidelines developed in a similar manner by other organizations make endorsement by ASCO more likely. If allowed by the partnering organization, ASCO may consider an adaptation of a guideline, building on the original guideline with further inquiry or modifications. Organizations seeking ASCO endorsement consideration are provided with ASCO’s endorsement and adaptation procedures at the time of endorsement submission They can request either Endorsement or Endorsement or Adaptation. ASCO endorsement entails a formal review by an independent ASCO Expert Panel, and, if modifications to the recommendations are made, depending upon the original endorsement request, guidelines will be adapted or discontinued, rather than endorsed. The process begins with approval from ASCO’s Clinical Practice Guideline Committee (CPGC) leadership to proceed with endorsement development. An ASCO Expert Panel of approximately 10 multidisciplinary content experts, patient representatives, community oncologists, and relevant health providers is formed to develop an ASCO endorsement. ASCO’s Conflict of Interest Policy Implementation for Clinical Practice Guidelines and procedures apply to all ASCO expert panels. The CPGC reviews and approves all ASCO guideline products on behalf of ASCO. The endorsement process described in this report is designed to preserve a high-quality and resource-efficient approach for potential ASCO endorsement or adaptation of guidelines developed by other health professional organizations, while maintaining the objectivity, quality, and high standards reflective of ASCO’s guiding principles.
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30
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Mamdani H, Schneider BJ, Kasi PM, Abushahin LI, Birdas TJ, Kesler K, Burney H, Perkins S, Jalal SI. Safety and efficacy of durvalumab following multimodality therapy for locally advanced esophageal and GEJ adenocarcinoma: Two-year follow-up results from Big Ten Cancer Research Consortium study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
404 Background: Concurrent chemoradiation(CRT) followed by esophagectomy is a standard of care for locally advanced esophageal(LA-EAC) and GEJ adenocarcinoma. Approximately 50% of patients(pts) experience disease relapse within the 1st yr after treatment(tx) completion. No adjuvant tx has been shown to improve survival in these pts. Immune checkpoint inhibitors have activity in metastatic PD-L1 positive EAC. Preclinical studies have shown radiation +/- chemotherapy upregulate PD-1/PD-L1 pathway. Methods: We conducted a phase II trial evaluating safety and efficacy of durvalumab(durva) in pts with LA-EAC and GEJ adenocarcinoma who have residual disease in surgical specimen after neoadjuvant CRT and R0 resection. Pts received durva 1500mg IV every 4 weeks for up to 1yr. Results: 24 pts were enrolled from 4/2016-1/2018(median age: 60yrs (range, 43-70). 18 received carbo/paclitaxel and 6 received cis/5-FU concurrently with radiation. Staging at diagnosis: T2N0(n = 3, 12.5%), T2N2(n = 3, 12.5%),T3N0(n = 6, 25%), T3N1(n = 6, 25%), T3N2(n = 4, 17%), T3N3(n = 1, 4%), T3Nx(n = 1, 4%).19 pts(79%) had positive lymph nodes(LNs) at the time of surgery following CRT. 12 pts completed 1yr of tx, 12 came off tx because of relapse(6), AEs(5), and consent withdrawal(1). Most common AEs were fatigue(n = 8, 33.3%) and nausea(n = 6, 25%). 3pts (12.5%) developed grade 3 irAEs: pneumonitis(1), hepatitis(1), colitis(1). At median follow up of 21.9mo(range, 1.7-23.9mo), 11 pts have relapsed: 9 distant and 2 locoregional. Two of 3 pts with grade 3 irAEs are alive and disease free at 17 and 23 mo respectively. 1-yr RFS and OS were 79.2% and 95.5%, respectively. RFS at 26 mo was 20.6%. Overall mOS and mOS after relapse were 28.1mo(range, 22.9-28.1) and 11.1 mo(range, 0.1-11.3mo) respectively. The study was expanded to enroll 14 additional pts who are currently undergoing tx. Conclusions: Adjuvant durvalumab following trimodality therapy for LA-EAC and GEJ adenocarcinoma is safe with improvement in 1-yr RFS to 79.2% compared to historical rate of 50%. RFS was 20.6% at 26 months. Evaluation of predictive biomarkers of RFS with durva is underway. Clinical trial information: NCT02639065.
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Affiliation(s)
| | | | | | - Laith I. Abushahin
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | | | | | | | - Susan Perkins
- Indiana University Health Simon Cancer Center, Indianapolis, IN
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31
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Hanna NH, Schneider BJ, Temin S, Baker S, Brahmer J, Ellis PM, Gaspar LE, Haddad RY, Hesketh PJ, Jain D, Jaiyesimi I, Johnson DH, Leighl NB, Phillips T, Riely GJ, Robinson AG, Rosell R, Schiller JH, Singh N, Spigel DR, Stabler JO, Tashbar J, Masters G. Therapy for Stage IV Non-Small-Cell Lung Cancer Without Driver Alterations: ASCO and OH (CCO) Joint Guideline Update. J Clin Oncol 2020; 38:1608-1632. [PMID: 31990617 DOI: 10.1200/jco.19.03022] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of this work is to provide evidence-based recommendations updating the 2017 ASCO guideline on systemic therapy for patients with stage IV non-small-cell lung cancer (NSCLC) without driver alterations. A guideline update for patients with stage IV NSCLC with driver alterations will be published separately. METHODS The American Society of Clinical Oncology and Ontario Health (Cancer Care Ontario) NSCLC Expert Panel made updated recommendations based on a systematic review of randomized controlled trials from December 2015 to 2019. RESULTS This guideline update reflects changes in evidence since the previous guideline update. Five randomized controlled trials provide the evidence base. Additional literature suggested by the Expert Panel is discussed. RECOMMENDATIONS Recommendations apply to patients without driver alterations in epidermal growth factor receptor or ALK. For patients with high programmed death ligand 1 (PD-L1) expression (tumor proportion score [TPS] ≥ 50%) and non-squamous cell carcinoma (non-SCC), the Expert Panel recommends single-agent pembrolizumab. Additional treatment options include pembrolizumab/carboplatin/pemetrexed, atezolizumab/carboplatin/paclitaxel/bevacizumab, or atezolizumab/carboplatin/nab-paclitaxel. For most patients with non-SCC and either negative (0%) or low positive (1% to 49%) PD-L1, the Expert Panel recommends pembrolizumab/carboplatin/pemetrexed. Additional options are atezolizumab/carboplatin/nab-paclitaxel, atezolizumab/carboplatin/paclitaxel/bevacizumab, platinum-based two-drug combination chemotherapy, or non-platinum-based two-drug therapy. Single-agent pembrolizumab is an option for low positive PD-L1. For patients with high PD-L1 expression (TPS ≥ 50%) and SCC, the Expert Panel recommends single-agent pembrolizumab. An additional treatment option is pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel). For most patients with SCC and either negative (0%) or low positive PD-L1 (TPS 1% to 49%), the Expert Panel recommends pembrolizumab/carboplatin/(paclitaxel or nab-paclitaxel) or chemotherapy. Single-agent pembrolizumab is an option in select cases of low positive PD-L1. Recommendations are conditional on the basis of histology, PD-L1 status, and/or the presence or absence of contraindications. Additional information is available at www.asco.org/lung-cancer-guidelines.
