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Smith EML, Cho Y, Hillman S, Scott MR, Harlos E, Wills R, Loprinzi C, Wilson CM, Zahrieh D. Patient-targeted education (ePRO-E) to increase ePRO intent within an Alliance clinical trial (A221805-SI1). JNCI Cancer Spectr 2024; 8:pkae002. [PMID: 38230706 PMCID: PMC10868392 DOI: 10.1093/jncics/pkae002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The Patient Cloud ePRO app was adopted by the National Cancer Institute National Clinical Trials Network (NCTN) to facilitate capturing electronic patient-reported (ePRO) outcome data, but use has been low. The study objectives were to test whether a patient-targeted ePRO educational resource (ePRO-E) would increase ePRO intent (number of users) and improve data quality (high quality: ≥80% of the required surveys submitted) within an ongoing NCTN study. METHODS The ePRO-E intervention, a patient-targeted educational resource (written material and 6-minute animated YouTube video), was designed to address ePRO barriers. ePRO intent and data quality were compared between 2 groups (N = 69): a historical control group and a prospectively recruited intervention group exposed to ePRO-E. Covariates included technology attitudes, age, sex, education, socioeconomic status, and comorbidity. RESULTS Intervention group ePRO intent (78.8%) was statistically significantly higher than historical control group intent (47.1%) (P = .03). Patients choosing ePRO versus paper surveys had more positive and higher technology attitudes scores (P = .03). The odds of choosing ePRO were 4.7 times higher (95% Confidence Interval [CI] = 1.2 to 17.8) (P = .02) among intervention group patients and 5.2 times higher (95% CI = 1.3 to 21.6) (P = .02) among patients with high technology attitudes scores, after controlling for covariates. However, the 80% submission rate (percentage submitting ≥80% of required surveys) in the ePRO group (30.6%) was statistically significantly lower than in the paper group (57.9%) (P = .05). CONCLUSIONS ePRO-E exposure increased ePRO intent. High technology attitudes scores were associated with ePRO selection. Since the ePRO survey submission rate was low, additional strategies are needed to promote high-quality data submission.
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Affiliation(s)
- Ellen M Lavoie Smith
- Department of Acute, Chronic and Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Youmin Cho
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Shauna Hillman
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Mary R Scott
- Department of Acute, Chronic and Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Elizabeth Harlos
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Rachel Wills
- Department of Central Protocol Operations, Alliance Protocol Operations Office, Chicago, IL, USA
| | | | - Christina M Wilson
- Department of Acute, Chronic and Continuing Care, University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - David Zahrieh
- Department of Quantitative Health Sciences, Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
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Jahan N, Cathcart-Rake E, Vierkant RA, Larson N, Loprinzi C, O'Sullivan CC, Faubion S, Kuhle C, Vencill JA, Couch F, Olson JE, Ruddy KJ. Sexual Dysfunction in Patients With Metastatic Breast Cancer. Clin Breast Cancer 2024; 24:72-78.e4. [PMID: 37867114 DOI: 10.1016/j.clbc.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Sexual well-being is a key determinant of quality of life. Sexual dysfunction in patients with metastatic breast cancer (MBC) is understudied. PATIENTS AND METHODS Patients were eligible for this study if they participated in the Mayo Clinic Breast Disease Registry (MCBDR), had a diagnosis of de novo MBC, and responded to a question about sexual dysfunction at the baseline MCBDR survey. Participants reported their sexual dysfunction on a scale of 0 (no dysfunction) to 10 (severe dysfunction) at baseline and then annually for 4 years. Participants answered additional sexual symptom questions in years 2 and 4. Associations between patient attributes and the presence and severity of sexual dysfunction, changes in sexual dysfunction from baseline to subsequent surveys, and associations between specific sexual symptoms and severity of sexual dysfunction were assessed. RESULTS One hundred three patients with de novo MBC answered the sexual dysfunction question at baseline. The prevalence of any sexual dysfunction (score of 1-10) was 56.3% at baseline (n = 103), 57.1 % at year 1 (n = 77), 80.4% at year 2 (n = 46), 65.8% at year 3 (n = 38), and 85% at year 4 (n = 20). Vaginal dryness was reported by approximately 49% and 39% of patients in years 2 and 4 respectively. Vaginal dryness was associated with higher severity of sexual dysfunction. CONCLUSIONS Self-reported sexual dysfunction is frequent in women with de novo MBC. Vaginal dryness is a frequently reported treatable symptom associated with higher severity of sexual dysfunction. Clinicians should assess patients with MBC for sexual dysfunction and discuss potential treatment strategies.
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Affiliation(s)
- Nusrat Jahan
- Division of Hematology and Oncology, University Alabama at Birmingham, Birmingham, AL
| | | | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nicole Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - Carol Kuhle
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer A Vencill
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Rose L, Lustberg M, Ruddy KJ, Cathcart-Rake E, Loprinzi C, Dulmage B. Hair loss during and after breast cancer therapy. Support Care Cancer 2023; 31:186. [PMID: 36826602 DOI: 10.1007/s00520-023-07634-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
For patients diagnosed with breast cancer, alopecia can be a distressing side effect of treatment. Major surgeries, cytotoxic chemotherapy, and endocrine therapy may result in several different types of alopecia. This article reviews the underlying mechanisms, etiology, prevention strategies, and treatment options for chemotherapy-induced alopecia, telogen effluvium, and endocrine-induced alopecia. Here, we aim to provide breast oncologists with a review of the types of hair loss related to cancer therapy and current preventative and treatment options to facilitate informative patient counseling.