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Affiliation(s)
- Nasser H Hanna
- Indiana University Simon Cancer Center, Indianapolis, IN
| | | | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | - Julie Brahmer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | - Laurie E Gaspar
- University of Colorado School of Medicine, Denver, CO.,Banner MD Anderson Cancer Center, Greeley, CO
| | | | | | | | | | | | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | | | - Andrew G Robinson
- Kingston General Hospital, School of Medicine, Queen's University, Ontario, Canada
| | | | | | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Joan Tashbar
- Circle of Hope for Cancer Research, St Cloud, FL
| | - Gregory Masters
- Helen F. Graham Cancer Center and Research Institute, Newark, DE
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Smith DC, Kroiss M, Kebebew E, Habra MA, Chugh R, Schneider BJ, Fassnacht M, Jafarinasabian P, Ijzerman MM, Lin VH, Mohideen P, Naing A. A phase 1 study of nevanimibe HCl, a novel adrenal-specific sterol O-acyltransferase 1 (SOAT1) inhibitor, in adrenocortical carcinoma. Invest New Drugs 2020; 38:1421-1429. [PMID: 31984451 DOI: 10.1007/s10637-020-00899-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/15/2020] [Indexed: 11/30/2022]
Abstract
Background Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with very limited treatment options. Nevanimibe HCl (formerly ATR-101), a novel adrenal-specific sterol O-acyltransferase 1 (SOAT1) inhibitor, has been shown in nonclinical studies to decrease adrenal steroidogenesis at lower doses and to cause apoptosis of adrenocortical cells at higher doses. Methods This phase 1, multicenter, open-label study assessed the safety and pharmacokinetics (PK) of nevanimibe in adults with metastatic ACC (NCT01898715). A "3 + 3" dose-escalation design was used. Adverse events (AEs), PK, and tumor response based on Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 were evaluated every 2 months. Results 63 patients with metastatic ACC, all of whom had previously failed systemic chemotherapy and only 2 of whom were mitotane-naïve, were dosed with oral nevanimibe at doses ranging from 1.6 mg/kg/day to 158.5 mg/kg/day. Subjects who did not experience tumor progression or a dose-limiting toxicity (DLT) could continue to receive additional cycles. No patients experienced a complete or partial response; however, 13 of the 48 (27%) patients who underwent imaging at 2 months had stable disease (SD), and 4 of these had SD > 4 months. In addition, drug-related adrenal insufficiency, considered a pharmacologic effect of nevanimibe, was observed in two patients. The most common treatment-emergent AEs were gastrointestinal disorders (76%), including diarrhea (44%) and vomiting (35%). A maximum tolerated dose (MTD) could not be defined, as very few dose-limiting toxicities (DLTs) occurred. Because the large number of tablets required at the highest dose (i.e., ~24 tablets/day) resulted in low-grade gastrointestinal adverse effects, a maximum feasible dose of 128.2 mg/kg/day was established as a dose that could be taken on a long-term basis. Conclusions This study demonstrated the safety of nevanimibe at doses of up to ~6000 mg BID. As the total number of tablets required to achieve an MTD exceeded practical administration limits, a maximum feasible dose was defined. Given that the expected exposure levels necessary for an apoptotic effect could not be achieved, the current formulation of nevanimibe had limited efficacy in patients with advanced ACC.
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Affiliation(s)
- David C Smith
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Matthias Kroiss
- Department of Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rashmi Chugh
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Bryan J Schneider
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Martin Fassnacht
- Department of Medicine, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | | | - Vivian H Lin
- Millendo Therapeutics US, Inc., Ann Arbor, MI, USA
| | | | - Aung Naing
- Department of Investigational Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Schneider BJ, Ismaila N, Altorki N. Lung Cancer Surveillance After Definitive Curative-Intent Therapy: ASCO Guideline Summary. JCO Oncol Pract 2020; 16:83-86. [PMID: 32045555 DOI: 10.1200/jop.19.00722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zeinali M, Lee M, Nadhan A, Mathur A, Hedman C, Lin E, Harouaka R, Wicha MS, Zhao L, Palanisamy N, Hafner M, Reddy R, Kalemkerian GP, Schneider BJ, Hassan KA, Ramnath N, Nagrath S. High-Throughput Label-Free Isolation of Heterogeneous Circulating Tumor Cells and CTC Clusters from Non-Small-Cell Lung Cancer Patients. Cancers (Basel) 2020; 12:cancers12010127. [PMID: 31947893 PMCID: PMC7016759 DOI: 10.3390/cancers12010127] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 11/25/2022] Open
Abstract
(1) Background: Circulating tumor cell (CTC) clusters are emerging as clinically significant harbingers of metastases in solid organ cancers. Prior to engaging these CTC clusters in animal models of metastases, it is imperative for technology to identify them with high sensitivity. These clusters often present heterogeneous surface markers and current methods for isolation of clusters may fall short. (2) Methods: We applied an inertial microfluidic Labyrinth device for high-throughput, biomarker-independent, size-based isolation of CTCs/CTC clusters from patients with metastatic non-small-cell lung cancer (NSCLC). (3) Results: Using Labyrinth, CTCs (PanCK+/DAPI+/CD45−) were isolated from patients (n = 25). Heterogeneous CTC populations, including CTCs expressing epithelial (EpCAM), mesenchymal (Vimentin) or both markers were detected. CTCs were isolated from 100% of patients (417 ± 1023 CTCs/mL). EpCAM− CTCs were significantly greater than EpCAM+ CTCs. Cell clusters of ≥2 CTCs were observed in 96% of patients—of which, 75% were EpCAM−. CTCs revealed identical genetic aberrations as the primary tumor for RET, ROS1 , and ALK genes using fluorescence in situ hybridization (FISH) analysis. (4) Conclusions: The Labyrinth device recovered heterogeneous CTCs in 100% and CTC clusters in 96% of patients with metastatic NSCLC. The majority of recovered CTCs/clusters were EpCAM−, suggesting that these would have been missed using traditional antibody-based capture methods.
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Affiliation(s)
- Mina Zeinali
- Chemical Engineering, University of Michigan, 2800 Plymouth Road, NCRC, Building 20-3rd Floor, Ann Arbor, MI 48109, USA; (M.Z.); (M.L.); (A.N.); (A.M.); (E.L.)
- Biointerfaces Institute, University of Michigan, 2800 Plymouth Road, NCRC B10-A184, Ann Arbor, MI 48109, USA
- Institute for Medical Technology of Heidelberg University & University of Applied Sciences Mannheim, Paul-Wittsack-Straße 10, 68163 Mannheim, Germany;
| | - Maggie Lee
- Chemical Engineering, University of Michigan, 2800 Plymouth Road, NCRC, Building 20-3rd Floor, Ann Arbor, MI 48109, USA; (M.Z.); (M.L.); (A.N.); (A.M.); (E.L.)
- Biointerfaces Institute, University of Michigan, 2800 Plymouth Road, NCRC B10-A184, Ann Arbor, MI 48109, USA
| | - Arthi Nadhan
- Chemical Engineering, University of Michigan, 2800 Plymouth Road, NCRC, Building 20-3rd Floor, Ann Arbor, MI 48109, USA; (M.Z.); (M.L.); (A.N.); (A.M.); (E.L.)
- Biointerfaces Institute, University of Michigan, 2800 Plymouth Road, NCRC B10-A184, Ann Arbor, MI 48109, USA
| | - Anvya Mathur
- Chemical Engineering, University of Michigan, 2800 Plymouth Road, NCRC, Building 20-3rd Floor, Ann Arbor, MI 48109, USA; (M.Z.); (M.L.); (A.N.); (A.M.); (E.L.)
- Biointerfaces Institute, University of Michigan, 2800 Plymouth Road, NCRC B10-A184, Ann Arbor, MI 48109, USA
| | - Casey Hedman
- Molecular, Cellular, and Developmental Biology, University of Michigan, 1105 North University Avenue, 2220 Biological Science Building, Ann Arbor, MI 48109, USA;
| | - Eric Lin
- Chemical Engineering, University of Michigan, 2800 Plymouth Road, NCRC, Building 20-3rd Floor, Ann Arbor, MI 48109, USA; (M.Z.); (M.L.); (A.N.); (A.M.); (E.L.)
- Biointerfaces Institute, University of Michigan, 2800 Plymouth Road, NCRC B10-A184, Ann Arbor, MI 48109, USA
| | - Ramdane Harouaka
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA; (R.H.); (M.S.W.); (G.P.K.); (B.J.S.); (K.A.H.)
| | - Max S. Wicha
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA; (R.H.); (M.S.W.); (G.P.K.); (B.J.S.); (K.A.H.)
| | - Lili Zhao
- Biostatistics Department, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Nallasivam Palanisamy
- Department of Urology, Henry Ford Health System, 1 Ford Place, Room 2D26, Detroit, MI 48202, USA;
| | - Mathias Hafner
- Institute for Medical Technology of Heidelberg University & University of Applied Sciences Mannheim, Paul-Wittsack-Straße 10, 68163 Mannheim, Germany;
| | - Rishindra Reddy
- Department of Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA;
| | - Gregory P. Kalemkerian
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA; (R.H.); (M.S.W.); (G.P.K.); (B.J.S.); (K.A.H.)
| | - Bryan J. Schneider
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA; (R.H.); (M.S.W.); (G.P.K.); (B.J.S.); (K.A.H.)
| | - Khaled A. Hassan
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA; (R.H.); (M.S.W.); (G.P.K.); (B.J.S.); (K.A.H.)
| | - Nithya Ramnath
- Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA; (R.H.); (M.S.W.); (G.P.K.); (B.J.S.); (K.A.H.)
- Veterans Administration Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
- Correspondence: (N.R.); (S.N.); Tel.: +734-936-9015 (N.R.); +734-647-7985 (S.N.)
| | - Sunitha Nagrath
- Chemical Engineering, University of Michigan, 2800 Plymouth Road, NCRC, Building 20-3rd Floor, Ann Arbor, MI 48109, USA; (M.Z.); (M.L.); (A.N.); (A.M.); (E.L.)
- Biointerfaces Institute, University of Michigan, 2800 Plymouth Road, NCRC B10-A184, Ann Arbor, MI 48109, USA
- Correspondence: (N.R.); (S.N.); Tel.: +734-936-9015 (N.R.); +734-647-7985 (S.N.)
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Schneider BJ, Ismaila N, Aerts J, Chiles C, Daly ME, Detterbeck FC, Hearn JWD, Katz SI, Leighl NB, Levy B, Meyers B, Murgu S, Nekhlyudov L, Santos ES, Singh N, Tashbar J, Yankelevitz D, Altorki N. Lung Cancer Surveillance After Definitive Curative-Intent Therapy: ASCO Guideline. J Clin Oncol 2019; 38:753-766. [PMID: 31829901 DOI: 10.1200/jco.19.02748] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing clinicians on radiographic imaging and biomarker surveillance strategies after definitive curative-intent therapy in patients with stage I-III non-small-cell lung cancer (NSCLC) and SCLC. METHODS ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, radiology, primary care, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2019. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 14 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Patients should undergo surveillance imaging for recurrence every 6 months for 2 years and then annually for detection of new primary lung cancers. Chest computed tomography imaging is the optimal imaging modality for surveillance. Fluorodeoxyglucose positron emission tomography/computed tomography imaging should not be used as a surveillance tool. Surveillance imaging may not be offered to patients who are clinically unsuitable for or unwilling to accept further treatment. Age should not preclude surveillance imaging. Circulating biomarkers should not be used as a surveillance strategy for detection of recurrence. Brain magnetic resonance imaging should not be used for routine surveillance in stage I-III NSCLC but may be used every 3 months for the first year and every 6 months for the second year in patients with stage I-III small-cell lung cancer who have undergone curative-intent treatment.