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Affiliation(s)
- Lucy Rose
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | | | | | - Brittany Dulmage
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Ruddy KJ, Zahrieh D, He J, Waechter B, Holleran JL, Lewis LD, Chow S, Beumer J, Weiss M, Trikalinos N, Faller B, Lustberg M, Rugo HS, Loprinzi C. Dexamethasone to prevent everolimus-induced stomatitis (Alliance MIST Trial: A221701). Semin Oncol 2023; 50:7-10. [PMID: 36693773 PMCID: PMC10247389 DOI: 10.1053/j.seminoncol.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
mTOR inhibitors such as everolimus may cause oral stomatitis, often a dose-limiting toxicity. Prior clinical research has suggested that a dexamethasone mouth rinse might help prevent and/or treat this. Alliance A221701 was a randomized phase III trial of patients initiating 10 mg daily oral everolimus that compared dexamethasone mouthwash taken preventively (initial dexamethasone group) versus therapeutically (initial placebo group) to assess two coprimary endpoints: the incidence of mTOR inhibitor-associated stomatitis (mIAS), and the area under the curve (AUC) of mIAS-associated pain over an 8-week treatment period. A Fisher's exact test was used to compare the incidences while a Wilcoxon rank-sum test was used to compare the AUCs. In addition, we performed an exploratory analysis of the association of everolimus trough concentrations and toxicity using a Mann-Whitney U test. Due to slow accrual, this study closed after 39 patients were randomized (19 to upfront placebo and 20 to upfront dexamethasone). There were no significant differences between groups seen in either of the coprimary endpoints; furthermore, we found no association between whole blood everolimus trough concentrations and toxicity. Although limited by poor enrollment, the results of this study do not suggest that prophylactic dexamethasone mouthwash is superior to therapeutic dexamethasone mouthwash (initiated at the first sign of mouth pain) for reducing the incidence or severity of mIAS from everolimus.
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Affiliation(s)
| | - David Zahrieh
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Jun He
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Blake Waechter
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | - Lionel D Lewis
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Selina Chow
- Alliance Protocol Operations Office, Chicago, IL
| | - Jan Beumer
- Cancer Therapeutics Program, UPMC Hillman Cancer Center, Pittsburgh, PA
| | | | | | | | | | - Hope S Rugo
- University of California San Francisco Medical Center, San Francisco, CA
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Chan A, Elsayed A, Ng DQ, Ruddy K, Loprinzi C, Lustberg M. A global survey on the utilization of cryotherapy and compression therapy for the prevention of chemotherapy-induced peripheral neuropathy. Support Care Cancer 2022; 30:10001-10007. [PMID: 36214880 PMCID: PMC9715474 DOI: 10.1007/s00520-022-07383-x] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/01/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect that is highly prevalent among cancer patients undergoing chemotherapy. There is a growing use of cryotherapy (CryTx) and compression therapy (ComTx) to prevent CIPN at cancer centers worldwide. In this study, we examined the awareness and recommendation of these modalities and evaluated factors associated with awareness. In addition, we investigated the type of technology utilized, barriers to implementation, and perceived adverse events of CryTx and ComTx. METHODS Active members of the Multinational Association of Supportive Care of Cancer (MASCC) were invited to complete an electronic survey that was sent via SurveyMonkey between September and October 2021. The survey assessed participants' awareness, recommendation, usage, barriers to utilization, and perceived adverse events of CryTx and ComTx. Descriptive statistics and multiple logistic regression were utilized to analyze findings. RESULTS Out of 184 participants, 70.1% were physicians, 73.4% had over 10 years of practice, and 49.5% were practicing in an outpatient setting. While more than half (63.3%) of participants indicated awareness of CryTx for taxane-induced peripheral neuropathy, less than a quarter (22.8%) indicated recommendation in their practice setting. Factors associated with higher awareness of CryTx for patients receiving taxanes include living in Europe (OR = 2.69, 95% CI [1.28-5.64], p = 0.009), not practicing in an inpatient setting (OR = 3.15, 95% CI [1.45-6.85], p = 0.004), and self-identifying as non-physician (OR = 2.40, 95% CI [1.03-4.37], p = 0.041). Commercial cooling (31.5%) and compression (16.8%) gloves and socks were the most used modalities for CryTx and ComTx, respectively. The most identified barriers to CryTx and ComTx utilization include insufficient evidence (53.5%), logistics (34.8%), and patient discomfort (23.4%). Redness/irritation of skin (27.7%) and numbness/tingling (24.5%) accounted for about half of the perceived adverse events associated with use of CryTx and ComTx. CONCLUSION Results of our global survey illustrated that there are varying modes in the delivery of CryTx and ComTx among cancer centers around the world. Education of the utilization of CryTx and ComTx, in addition to efficacy and implementation studies, is needed to close the gap between awareness and implementation in clinical practice.
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Affiliation(s)
- Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, Irvine, CA, USA.
- Department of Pharmacy, University of California Irvine Health, Irvine, CA, USA.
| | - Amna Elsayed
- Department of Pharmacy, University of California Irvine Health, Irvine, CA, USA
| | - Ding Quan Ng
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, Irvine, CA, USA
| | - Kathryn Ruddy
- Department of Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Charles Loprinzi
- Department of Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Maryam Lustberg
- Breast Medical Oncology, Yale Cancer Center, New Haven, CT, USA
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Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2022; 40:3998-4024. [PMID: 36122322 DOI: 10.1200/jco.22.01357] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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 The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other health care providers on integrative approaches to managing pain in patients with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included pain intensity, symptom relief, and adverse events. Expert panel members used this evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 227 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Among adult patients, acupuncture should be recommended for aromatase inhibitor-related joint pain. Acupuncture or reflexology or acupressure may be recommended for general cancer pain or musculoskeletal pain. Hypnosis may be recommended to patients who experience procedural pain. Massage may be recommended to patients experiencing pain during palliative or hospice care. These recommendations are based on an intermediate level of evidence, benefit outweighing risk, and with moderate strength of recommendation. The quality of evidence for other mind-body interventions or natural products for pain is either low or inconclusive. There is insufficient or inconclusive evidence to make recommendations for pediatric patients. More research is needed to better characterize the role of integrative medicine interventions in the care of patients with cancer.Additional information is available at https://integrativeonc.org/practice-guidelines/guidelines and www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Ting Bao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra Barton
- University of Michigan School of Nursing, Ann Arbor, MI
| | - Eran Ben-Arye
- Lin & Carmel Medical Centers, Clalit Health Services; Technion Faculty of Medicine, Haifa, Israel
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City, UT
| | | | | | - Richard T Lee
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ana Maria Lopez
- Thomas Jefferson. Sidney Kimmel Cancer Center, Philadelphia, PA
| | | | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jodi MacLeod
- Patient Representative, Memorial Sloan Kettering Integrative Medicine Service, New York, NY
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA
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Vaz-Luis I, Masiero M, Cavaletti G, Cervantes A, Chlebowski RT, Curigliano G, Felip E, Ferreira AR, Ganz PA, Hegarty J, Jeon J, Johansen C, Joly F, Jordan K, Koczwara B, Lagergren P, Lambertini M, Lenihan D, Linardou H, Loprinzi C, Partridge AH, Rauh S, Steindorf K, van der Graaf W, van de Poll-Franse L, Pentheroudakis G, Peters S, Pravettoni G. ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe. Ann Oncol 2022; 33:1119-1133. [PMID: 35963481 DOI: 10.1016/j.annonc.2022.07.1941] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. DESIGN AND METHODS Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. RESULTS We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. CONCLUSIONS The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.