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Affiliation(s)
| | | | - Joachim Aerts
- Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | | | - Megan E Daly
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Sharyn I Katz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Benjamin Levy
- Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC
| | | | | | | | | | - Navneet Singh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Reddy CA, Schneider BJ, Brackett LM, Tai AW. Nivolumab-induced large-duct cholangiopathy treated with ursodeoxycholic acid and tocilizumab. Immunotherapy 2019; 11:1527-1531. [PMID: 31789069 DOI: 10.2217/imt-2019-0121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Immune checkpoint inhibitor therapy has become a cornerstone in the management of many oncologic diseases. Although it is well tolerated in most patients, a wide spectrum of adverse events has been described as a result of immune system alteration. We present a case of a woman with metastatic bronchogenic adenocarcinoma who was initially thought to have immune-mediated hepatitis, but eventually discovered to have a rarely described immune-mediated cholangiopathy. Her cholangiopathy appeared to stabilize following ursodeoxycholic acid and tocilizumab after several lines of guideline-directed therapy. Awareness of this unique toxicity following immune checkpoint inhibitor, and potential treatment options may help clinicians manage this rare but serious complication.
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Affiliation(s)
- Chanakyaram A Reddy
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bryan J Schneider
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lindsay M Brackett
- Division of Hematology & Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrew W Tai
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
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Qin A, Rengan R, Lee S, Santana-Davila R, Goulart BHL, Martins R, Baik C, Kalemkerian GP, Hassan KA, Schneider BJ, Hayman JA, Jolly S, Hearn J, Lawrence TS, Towlerton AMH, Tewari M, Thomas D, Zhao L, Brown N, Frankel TL, Warren EH, Ramnath N. A Pilot Study of Atezolizumab Plus Hypofractionated Image Guided Radiation Therapy for the Treatment of Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019; 108:170-177. [PMID: 31756415 DOI: 10.1016/j.ijrobp.2019.10.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Preclinical data and subset analyses from immunotherapy clinical trials indicate that prior radiation therapy was associated with better progression-free survival and overall survival when combined with immune checkpoint inhibitors in patients with non-small cell lung cancer. We present a prospective study of hypofractionated image guided radiation therapy (HIGRT) to a single site of metastatic disease concurrently with atezolizumab in patients with metastatic non-small cell lung cancer. METHODS AND MATERIALS Patients meeting eligibility criteria received 1200 mg of atezolizumab intravenously every 3 weeks with concurrent 3- or 5-fraction HIGRT starting no later than the second cycle. The 3-fraction regimen employed a minimum of 8 Gy per fraction compared with 6 Gy for the 5-fraction regimen. Imaging was obtained every 12 weeks to assess response. RESULTS From October 2015 to February 2017, 12 patients were enrolled in the study (median age 64; range, 55-77 years). The best response by the Response Evaluation in Solid Tumors criteria was partial response in 3 and stable disease in 3, for a disease control rate of 50%. Five patients had a grade 3 immune-related adverse event, including choreoretinitis (n = 1), pneumonitis (n = 1), transaminitis (n = 1), fatigue (n = 1), and peripheral neuropathy (n = 1). The median progression-free survival was 2.3 months, and the median overall survival was 6.9 months (range, 0.4-not reached). There was no clear association between peripheral blood T cell repertoire characteristics at baseline, PD-L1, or tumor mutations and response or outcome. One long-term survivor exhibited oligoclonal T cell populations in a baseline tumor biopsy that were consistently detected in peripheral blood over the entire course of the study. CONCLUSIONS HIGRT plus atezolizumab resulted in an overall response rate of 25% and disease control rate of 50% in this pilot study. The incidence of grade 3 adverse events was similar to that of atezolizumab alone. Alhough it was a pilot study with limited sample size, the results generated hypotheses worthy of further investigation.
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Affiliation(s)
- Angel Qin
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Sylvia Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Rafael Santana-Davila
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Bernardo H L Goulart
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Renato Martins
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Christina Baik
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Gregory P Kalemkerian
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan
| | - Khaled A Hassan
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan
| | - Bryan J Schneider
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Jason Hearn
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Muneesh Tewari
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan
| | - Dafydd Thomas
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Noah Brown
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | | | - Edus H Warren
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Nithya Ramnath
- Department of Medicine, Hematology-Oncology, University of Michigan, Ann Arbor, Michigan.
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Zeinali M, Lee M, Nadhan A, Mathur A, Huang W, Lin E, Harouaka R, Wicha MS, Palanisamy N, Hafner M, Reddy R, Kalemkerian GP, Schneider BJ, Hassan KA, Ramnath N, Nagrath S. Abstract 1332: High Throughput isolation and expansion of circulating tumor cells (CTCs) from Non-small cell lung cancer (NSCLC) patients for personalized treatments. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Circulating tumor cells (CTCs) have emerged as important blood-based surrogate markers of primary tumors. Current methods for isolation of lung CTCs mostly rely on biomarker dependent antibody-based capture, missing populations that may be stem-like in nature. Results: We have applied the microfluidic Labyrinth device for high throughput, label-free, size-based isolation of CTCs from non-small cell lung cancer patients (NSCLC). The Labyrinth device was optimized and tested for inertial separation of cancer cells using the human lung cancer cell line H1650. The recovery and purity were >82% and >78%, respectively, operating at a flow rate of 2.5 mL/min. Using the biomarker-independent Labyrinth separation device, heterogeneous CTC populations were isolated from metastatic NSCLC patients (n=21). Heterogeneous CTC populations were detected, including CTCs (PanCK+ and CD45-), CTCs expressing EpCAM or Vimentin, and CTCs expressing both markers representing an EMT-like population of CTCs. Using Labyrinth, we were able to isolate CTCs from 100% of patients with an average yield of 180±168 CTCs/mL. Among the captured CTCs, EpCAM- CTCs were significantly more common than EpCAM+ CTCs (115.7 vs. 39.1 CTCs/mL respectively). Cell clusters of 2 or more CTCs were also observed in 95% of patients; 79% of these clusters were negative for EpCAM expression, whereas 35% expressed Vimentin, suggestive of an EMT phenotype. Recovered CTCs from patients with RET, ROS1 and ALK rearranged tumors showed aberrations matching with the primary tumor for each gene using FISH analysis. We have successfully expanded the recovered CTCs from 2 patients and screened for therapeutic targeting. We have found that TPX-0005 might be effective in these patients and would direct them to a clinical trial using this compound. Conclusion: The label-free Labyrinth device demonstrated the capability of collecting recovered CTCs from the device using a continuous processing technique while in a suspension state. This advantage opens the opportunities not only for CTC expansion off-chip, but also for ex-vivo drug testing to direct patient-specific therapies.
Citation Format: Mina Zeinali, Maggie Lee, Arthi Nadhan, Anvya Mathur, Wei Huang, Eric Lin, Ramdane Harouaka, Max S. Wicha, Nallasivam Palanisamy, Mathias Hafner, Rishindra Reddy, Gregory P. Kalemkerian, Bryan J. Schneider, Khaled A. Hassan, Nithya Ramnath, Sunitha Nagrath. High Throughput isolation and expansion of circulating tumor cells (CTCs) from Non-small cell lung cancer (NSCLC) patients for personalized treatments [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1332.
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Affiliation(s)
| | | | | | | | - Wei Huang
- 1University of Michigan, Ann Arbor, MI
| | - Eric Lin
- 1University of Michigan, Ann Arbor, MI
| | | | | | | | - Mathias Hafner
- 3Institute for Medical Technology of Heidelberg University & University of Applied Sciences Mannheim, Mannheim, Germany
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Reddy HG, Weis TM, Hough S, Daignault S, Schneider BJ. Immune related adverse events in NSCLC patients treated with immune checkpoint therapy who received the influenza vaccination versus no vaccination. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20657 Background: Influenza vaccination is recommended by the CDC for cancer patients to reduce the risk of influenza-related complications. There is concern that the incidence of immune-related adverse events (irAEs) may be greater in vaccinated patients receiving immune checkpoint inhibitors (ICPI). We sought to interrogate if influenza vaccination in patients with NSCLC receiving ICPI therapy had an increased incidence of irAEs compared to non-vaccinated patients. Methods: We conducted a single-center retrospective analysis of patients with advanced NSCLC who received PD-1 or PD-L1 inhibitor monotherapy between 3/2015 – 12/2018. Influenza immunization records from both institutional and state-wide registries were obtained from 2014 -2019. Comparisons of adverse event incidence between flu vaccinated and control patients were tested using chi-square statistics. Results: 117 patients were included in our analysis, 33 (28%) were vaccinated during ICPI therapy, 19 (58%) received quadrivalent influenza vaccine, 13 (39%) received trivalent influenza vaccine and 1 (3%) was undetermined. 22 (67%) vaccinated patients had an irAE vs 53 (63%) patients who were not vaccinated during ICPI therapy (p = 0.720). 8 (24%) vaccinated patients had an irAE leading to discontinuation of therapy vs 12 (14%) patients who were not vaccinated during ICPI therapy (p = 0.198). The most frequent irAE in both groups was fatigue 16 (48%) vs 28 (33%) (p = 0.128). Notable irAEs included colitis (0 vs 1), pneumonitis (3 vs 3), hepatitis (1 vs 4) in vaccinated patients vs without vaccine, respectively. There were no statistically significant differences in baseline demographics between both groups including age, race, gender, tumor histology or ECOG performance status. Conclusions: Our study suggests that irAEs are not significantly increased with vaccination for influenza during ICPI therapy. However, there is a slight trend toward increased incidence of irAE warranting ICPI discontinuation for which further investigation is needed. Limitations of this study include a small sample size and inability to grade irAE retrospectively.
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Affiliation(s)
- Haritha G. Reddy
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Taylor Mai Weis
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | - Shannon Hough
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Mamdani H, Schneider BJ, Abushahin LI, Birdas TJ, Kesler K, Burney H, Perkins SM, Jalal SI. Safety and efficacy of durvalumab following multimodality therapy for locally advanced esophageal and GEJ adenocarcinoma: Results from Big Ten Cancer Research Consortium study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
4058 Background: Concurrent chemoradiation (CRT) followed by esophagectomy is a standard of care for locally advanced esophageal (LA-EAC) and GEJ adenocarcinoma. Approximately 50% of patients (pts) experience disease relapse within the 1st yr after treatment(tx) completion. No adjuvant tx has been shown to improve survival in these pts. Immune checkpoint inhibitors have activity in metastatic PD-L1 positive EAC. Preclinical studies have shown upregulation of PD-1/PD-L1 pathway with RT +/- chemotherapy. Methods: We conducted a phase II trial evaluating safety and efficacy of durvalumab (durva), a monoclonal antibody against PD-L1, in pts with LA-EAC and GEJ adenocarcinoma who have viable tumor in surgical specimen after neoadjuvant CRT and R0 resection. Pts received durva 1500mg IV every 4 weeks for up to 1yr. Results: 24 pts were enrolled from 4/2016-1/2018 (median age: 60yrs (range, 43-70). 18 received carbo/paclitaxel and 6 received cis/5-FU concurrently with radiation. Staging at diagnosis: T2N0 (n=3, 12.5%), T2N2 (n=3, 12.5%),T3N0 (n=6, 25%), T3N1 (n=6, 25%), T3N2 (n=4, 17%), T3N3 (n=1, 4%), T3Nx (n=1, 4%).19 pts (79%) had positive lymph nodes (LNs) at the time of surgery following CRT. 12 pts completed 1yr of tx, 12 came off tx before 1yr because of relapse(6), AEs(5), and consent withdrawal (1). Median number of tx cycles was 12.5 (range, 2-13). Most common AEs were fatigue (n=8, 33.3%) and nausea (n=6, 25%). 3pts (12.5%) developed grade 3 irAEs: pneumonitis (1), hepatitis (1), colitis (1). At median follow up of 14.5 mo (range, 1.7-24mo), 17 are disease free (including 5 who came off tx before 1yr). 7pts (29%) have relapsed (3 alive, 4 died). 6/7pts had distant relapse (lung, brain, bone, cervical LNs) and 1 had locoregional relapse. 1-yr RFS and OS were 79.2% and 95.5%, respectively. 2-yr OS was 59.2%. RFS probability at 26 mo was 67.9%. Median survival after relapse was 11.1 mo (range, 0.1-11.3mo). Conclusions: Adjuvant durvalumab following trimodality therapy for LA-EAC and GEJ adenocarcinoma was safe and feasible with improvement in 1-yr RFS to 79.2% compared to historical rate of 50%. OS results are encouraging in this high risk pt population. Clinical trial information: NCT02639065.