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Affiliation(s)
- I Vaz-Luis
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif; UMR 981, Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy-Cancer Campus, Villejuif, France.
| | - M Masiero
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - A Cervantes
- Department of Medical Oncology, INCLIVA, Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon; Catolica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - P A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, USA
| | - J Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - J Jeon
- Exercise Medicine Center for Cancer and Diabetes Patients (ICONS), Department of Sport Industry, Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - C Johansen
- Centre for Cancer Late Effect Research (CASTLE), Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Joly
- Department of Medical Oncology, Centre François Baclesse, U1086 Anticipe, Unicaen Normandy Universtity, Caen, France
| | - K Jordan
- Department for Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - B Koczwara
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - P Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Lenihan
- International Cardio-Oncology Society, Tampa, USA
| | - H Linardou
- Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece
| | | | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Rauh
- Department of Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - W van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer institute, Erasmus University Medical Center, Rotterdam
| | - L van de Poll-Franse
- Division of Psychosocial Research & Epidemiology, Department of Psycological Research, The Netherlands Cancer Institute, Amsterdam; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S Peters
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
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Storandt MH, Durani U, Stan D, Larson N, Loprinzi C, Couch F, Olson JE, Khera N, Ruddy KJ. Abstract 1012: Financial hardship in breast cancer survivors. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1012] [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: Medical financial hardship, encompassing material, behavioral, and psychologic domains, is becoming an increasingly common consequence of illness in cancer patients. Identifying at-risk patients is the first step to develop proactive approaches to mitigate this problem. To try and address this need, Mayo Clinic Breast Disease Registry (MCBDR) is prospectively collecting data about financial concerns in addition to the usual sociodemographic and clinical information.
Methods: We used data from Mayo Clinic Breast Disease Registry, a prospective cohort of consenting patients seen at Mayo Clinic Rochester within one year of initial breast cancer diagnosis. Participants completed baseline and annual follow-up surveys rating their financial concerns on a linear analogue scale from 0 (“none”) to 10 (“constant concerns”). We compared patient-reported financial concern at baseline to that on each patient’s most recent survey, with worsening concerns defined as a 1+-point increase. Logistic regression evaluated for predictors of worsening financial concerns.
Results: 1,957 participants responded to financial concern questions on a baseline and at least one follow-up survey between 2015 and 2020. Mean age was 58.5 years (SD 12.5), and mean time between diagnosis and the most recent follow-up was 25.6 months (SD 16.2). 357 (18.2%) reported worsening financial concerns. Only lower baseline financial status was associated with a greater likelihood of worsening financial concerns (see Table). Conclusions: More than one in seven breast cancer survivors develop worsening financial concerns within 5-years of diagnosis, and those with less financial security at baseline appear to be most vulnerable.
Funding: Breast Cancer Research Foundation (CLL) and NR015259 (KJR).
Patient and tumor characteristics, compared by whether financial status worsened over time Full Cohort (n=1957) Worsening, ≥ 1-point change (n=357) Stable/Improved (n=1600) p value Full Cohort (n=1957) Worsening, ≥ 1-point change (n=357) Stable/Improved (n=1600) p value Age at diagnosis II or III 502 (25.7%) 98 (27.5%) 404 (25.3%) 0.239 ≤ 50 546 (27.9%) 105 (29.4%) 441 (27.6%) IV 67 (3.4%) 17 (4.8%) 50 (3.1%) 0.086 51-64 757 (38.7%) 136 (38.1%) 621 (38.8%) 0.562 Unknown 351 (17.9%) 65 (18.2%) 286 (17.9%) 0.536 ≥65 654 (33.4%) 116 (32.5%) 538 (33.6%) 0.506 ER and/or PR positive Race No/Unknown 482 (24.6%) 92 (25.8%) 390 (24.4%) White 1863 (95.2%) 337 (94.4%) 1526 (95.4%) Yes 1475 (75.4%) 265 (74.2%) 1210 (75.6%) 0.580 Non-white 24 (1.2%) 5 (1.4%) 19 (1.2%) 0.729 Her2 positive Other/Unknown/Choose not to respond 70 (3.6%) 15 (4.2%) 55 (3.4%) 0.478 No/Unknown 1746 (89.2%) 314 (88.0%) 1432 (89.5%) Educational status Yes 176 (9.0%) 37 (10.4%) 139 (8.7%) 0.321 Less than bachelor’s degree 880 (45.0%) 168 (47.1%) 712 (44.5%) Borderline 35 (1.8%) 6 (1.7%) 29 (1.8%) 0.898 Bachelor's degree or higher 1065 (54.4%) 187 (52.4%) 878 (54.9%) 0.384 Radiation Unknown 12 (0.6%) 2 (0.6%) 10 (0.6%) 0.832 No/Unknown 781 (39.9%) 140 (39.2%) 641 (40.1%) Financial status near time of diagnosis Yes 1176 (60.1%) 217 (60.8%) 959 (59.9%) 0.768 Pay bills, money for special things 1412 (72.2%) 244 (68.3%) 1168 (73.0%) Chemotherapy/targeted therapy Pay bills, no money for special things 367 (18.8%) 80 (22.4%) 287 (17.9%) 0.046 No/Unknown 1264 (64.6%) 221 (61.9%) 1043 (65.2%) Pay bills by making cuts 102 (5.2%) 19 (5.3%) 83 (5.2%) 0.729 Yes 693 (35.4%) 136 (38.1%) 557 (34.8%) 0.241 Unable to pay bills 56 (2.9%) 10 (2.8%) 46 (2.9%) 0.911 Hormone/endocrine therapy Unknown 20 (1.0%) 4 (1.1%) 16 (1.0%) 0.750 No/Unknown 710 (36.3%) 141 (39.5%) 569 (35.6%) Employment status at time of diagnosis Yes 1247 (63.7%) 216 (60.5%) 1031 (64.4%) 0.163 Employed full-time 462 (23.6%) 83 (23.2%) 379 (23.7%) Surgery type Employed part-time/unemployed/retired 525 (26.8%) 92 (25.8%) 433 (27.1%) 0.856 Lumpectomy 846 (43.2%) 145 (40.6%) 701 (43.8%) Not available 970 (49.6%) 182 (51.0%) 788 (49.3%) 0.716 Mastectomy 903 (46.1%) 165 (46.2%) 738 (46.1%) 0.535 Stage at time of diagnosis None/Unknown 208 (10.6%) 47 (13.2%) 161 (10.1%) 0.069 0 or I 1037 (53.0%) 177 (49.6%) 860 (53.8%)
Citation Format: Michael H. Storandt, Urshila Durani, Daniela Stan, Nicole Larson, Charles Loprinzi, Fergus Couch, Janet E. Olson, Nandita Khera, Kathryn J. Ruddy. Financial hardship in breast cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1012.