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Wozniak AJ, Schneider BJ, Kalemkerian GP, Daly RM, Chen W, Ventimiglia J, Nagasaka M, Zauderer MG. A phase II trial of nintedanib in recurrent malignant pleural mesothelioma (MPM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20061] [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
e20061 Background: Malignant pleural mesothelioma (MPM) is a disease that is resistant to chemotherapy and there remains an unmet need for better therapeutic options. Nintedanib (BIBF 1120) is an oral multikinase inhibitor impacting VEGFR, FGFR, PDGFR, and other kinase activity such as TGFß signaling pathways. VEGF, FGF, and TGFβ are commonly expressed in MPM. We conducted a phase II trial in patients with recurrent MPM after platinum-based chemotherapy. Methods: Patients (pts) with MPM previously treated with platinum-based chemotherapy, performance status (PS) 0-1, adequate organ function, and no contraindications to anti-angiogenic therapy were eligible for treatment. Nintedanib 200 mg twice per day was administered until disease progression or unacceptable toxicity. The primary endpoint was the 4-month progression-free survival (PFS). A two-stage design was used and > 4 pts had to have a PFS of ≥4 months to proceed to the second stage. Results: Twenty pts. were enrolled. The median age was 70 yrs. (32-81), 90% were male, and 80% were PS = 1. The histology was 70% epithelioidal, 5% sarcomatoid, 10% biphasic, and 15% unknown. 15% had prior bevacizumab. The median follow-up is 16.4 mo. A median of 2 treatment cycles (range 1-18) were delivered. There were no responses but 40% had stable disease. The median PFS was 1.8 mo. (95% CI: 1.68, 3.55) and the PFS rate at 4 mo. was 13%. The median OS was 4.2 mo. (95% CI: 2.53, 8.74) and the OS rate at 4 mo. was 55%. Toxicities were usually grade 1-2 and included diarrhea, fatigue, edema, transaminase elevation, anorexia, nausea, vomiting and dyspnea. Conclusions: The activity of nintedanib in previously treated MPM pts. was modest. The trial did not meet the primary PFS endpoint. However, there was a small subset of pts. that had prolonged stable disease for > 4 months thus potentially deriving some clinical benefit from treatment. Supported by Boehringer Ingelheim. Clinical trial information: NCT02568449.
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Affiliation(s)
| | | | | | | | - Wei Chen
- Karmanos Cancer Institute, Detroit, MI
| | | | - Misako Nagasaka
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI
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Qin A, Lusk E, Daignault-Newton S, Schneider BJ. Chemotherapy and Radiation Versus Chemotherapy Alone for Elderly Patients With N3 Stage IIIB NSCLC. Clin Lung Cancer 2019; 20:e495-e503. [PMID: 31088760 DOI: 10.1016/j.cllc.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/23/2019] [Revised: 03/06/2019] [Accepted: 04/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Standard treatment for stage III non-small-cell lung cancer (NSCLC) is concurrent chemotherapy and radiation (chemo-RT). However, N3 stage IIIB disease portends a worse prognosis and the tolerability of chemo-RT in patients ≥70 years old is a concern. In this analysis, we evaluate the survival of patients with N3 stage IIIB NSCLC who were treated with chemo-RT or chemotherapy alone with a focus on elderly patients. PATIENTS AND METHODS We retrospectively analyzed patients diagnosed with N3 stage IIIB NSCLC between 2010 and 2013 using the National Cancer Database. We compared overall survival (OS) between patients who underwent chemo-RT versus chemotherapy alone. The Kaplan-Meier method was used for median OS with log rank tests. Multivariable Cox models were used for multivariable and subgroup analyses. RESULTS We included 9769 patients in our analysis, 7770 of whom received chemo-RT and 1999 who received chemotherapy alone. The median OS for patients who received chemo-RT was 16.4 months versus 12.7 months with chemotherapy alone (P < .0001). The median OS for patients ≥70 years old who received chemo-RT was 15.0 months versus 12.4 months with chemotherapy alone (P < .0001). In multivariable analyses, the benefit of chemo-RT was similar regardless of age. Subgroup analyses in patients ≥70 years indicated a benefit of chemo-RT (hazard ratio, <1.0) across all patient and disease strata. CONCLUSION Survival was improved in elderly patients who received chemo-RT versus chemotherapy alone for N3 stage IIIB NSCLC. Our findings suggest that age and comorbidities should not preclude clinicians from recommending chemo-RT to these patients.
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Affiliation(s)
- Angel Qin
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
| | - Elizabeth Lusk
- Center for Cancer Biostatistics, Analytics, and Bioinformatics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Stephanie Daignault-Newton
- Center for Cancer Biostatistics, Analytics, and Bioinformatics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Bryan J Schneider
- Center for Cancer Biostatistics, Analytics, and Bioinformatics, School of Public Health, University of Michigan, Ann Arbor, MI
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Thompson JA, Schneider BJ, Brahmer J, Andrews S, Armand P, Bhatia S, Budde LE, Costa L, Davies M, Dunnington D, Ernstoff MS, Frigault M, Hoffner B, Hoimes CJ, Lacouture M, Locke F, Lunning M, Mohindra NA, Naidoo J, Olszanski AJ, Oluwole O, Patel SP, Reddy S, Ryder M, Santomasso B, Shofer S, Sosman JA, Wahidi M, Wang Y, Johnson-Chilla A, Scavone JL. Management of Immunotherapy-Related Toxicities, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 17:255-289. [DOI: 10.6004/jnccn.2019.0013] [Citation(s) in RCA: 288] [Impact Index Per Article: 57.6] [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]
Abstract
The aim of the NCCN Guidelines for Management of Immunotherapy-Related Toxicities is to provide guidance on the management of immune-related adverse events resulting from cancer immunotherapy. The NCCN Management of Immunotherapy-Related Toxicities Panel is an interdisciplinary group of representatives from NCCN Member Institutions and ASCO, consisting of medical and hematologic oncologists with expertise in a wide array of disease sites, and experts from the fields of dermatology, gastroenterology, neuro-oncology, nephrology, emergency medicine, cardiology, oncology nursing, and patient advocacy. Several panel representatives are members of the Society for Immunotherapy of Cancer (SITC). The initial version of the NCCN Guidelines was designed in general alignment with recommendations published by ASCO and SITC. The content featured in this issue is an excerpt of the recommendations for managing toxicity related to immune checkpoint blockade and a review of existing evidence. For the full version of the NCCN Guidelines, including recommendations for managing toxicities related to chimeric antigen receptor T-cell therapy, visitNCCN.org.
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Affiliation(s)
- John A. Thompson
- 1Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Julie Brahmer
- 3The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | - Shailender Bhatia
- 1Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | - Luciano Costa
- 7University of Alabama at Birmingham Comprehensive Cancer Center
| | | | | | | | | | | | - Christopher J. Hoimes
- 13Case Comprehensive Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | - Nisha A. Mohindra
- 16Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Jarushka Naidoo
- 3The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | | | | | | | - Jeffrey A. Sosman
- 16Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Yinghong Wang
- 23The University of Texas MD Anderson Cancer Center; and
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Mamdani H, Schneider BJ, Abushahin LI, Birdas TJ, Kesler K, Lee A, Burney H, Perkins S, Jalal SI. Safety and efficacy of durvalumab following trimodality therapy for locally advanced esophageal and GEJ adenocarcinoma: Early efficacy results from Big Ten Cancer Research Consortium study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5 Background: The standard of care for locally advanced esophageal adenocarcinoma(LA-EAC) is concurrent chemoradiation (CRT) followed by esophagectomy. Approximately 30% of patients (pts) achieve complete pathologic response (pCR) with this approach. The risk of relapse in the remaining 70% of pts is high, with 1-yr relapse free survival (RFS) of 50%. No adjuvant therapies have been shown to improve survival. Immune checkpoint inhibitors have activity in metastatic PD-L1 positive EAC. Preclinical studies have shown upregulation of PD-1 pathway with radiation +/- chemotherapy. Methods: We conducted a phase II study evaluating safety and efficacy of durvalumab (durva), a monoclonal antibody against PD-L1, in pts with LA-EAC and GE junction (GEJ) adenocarcinoma who do not achieve pCR after neoadjuvant CRT and R0 resection. Pts received durva 1500mg IV every 4 weeks for up to 1 yr after surgery. Primary objective was 1-yr RFS. Secondary objectives were incidence and severity of treatment related adverse events (AEs). Results: Twenty-four pts were enrolled from Apr 2016 to Jan 2018 (median age: 60yrs (range, 43-74)). Fourteen pts had GEJ adenocarcinoma and 10 had distal EAC. Eighteen received carboplatin/paclitaxel and six received cisplatin/5-FU concurrently with 50-50.4Gy radiation. Nineteen pts (79%) had positive lymph nodes at the time of surgery after neoadjuvant CRT, including three (12.5%) with N3, nine (37.5%) with N2, and seven (29%) with N1 disease. Among N0 pts, two had T3N0, one had T2N0, and two had T1N0 disease. At median follow-up of 11.7 mo (range 1.7-23.9 mo), seven pts (29%) have relapsed (five alive, two died); 17(67%) are disease free (six on treatment, seven completed treatment, three off-treatment); 1-yr and projected 26 mo RFS are 78.6% and 62.9%, respectively. Five pts (20.8%) developed grade 3 AEs: diarrhea (n = 1), hepatitis (n = 1), encephalopathy (n = 1), hyperglycemia (n = 1), hypoglycemia (n = 1). Most common grade 1 and 2 AEs were fatigue (33.3%), nausea (25.0%), and cough (20.8%). Conclusions: Adjuvant durva in pts with residual disease following trimodality therapy for EAC and GEJ adenocarcinoma is safe and feasible with 1-yr RFS of 78.6% compared to historical rate of 50%. Clinical trial information: NCT02639065.
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Affiliation(s)
| | | | - Laith I. Abushahin
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | | | | | - Ahran Lee
- Big Ten Cancer Research Consortium, Indianapolis, IN
| | | | - Susan Perkins
- Indiana University Health Simon Cancer Center, Indianapolis, IN
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Campagnaro E, Reimers MA, Qin A, Alva AS, Schneider BJ, Van Poznak CH. Use of Bone-Modifying Agents in Myeloma and Bone Metastases: How Recent Dosing Interval Studies Have Affected Our Practice. J Oncol Pract 2018; 14:457-464. [DOI: 10.1200/jop.18.00236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The management of bone lesions from advanced solid tumors and multiple myeloma typically includes use of a bone-modifying agent to reduce the risk of skeletal-related events. Recent data demonstrate that when using zoledronic acid to reduce the risk of skeletal-related events in metastatic breast cancer, metastatic prostate cancer, and multiple myeloma, the dosing interval of zoledronic acid may be extended from every 4 weeks to every 12 weeks. The ASCO guidelines on the role of bone-modifying agents in metastatic breast cancer and multiple myeloma address zoledronic acid dosing intervals. Herein, we discuss how new data on dosing of bone-modifying agents influence our clinical practice.
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Affiliation(s)
| | | | - Angel Qin
- University of Michigan, Ann Arbor, MI
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Brahmer JR, Lacchetti C, Schneider BJ, Atkins MB, Brassil KJ, Caterino JM, Chau I, Ernstoff MS, Gardner JM, Ginex P, Hallmeyer S, Holter Chakrabarty J, Leighl NB, Mammen JS, McDermott DF, Naing A, Nastoupil LJ, Phillips T, Porter LD, Puzanov I, Reichner CA, Santomasso BD, Seigel C, Spira A, Suarez-Almazor ME, Wang Y, Weber JS, Wolchok JD, Thompson JA. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018. [PMID: 29442540 DOI: 10.1200/jco.2017.77.638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Purpose To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events in patients treated with immune checkpoint inhibitor (ICPi) therapy. Methods A multidisciplinary, multi-organizational panel of experts in medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, urology, neurology, hematology, emergency medicine, nursing, trialist, and advocacy was convened to develop the clinical practice guideline. Guideline development involved a systematic review of the literature and an informal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, randomized controlled trials, and case series published from 2000 through 2017. Results The systematic review identified 204 eligible publications. Much of the evidence consisted of systematic reviews of observational data, consensus guidelines, case series, and case reports. Due to the paucity of high-quality evidence on management of immune-related adverse events, recommendations are based on expert consensus. Recommendations Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, with the exception of some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert to grade 1 or less. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids (prednisone 1 to 2 mg/kg/d or methylprednisolone 1 to 2 mg/kg/d). Corticosteroids should be tapered over the course of at least 4 to 6 weeks. Some refractory cases may require infliximab or other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, with the exception of endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Julie R Brahmer
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Christina Lacchetti
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Bryan J Schneider
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Michael B Atkins
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Kelly J Brassil
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jeffrey M Caterino
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Ian Chau
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Marc S Ernstoff
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jennifer M Gardner
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Pamela Ginex
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Sigrun Hallmeyer
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jennifer Holter Chakrabarty
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Natasha B Leighl
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jennifer S Mammen
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - David F McDermott
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Aung Naing
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Loretta J Nastoupil
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Tanyanika Phillips
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Laura D Porter
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Igor Puzanov
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Cristina A Reichner
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Bianca D Santomasso
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Carole Seigel
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Alexander Spira
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Maria E Suarez-Almazor