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Affiliation(s)
| | - Urshila Durani
- 2Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Daniela Stan
- 2Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Nicole Larson
- 2Mayo Clinic College of Medicine and Science, Rochester, MN
| | | | - Fergus Couch
- 2Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Janet E. Olson
- 2Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Nandita Khera
- 3Mayo Clinic College of Medicine and Science, Phoenix, AZ
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Karam DP, Vierkant RA, Ehlers S, Freedman RA, Austin J, Choudhery S, Larson N, Loprinzi C, Olson JE, Couch F, Ruddy KJ. BPI22-021: Surveillance Mammography in Elderly Breast Cancer Survivors (Project Funded by Breast Cancer Research Foundation). J Natl Compr Canc Netw 2022. [DOI: 10.6004/jnccn.2021.7167] [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: 11/17/2022]
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10
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D'Andre S, McAllister S, Nagi J, Giridhar KV, Ruiz-Macias E, Loprinzi C. Topical Cannabinoids for Treating Chemotherapy-Induced Neuropathy: A Case Series. Integr Cancer Ther 2021; 20:15347354211061739. [PMID: 34841942 PMCID: PMC8646190 DOI: 10.1177/15347354211061739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy is a common and often severe side effect from many chemotherapeutic agents, with limited treatment options. There is no literature on the use of topical cannabinoids for chemotherapy-induced neuropathy. CASE PRESENTATIONS The current manuscript presents a case series of patients presenting in oncology clinics at Sutter Health, CA and Mayo Clinic, Rochester, MN from April 2019 to December 2020 with chemotherapy-induced peripheral neuropathy who used topical creams containing the cannabinoids delta-nine-tetrahydrocannabinol (THC) and/or cannabidiol (CBD). CONCLUSIONS This case series suggests that topical cannabinoids may be helpful for patients with chemotherapy-induced peripheral neuropathy. This paper also discusses the potential mechanisms of action by which topical cannabinoids might alleviate established CIPN symptoms. A randomized placebo-controlled trial using a standardized product is planned to study the actual efficacy of such treatment.
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Affiliation(s)
- Stacy D'Andre
- Sutter Institute for Medical Research, Sacramento, CA, USA
| | - Sean McAllister
- Sutter California Pacific Medical Research Institute, San Francisco, CA, USA
| | - Jasdeepa Nagi
- Sutter Institute for Medical Research, Sacramento, CA, USA
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12
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Patel SR, Zayas J, Medina-Inojosa JR, Loprinzi C, Cathcart-Rake EJ, Bhagra A, Olson JE, Couch FJ, Ruddy KJ. Real-World Experiences With Yoga on Cancer-Related Symptoms in Women With Breast Cancer. Glob Adv Health Med 2021; 10:2164956120984140. [PMID: 33473331 PMCID: PMC7797571 DOI: 10.1177/2164956120984140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/13/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Integrative therapies such as yoga are potential treatments for many psychological and physical symptoms that occur during and/or after treatment for cancer. The purpose of the current study was to evaluate the patient-perceived benefit of yoga for symptoms commonly experienced by breast cancer survivors. Methods 1,049 breast cancer survivors who had self-reported use of yoga on a follow up survey, in an ongoing prospective Mayo Clinic Breast Disease Registry (MCBDR), received an additional mailed yoga-focused survey asking about the impact of yoga on a variety of symptoms. Differences between pre- and post- scores were assessed using Wilcoxon Signed Rank Test. Results 802/1,049 (76%) of women who were approached to participate, consented and returned the survey. 507/802 (63%) reported use of yoga during and/or after their cancer diagnosis. The vast majority of respondents (89.4%) reported some symptomatic benefit from yoga. The most common symptoms that prompted the use of yoga were breast/chest wall pain, lymphedema, and anxiety. Only 9% of patients reported that they had been referred to yoga by a medical professional. While the greatest symptom improvement was reported with breast/chest wall pain and anxiety, significant improvement was also perceived in joint pain, muscle pain, fatigue, headache, quality of life, hot flashes, nausea/vomiting, depression, insomnia, lymphedema, and peripheral neuropathy, (all p-values <0.004). Conclusion Data supporting the use of yoga for symptom management after cancer are limited and typically focus on mental health. In this study, users of yoga often reported physical benefits as well as mental health benefits. Further prospective studies investigating the efficacy of yoga in survivorship are warranted.
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Affiliation(s)
- Shruti R Patel
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacqueline Zayas
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Medicine and the Mayo Clinic Medical Scientist Training Program, Rochester, Minnesota
| | | | - Charles Loprinzi
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Anjali Bhagra
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Kathryn J Ruddy
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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13
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Paskett ED, Le-Rademacher J, Oliveri JM, Liu H, Seisler DK, Sloan JA, Armer JM, Naughton MJ, Hock K, Schwartz M, Unzeitig G, Melnik M, Yee LD, Fleming GF, Taylor JR, Loprinzi C. A randomized study to prevent lymphedema in women treated for breast cancer: CALGB 70305 (Alliance). Cancer 2020; 127:291-299. [PMID: 33079411 DOI: 10.1002/cncr.33183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema affects many women who are treated for breast cancer. We examined the effectiveness of an education-only (EO) versus education plus sleeve compression/exercise intervention (lymphedema education and prevention [LEAP]) on lymphedema incidence and range of motion (ROM) in a group-randomized trial across 38 cooperative group sites. METHODS The treating institution was randomly assigned to either EO or LEAP by a study statistician. All patients at a treating institution participated in the same intervention (EO or LEAP) to minimize contamination bias. Participants completed surveys, arm volume measurements, and self-reported ROM assessments before surgery and at 12 and 18 months after surgery. Lymphedema was defined as a ≥10% difference in limb volume at any time post-surgery up to 18 months after surgery or diagnosis by a health provider. Cochran-Mantel-Haenszel tests were used to compare lymphedema-free rates between groups, stratified by lymph node surgery type. Self-reported ROM differences were compared between groups. RESULTS A total of 554 participants (56% LEAP) were included in the analyses. At 18 months, lymphedema-free rates were 58% (EO) versus 55% (LEAP) (P = .37). ROM for both arms was greater in LEAP versus EO at 12 months; by 18 months, most women reported full ROM, regardless of group. In LEAP, only one-third wore a sleeve ≥75% of the time; 50% performed lymphedema exercises at least weekly. CONCLUSION Lymphedema incidence did not differ by intervention group at 18 months. Poor adherence in the LEAP group may have contributed. However, physical therapy may speed recovery of ROM. Further research is needed to effectively reduce the incidence and severity of lymphedema in patients who have breast cancer.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Columbus, Ohio
| | - Jennifer Le-Rademacher
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jill M Oliveri
- The Ohio State University Comprehensive Cancer Center, Population Sciences, Columbus, Ohio
| | - Heshan Liu
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Drew K Seisler
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey A Sloan
- Department of Health Sciences Research, Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, Missouri
| | - Michelle J Naughton
- The Ohio State University Comprehensive Cancer Center, Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, Columbus, Ohio
| | - Karen Hock
- The Ohio State University Comprehensive Cancer Center, Stefanie Spielman Comprehensive Breast Center Oncology Rehabilitation, Columbus, Ohio
| | - Michael Schwartz
- Department of Medicine, Division of Medical Oncology and Hematology, Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Marianne Melnik
- Department of General Surgery, Division of Surgical Oncology and Breast Care Services, Spectrum Health, Grand Rapids, Michigan
| | - Lisa D Yee
- Division of Surgical Oncology, City of Hope, Duarte, California
| | - Gini F Fleming
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - John R Taylor
- Biological Sciences Division, The University of Chicago, Alliance Protocol Operations Program Office, Chicago, Illinois
| | - Charles Loprinzi
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Naughton MJ, Liu H, Seisler DK, Le-Rademacher J, Armer JM, Oliveri JM, Sloan JA, Hock K, Schwartz M, Unzeitig G, Melnik M, Yee LD, Fleming GF, Taylor JR, Loprinzi C, Paskett ED. Health-related quality of life outcomes for the LEAP study-CALGB 70305 (Alliance): A lymphedema prevention intervention trial for newly diagnosed breast cancer patients. Cancer 2020; 127:300-309. [PMID: 33079393 DOI: 10.1002/cncr.33184] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 06/19/2020] [Accepted: 07/17/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lymphedema is an adverse effect of breast cancer treatment that causes swelling and pain in the arm and hand. We tested 2 lymphedema prevention interventions and their impact on health-related quality of life (HRQOL) in a group-randomized trial at 38 cooperative group sites within the United States. METHODS Patients were recruited before breast surgery. Sites were randomly assigned to education-only (EO) lymphedema prevention or education plus exercise and physical therapy (LEAP). Lymphedema was defined as a ≥10% difference in arm volume at any time from baseline to 18 months postsurgery. HRQOL was assessed using the Functional Assessment of Cancer Therapy-Breast plus 4 lymphedema items (FACT-B+4). Longitudinal mixed model regression analysis, adjusting for key demographic and clinical variables, examined participants' HRQOL by intervention group and lymphedema status. RESULTS A total of 547 patients (56% LEAP) were enrolled and completed HRQOL assessments. The results revealed no differences between the interventions in preventing lymphedema (P = .37) or HRQOL (FACT-B+4 total score; P = .8777). At 18 months, the presence of lymphedema was associated with HRQOL at borderline significance (P = .0825). However, African American patients reported greater lymphedema symptoms (P = .0002) and better emotional functioning (P = .0335) than patients of other races or ethnicities. Lower HRQOL during the intervention was associated with younger age (P ≤ .0001), Eastern Cooperative Oncology Group performance status >0 (P = .0002), ≥1 positive lymph nodes (P = .0009), having no education beyond high school (P < .0001), having undergone chemotherapy (P = .0242), and having had only axillary node dissection or sentinel node biopsy versus both (P = .0007). CONCLUSION The tested interventions did not differ in preventing lymphedema or in HRQOL outcomes. African American women reported greater HRQOL impacts due to lymphedema symptoms than women of other races or ethnicities.
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Affiliation(s)
| | | | | | | | - Jane M Armer
- Department of Nursing Research, University of Missouri, Columbia, Missouri
| | - Jill M Oliveri
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey A Sloan
- Division of Oncology & Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Karen Hock
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | | | | | - Marianne Melnik
- Cancer Research Consortium of West Michigan, Grand Rapids, Michigan
| | - Lisa D Yee
- Division of Surgical Oncology, City of Hope, Duarte, California
| | - Gini F Fleming
- Department of Hematology/Oncology, University of Chicago, Chicago, Illinois
| | - John R Taylor
- Alliance for Clinical Trials in Oncology Foundation, Protocol Operations Program Office, Chicago, Illinois
| | - Charles Loprinzi
- North Central Cancer Treatment Group, Mayo Clinic, Rochester, Minnesota