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Yinghong Wang
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jeffrey S Weber
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jedd D Wolchok
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - John A Thompson
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
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Brahmer JR, Lacchetti C, Schneider BJ, Atkins MB, Brassil KJ, Caterino JM, Chau I, Ernstoff MS, Gardner JM, Ginex P, Hallmeyer S, Holter Chakrabarty J, Leighl NB, Mammen JS, McDermott DF, Naing A, Nastoupil LJ, Phillips T, Porter LD, Puzanov I, Reichner CA, Santomasso BD, Seigel C, Spira A, Suarez-Almazor ME, Wang Y, Weber JS, Wolchok JD, Thompson JA. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018; 36:1714-1768. [PMID: 29442540 PMCID: PMC6481621 DOI: 10.1200/jco.2017.77.6385] [Citation(s) in RCA: 2239] [Impact Index Per Article: 373.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To increase awareness, outline strategies, and offer guidance on the recommended management of immune-related adverse events in patients treated with immune checkpoint inhibitor (ICPi) therapy. Methods A multidisciplinary, multi-organizational panel of experts in medical oncology, dermatology, gastroenterology, rheumatology, pulmonology, endocrinology, urology, neurology, hematology, emergency medicine, nursing, trialist, and advocacy was convened to develop the clinical practice guideline. Guideline development involved a systematic review of the literature and an informal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, randomized controlled trials, and case series published from 2000 through 2017. Results The systematic review identified 204 eligible publications. Much of the evidence consisted of systematic reviews of observational data, consensus guidelines, case series, and case reports. Due to the paucity of high-quality evidence on management of immune-related adverse events, recommendations are based on expert consensus. Recommendations Recommendations for specific organ system-based toxicity diagnosis and management are presented. While management varies according to organ system affected, in general, ICPi therapy should be continued with close monitoring for grade 1 toxicities, with the exception of some neurologic, hematologic, and cardiac toxicities. ICPi therapy may be suspended for most grade 2 toxicities, with consideration of resuming when symptoms revert to grade 1 or less. Corticosteroids may be administered. Grade 3 toxicities generally warrant suspension of ICPis and the initiation of high-dose corticosteroids (prednisone 1 to 2 mg/kg/d or methylprednisolone 1 to 2 mg/kg/d). Corticosteroids should be tapered over the course of at least 4 to 6 weeks. Some refractory cases may require infliximab or other immunosuppressive therapy. In general, permanent discontinuation of ICPis is recommended with grade 4 toxicities, with the exception of endocrinopathies that have been controlled by hormone replacement. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Julie R Brahmer
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Christina Lacchetti
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Bryan J Schneider
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Michael B Atkins
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Kelly J Brassil
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jeffrey M Caterino
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Ian Chau
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Marc S Ernstoff
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jennifer M Gardner
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Pamela Ginex
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Sigrun Hallmeyer
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jennifer Holter Chakrabarty
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Natasha B Leighl
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jennifer S Mammen
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - David F McDermott
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Aung Naing
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Loretta J Nastoupil
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Tanyanika Phillips
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Laura D Porter
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Igor Puzanov
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Cristina A Reichner
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Bianca D Santomasso
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Carole Seigel
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Alexander Spira
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Maria E Suarez-Almazor
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Yinghong Wang
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jeffrey S Weber
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - Jedd D Wolchok
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
| | - John A Thompson
- Julie R. Brahmer, Johns Hopkins Kimmel Cancer Center; Jennifer S. Mammen, Johns Hopkins University, Baltimore, MD; Christina Lacchetti, American Society of Clinical Oncology, Alexandria; Alexander Spira, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA; Bryan J. Schneider, University of Michigan Health System, Ann Arbor, MI; Michael B. Atkins, Georgetown Lombardi Comprehensive Cancer Center; Cristina A. Reichner, Georgetown University; Laura D. Porter, Colon Cancer Alliance; Washington, DC; Kelly J. Brassil, Aung Naing, Loretta J. Nastoupil, Maria E. Suarez-Almazor, and Yinghong Wang, MD Anderson Cancer Center, Houston, TX; Jeffrey M. Caterino, The Ohio State University Wexner Medical Center, Columbus, OH; Ian Chau, The Royal Marsden Hospital and Institute of Cancer Research, London and Surrey, United Kingdom; Marc S. Ernstoff and Igor Puzanov, Roswell Park Cancer Institute, Buffalo; Bianca D. Santomasso and Jedd D. Wolchok, Memorial Sloan Kettering Cancer Center; Jeffrey S. Weber, New York University Langone Medical Center, New York, NY; Pamela Ginex, Oncology Nursing Society, Pittsburgh, PA; Jennifer M. Gardner, Seattle Cancer Care Alliance and University of Washington, Seattle, WA; Sigrun Hallmeyer, Oncology Specialists SC, Park Ridge, IL; Jennifer Holter Chakrabarty, University of Oklahoma, Stephenson Cancer Center, Oklahoma City, OK; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; David F. McDermott, Beth Israel Deaconess Medical Center; Carole Seigel, Massachusetts General Hospital Cancer Center, Boston, MA; John A. Thompson, Seattle Cancer Care Alliance, University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle, WA; and Tanyanika Phillips, CHRISTUS St Frances Cabrini Cancer Center, Alexandria, LA
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48
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Cho DC, Mahipal A, Dowlati A, Chow WA, Segal NH, Chung KY, Schneider BJ, Nemunaitis JJ, Abdul Razak AR, Tsai FYC, Balmanoukian AS, Bazhenova L, Xiao F, Angra N, Abdullah SE, Luke JJ. Safety and clinical activity of durvalumab in combination with tremelimumab in extensive disease small-cell lung cancer (ED-SCLC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8517] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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)
- Daniel C. Cho
- Perlmutter Cancer Center at NYU Langone Medical Center, New York, NY
| | | | - Afshin Dowlati
- University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jason J. Luke
- University of Chicago Comprehensive Cancer Center, Chicago, IL
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49
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Qin A, Lusk E, Daignault-Newton S, Schneider BJ. Concurrent chemotherapy and radiation versus chemotherapy alone for N3 stage IIIb NSCLC in elderly patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.8536] [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)
- Angel Qin
- University of Michigan, Ann Arbor, MI
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50
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Mamdani H, Schneider BJ, Abushahin LI, Birdas TJ, Kesler K, Lee A, Burney H, Perkins SM, Jalal SI. Safety and efficacy of durvalumab following multimodality therapy for locally advanced esophageal adenocarcinoma: Early results from Big Ten Cancer Research Consortium study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16070] [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)
| | | | - Laith I. Abushahin
- University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City, IA
| | | | | | - Ahran Lee
- Big Ten Cancer Research Consortium, Indianapolis, IN
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