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Schünemann HJ, Ventresca M, Crowther M, Briel M, Zhou Q, Noble S, Macbeth F, Griffiths G, Garcia D, Lyman GH, Di Nisio M, Iorio A, Mbuagbaw L, Neumann I, van Es N, Brouwers M, Guyatt G, Streiff MB, Marcucci M, Baldeh T, Florez ID, Alma OG, Solh Z, Bossuyt PM, Kahale LA, Ageno W, Bozas G, Büller HR, Lebeau B, Lecumberri R, Loprinzi C, McBane R, Sideras K, Maraveyas A, Pelzer U, Perry J, Klerk C, Agnelli G, Akl EA. Evaluating prophylactic heparin in ambulatory patients with solid tumours: a systematic review and individual participant data meta-analysis. Lancet Haematol 2020; 7:e746-e755. [PMID: 32976752 DOI: 10.1016/s2352-3026(20)30293-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Study-level meta-analyses provide high-certainty evidence that heparin reduces the risk of symptomatic venous thromboembolism for patients with cancer; however, whether the benefits and harms associated with heparin differ by cancer type is unclear. This individual participant data meta-analysis of randomised controlled trials examines the effect of heparin on survival, venous thromboembolism, and bleeding in patients with cancer in general and by type. METHODS In this systematic review and meta-analysis we searched MEDLINE, Embase, and The Cochrane Library for randomised controlled trials comparing parenteral anticoagulants with placebo or standard care in ambulatory patients with solid tumours and no indication for anticoagulation published from the inception of each database to January 14, 2017, and updated it on May 14, 2020, without language restrictions. We calculated the effect of parenteral anticoagulant administration on all-cause mortality, venous thromboembolism occurrence, and bleeding related outcomes through multivariable hierarchical models with patient-level variables as fixed effects and a categorical trial variable as a random effect, adjusting for age, cancer type, and metastatic status. Interaction terms were tested to investigate effects in predefined subgroups. This study is registered with PROSPERO, CRD42013003526. FINDINGS We obtained individual participant data from 14 of 20 eligible randomised controlled trials (8278 [79%] of 10 431 participants; 4139 included in the low-molecular-weight heparin group and 4139 in the control group). Meta-analysis showed an adjusted relative risk (RR) of mortality at 1 year of 0·99 (95% CI 0·93-1·06) and a hazard ratio of 1·01 (95% CI 0·96-1·07). The number of patients with venous thromboembolic events was 158 (4·0%) of 3958 with available data in the low-molecular-weight heparin group compared with 279 (7·1%) of 3957 in the control group. Major bleeding events occurred in 71 (1·7%) of 4139 patients in the control population and 88 (2·1%) in the low-molecular-weight heparin group, and minor bleeding events in 478 (12·1%) of 3945 patients with available data in the control group and 652 (16·6%) of 3937 patients in the low-molecular-weight heparin group. The adjusted RR was 0·58 (95% CI 0·47-0·71) for venous thromboembolism, 1·27 (0·92-1·74) for major bleeding, and 1·34 (1·19-1·51) for minor bleeding. Prespecified subgroup analysis of venous thromboembolism occurrence by cancer type identified the most certain benefit from heparin treatment in patients with lung cancer (RR 0·59 [95% CI 0·42-0·81]), which dominated the overall reduction in venous thromboembolism. Certainty of the evidence for the outcomes ranged from moderate to high. INTERPRETATION Low-molecular-weight heparin reduces risk of venous thromboembolism without increasing risk of major bleeding compared with placebo or standard care in patients with solid tumours, but it does not improve survival. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Holger J Schünemann
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Matthew Ventresca
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthias Briel
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Qi Zhou
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, Wales, UK
| | - Fergus Macbeth
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Gareth Griffiths
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - David Garcia
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G D'Annunzio, Chieti-Pescara, Italy; Department of Vascular Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Alfonso Iorio
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Division of Haematology, Department of Medicine, McMaster University, Hamilton, ON, Canada; Division of Haematology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Ignacio Neumann
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nick van Es
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Vascular Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Melissa Brouwers
- Faculty of Medicine, School of Epidemiology and Public Heath, University of Ottawa, Ottawa, ON, Canada
| | - Gordon Guyatt
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maura Marcucci
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tejan Baldeh
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ivan D Florez
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia
| | | | - Ziad Solh
- Transfusion Medicine Section, Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Lara A Kahale
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - George Bozas
- Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Harry R Büller
- Department of Vascular Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Bernard Lebeau
- Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Ramon Lecumberri
- Haematology Service, University Clinic of Navarra, Pamplona, Spain
| | - Charles Loprinzi
- Divisions of Cardiology and Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Robert McBane
- Divisions of Vascular Medicine and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kostandinos Sideras
- Divisions of Medical Oncology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Anthony Maraveyas
- Division of Cancer, Hull York Medical School, University of Hull, Hull, UK
| | - Uwe Pelzer
- Division of Haematology, Oncology and Tumour Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität - Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - James Perry
- Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, ON, Canada; Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Clara Klerk
- Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, Netherlands
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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van Es N, Ventresca M, Di Nisio M, Zhou Q, Noble S, Crowther M, Briel M, Garcia D, Lyman GH, Macbeth F, Griffiths G, Iorio A, Mbuagbaw L, Neumann I, Brozek J, Guyatt G, Streiff MB, Baldeh T, Florez ID, Gurunlu Alma O, Agnelli G, Ageno W, Marcucci M, Bozas G, Zulian G, Maraveyas A, Lebeau B, Lecumberri R, Sideras K, Loprinzi C, McBane R, Pelzer U, Riess H, Solh Z, Perry J, Kahale LA, Bossuyt PM, Klerk C, Büller HR, Akl EA, Schünemann HJ. The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta-analysis. J Thromb Haemost 2020; 18:1940-1951. [PMID: 32336010 DOI: 10.1111/jth.14824] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/21/2020] [Accepted: 03/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oncology guidelines suggest using the Khorana score to select ambulatory cancer patients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain. OBJECTIVE To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of low-molecular-weight heparin (LMWH) among high-risk Khorana score patients. METHODS This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. RESULTS A total of 3293 patients from the control groups with an available Khorana score had lung (n = 1913; 58%), colorectal (n = 452; 14%), pancreatic (n = 264; 8%), gastric (n = 201; 6%), ovarian (n = 184; 56%), breast (n = 164; 5%), brain (n = 84; 3%), or bladder cancer (n = 31; 1%). The 6-month VTE incidence was 9.8% among high-risk Khorana score patients and 6.4% among low-to-intermediate-risk patients (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2). The dichotomous Khorana score performed differently in lung cancer patients (OR 1.1; 95% CI, 0.72-1.7) than in the group with other cancer types (OR 3.2; 95% CI, 1.8-5.6; Pinteraction = .002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared with controls (OR 0.36; 95% CI, 0.22-0.58), without increasing the risk of major bleeding (OR 1.1; 95% CI, 0.59-2.1). CONCLUSION The Khorana score was unable to stratify patients with lung cancer based on their VTE risk. Among those with other cancer types, a high-risk score was associated with a three-fold increased risk of VTE compared with a low-to-intermediate risk score. Thromboprophylaxis was effective and safe in patients with a high-risk Khorana score.
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Affiliation(s)
- Nick van Es
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Matthew Ventresca
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Qi Zhou
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK
| | - Mark Crowther
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthias Briel
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Gary H Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK
| | - Gareth Griffiths
- Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK
- Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Alfonso Iorio
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Division of Hematology, Department of Medicine, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Ignacio Neumann
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jan Brozek
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Gordon Guyatt
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Michael B Streiff
- Division of Hematology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tejan Baldeh
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Ivan D Florez
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia
| | | | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine-Stroke Unit, Università di Perugia, Perugia, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maura Marcucci
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - George Bozas
- Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Gilbert Zulian
- Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Anthony Maraveyas
- Division of Cancer-Hull York Medical School, University of Hull, Hull, UK
| | - Bernard Lebeau
- Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Ramon Lecumberri
- Hematology Service, University Clinic of Navarra, Pamplona, Spain
| | - Kostandinos Sideras
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Charles Loprinzi
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert McBane
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Uwe Pelzer
- Division of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt Universität-Universität zu Berlin, Berlin, Germany
| | - Hanno Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité, University Hospital, Berlin, Germany
| | - Ziad Solh
- Transfusion Medicine Section, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - James Perry
- Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada
- Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Lara A Kahale
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Klerk
- Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elie A Akl
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Temel JS, Sloan J, Zemla T, Greer JA, Jackson VA, El-Jawahri A, Kamdar M, Kamal A, Blinderman CD, Strand J, Zylla D, Daugherty C, Furqan M, Obel J, Razaq M, Roeland EJ, Loprinzi C. Multisite, Randomized Trial of Early Integrated Palliative and Oncology Care in Patients with Advanced Lung and Gastrointestinal Cancer: Alliance A221303. J Palliat Med 2020; 23:922-929. [PMID: 32031887 PMCID: PMC7307668 DOI: 10.1089/jpm.2019.0377] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: We conducted a multicenter, randomized trial of early integrated palliative and oncology care in patients with advanced cancer to confirm the benefits of early palliative care (PC) seen in prior single-center studies. Methods: We randomly assigned patients with newly diagnosed incurable cancer to early integrated palliative and oncology care (n = 195) or usual oncology care (n = 196) at sites through the Alliance for Clinical Trials in Oncology. Patients assigned to the intervention were expected to meet with a PC clinician at least monthly until death, whereas usual care patients consulted PC on request. The primary endpoint was the change in quality of life from baseline to week 12 per the Functional Assessment of Cancer Therapy-General (FACT-G). Secondary outcomes included anxiety, depression, and communication about prognosis and end-of-life care. Results: Due to significant morbidity and a high proportion of measures that were not completed within the protocol window or for unknown reasons, the rate of missing data was high. We anticipated that 70% of patients (n = 280) would complete the FACT-G at baseline and week 12, but only 49.3% (n = 193/391) completed the measure. Delivery of the intervention was also suboptimal, as 14.9% (n = 29/195) of intervention patients had no PC visits by week 12. Intervention patients reported a mean 3.35 (standard deviation [SD] = 14.7) increase in FACT-G scores from baseline to week 12 compared with usual care patients who reported a 0.12 (SD = 12.7) increase from baseline (p = 0.10). Conclusion: This study highlights the difficulties of conducting multicenter trials of supportive care interventions in patients with advanced cancer. Clinical Trials Registration: NCT02349412.
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Affiliation(s)
- Jennifer S. Temel
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Address correspondence to: Jennifer S. Temel, MD, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | | | | | | | | - Mihir Kamdar
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arif Kamal
- Duke University Medical Center, Durham, North Carolina, USA
| | | | | | - Dylan Zylla
- Park Nicollet/HealthPartners, Metro-Minnesota Community Oncology Research Consortium, Minneapolis, Minnesota, USA
| | | | - Muhummad Furqan
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jennifer Obel
- NorthShore University HealthSystem CCOP, Evanston, Illinois, USA
| | - Mohammad Razaq
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Eric J. Roeland
- University of California San Diego Moores Cancer Center, La Jolla, California, USA
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Vera J, Paludo J, Kottschade L, Block M, Yan Y, Loprinzi C, Markovic S. Abstract B15: Dabrafenib-trametinib-induced pyrexia successfully treated with colchicine. Mol Cancer Res 2020. [DOI: 10.1158/1557-3125.ras18-b15] [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
The most common adverse event (AE) of dabrafenib and trametinib (DT) is pyrexia, which has been reported to occur in up to 71% of patients. Pyrexia resulted in therapy discontinuation in up to 26% of patients who otherwise were benefiting from the treatment. Little is known about the pathogenesis and optimal management of this common AE. We hypothesized that the etiology of pyrexia in patients treated with DT could be extrapolated from DT-related cutaneous adverse effects in which a paradoxical MAPK pathway activation has been identified. We hypothesized that the mechanism of MAPK pathway activation with DT therapy is similar to that reported in patients with familial Mediterranean fever (FMF), a rare, inherited condition characterized by episodes of fever and rash that responds exceedingly well to colchicine-based therapy. Based on this association, our group explored the use of oral colchicine for the treatment of DT-associated pyrexia in five patients with metastatic melanoma.
Citation Format: Jesus Vera, Jonas Paludo, Lisa Kottschade, Matthew Block, Yiyi Yan, Charles Loprinzi, Svetomir Markovic. Dabrafenib-trametinib-induced pyrexia successfully treated with colchicine [abstract]. In: Proceedings of the AACR Special Conference on Targeting RAS-Driven Cancers; 2018 Dec 9-12; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2020;18(5_Suppl):Abstract nr B15.
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Cheville AL, Moynihan T, Herrin J, Loprinzi C, Kroenke K. Effect of Collaborative Telerehabilitation on Functional Impairment and Pain Among Patients With Advanced-Stage Cancer: A Randomized Clinical Trial. JAMA Oncol 2020; 5:644-652. [PMID: 30946436 DOI: 10.1001/jamaoncol.2019.0011] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Most patients with advanced-stage cancer develop impairment and pain-driven functional losses that jeopardize their independence. Objective To determine whether collaborative telerehabilitation and pharmacological pain management improve function, lessen pain, and reduce requirements for inpatient care. Design, Setting, and Patients The Collaborative Care to Preserve Performance in Cancer (COPE) study was a 3-arm randomized clinical trial conducted at 3 academic medical centers within 1 health care system. Patient recruitment began in March 2013 and follow-up concluded in October 2016. Participants (N = 516) were low-level community or household ambulators with stage IIIC or IV solid or hematologic cancer. Interventions Participants were randomly assigned to the (1) control arm, (2) telerehabilitation arm, or (3) telerehabilitation with pharmacological pain management arm. All patients underwent automated function and pain monitoring with data reporting to their care teams. Participants in arms 2 and 3 received 6 months of centralized telerehabilitation provided by a physical therapist-physician team. Those in arm 3 also received nurse-coordinated pharmacological pain management. Main Outcomes and Measures Blinded assessment of function using the Activity Measure for Postacute Care computer adaptive test, pain interference and average intensity using the Brief Pain Inventory, and quality of life using the EQ-5D-3L was performed at baseline and months 3 and 6. Hospitalizations and discharges to postacute care facilities were recorded. Results The study included 516 participants (257 women and 259 men; mean [SD] age, 65.6 [11.1] years), with 172 randomized to 1 of 3 arms. Compared with the control group, the telerehabilitation arm 2 had improved function (difference, 1.3; 95% CI, 0.08-2.35; P = .03) and quality of life (difference, 0.04; 95% CI, 0.004-0.071; P = .01), while both telerehabilitation arms 2 and 3 had reduced pain interference (arm 2, -0.4; 95% CI, -0.78 to -0.09; P = .01 and arm 3, -0.4; 95% CI, -0.79 to -0.10; P = .01), and average intensity (arm 2, -0.4; 95% CI, -0.78 to -0.07; P = .02 and arm 3, -0.5; 95% CI, -0.84 to -0.11; P = .006). Telerehabilitation was associated with higher odds of home discharge in arms 2 (odds ratio [OR], 4.3; 95% CI, 1.3-14.3; P = .02) and 3 (OR, 3.8; 95% CI, 1.1-12.4; P = .03) and fewer days in the hospital in arm 2 (difference, -3.9 days; 95% CI, -2.4 to -4.6; P = .01). Conclusions and Relevance Collaborative telerehabilitation modestly improved function and pain, while decreasing hospital length of stay and the requirement for postacute care, but these outcomes were not enhanced with the addition of pharmacological pain management. Trial Registration ClinicalTrials.gov identifier: NCT01721343.
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Affiliation(s)
- Andrea L Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Timothy Moynihan
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jeph Herrin
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
| | - Charles Loprinzi
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kurt Kroenke
- Center for Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
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20
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Cheville A, Moynihan T, Herrin J, Kroenke K, Loprinzi C. Collaborative Tele-Rehabilitation Among Patients With Advanced Stage Cancers: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Chan A, Hertz DL, Morales M, Adams EJ, Gordon S, Tan CJ, Staff NP, Kamath J, Oh J, Shinde S, Pon D, Dixit N, D'Olimpio J, Dumitrescu C, Gobbo M, Kober K, Mayo S, Pang L, Subbiah I, Beutler AS, Peters KB, Loprinzi C, Lustberg MB. Biological predictors of chemotherapy-induced peripheral neuropathy (CIPN): MASCC neurological complications working group overview. Support Care Cancer 2019; 27:3729-3737. [PMID: 31363906 DOI: 10.1007/s00520-019-04987-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating condition associated with a number of chemotherapeutic agents. Drugs commonly implicated in the development of CIPN include platinum agents, taxanes, vinca alkaloids, bortezomib, and thalidomide analogues. As a drug response can vary between individuals, it is hypothesized that an individual's specific genetic variants could impact the regulation of genes involved in drug pharmacokinetics, ion channel functioning, neurotoxicity, and DNA repair, which in turn affect CIPN development and severity. Variations of other molecular markers may also affect the incidence and severity of CIPN. Hence, the objective of this review was to summarize the known biological (molecular and genomic) predictors of CIPN and discuss the means to facilitate progress in this field.
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Affiliation(s)
- Alexandre Chan
- National University of Singapore, Singapore, Singapore
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Manuel Morales
- University Hospital Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Elizabeth J Adams
- The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - Sharon Gordon
- University of Connecticut, Storrs, USA
- East Carolina University, Greenville, USA
| | - Chia Jie Tan
- National University of Singapore, Singapore, Singapore
- National Cancer Centre Singapore, Singapore, Singapore
| | | | - Jayesh Kamath
- University of Connecticut Health Center, Storrs, USA
| | - Jeong Oh
- MD Anderson Cancer Center, Houston, USA
| | - Shivani Shinde
- University of Colorado, Colorado, USA
- VA Eastern Colorado Health Care Systems, Aurora, MS, USA
| | - Doreen Pon
- Western University of Health Sciences, Pomona, USA
| | - Niharkia Dixit
- University of California San Francisco, San Francisco, USA
- Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - James D'Olimpio
- Northwell Cancer Institute, New Hyde Park, USA
- Zucker School of Medicine at Hofstra, 500 Hofstra Blvd, Hempstead, USA
| | | | | | - Kord Kober
- University of California San Francisco, San Francisco, USA
- Helen Diller Comprehensive Cancer Centre, San Francisco, USA
| | | | | | | | | | | | | | - Maryam B Lustberg
- The Ohio State University Comprehensive Cancer Center, Columbus, USA.
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22
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Vera J, Paludo J, Kottschade L, Brandt J, Yan Y, Block M, McWilliams R, Dronca R, Loprinzi C, Grothey A, Markovic SN. Case series of dabrafenib-trametinib-induced pyrexia successfully treated with colchicine. Support Care Cancer 2019; 27:3869-3875. [DOI: 10.1007/s00520-019-4654-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/15/2019] [Indexed: 01/15/2023]
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23
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Gewandter JS, Brell J, Cavaletti G, Dougherty PM, Evans S, Howie L, McDermott MP, O'Mara A, Smith AG, Dastros-Pitei D, Gauthier LR, Haroutounian S, Jarpe M, Katz NP, Loprinzi C, Richardson P, Lavoie-Smith EM, Wen PY, Turk DC, Dworkin RH, Freeman R. Trial designs for chemotherapy-induced peripheral neuropathy prevention: ACTTION recommendations. Neurology 2018; 91:403-413. [PMID: 30054438 DOI: 10.1212/wnl.0000000000006083] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/24/2018] [Indexed: 12/26/2022] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and potentially dose-limiting side effect of neurotoxic chemotherapies. No therapies are available to prevent CIPN. The small number of positive randomized clinical trials (RCTs) evaluating preventive therapies for CIPN provide little guidance to inform the design of future trials. Moreover, the lack of consensus regarding major design features in this area poses challenges to development of new therapies. An Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities and Networks (ACTTION)-Consortium on Clinical Endpoints and Procedures for Peripheral Neuropathy Trials (CONCEPPT) meeting attended by neurologists, oncologists, pharmacists, clinical trialists, statisticians, and regulatory experts was convened to discuss design considerations and provide recommendations for CIPN prevention trials. This article outlines considerations related to design of RCTs that evaluate preventive therapies for CIPN including (1) selection of eligibility criteria (e.g., cancer types, chemotherapy types, inclusion of preexisting neuropathy); (2) selection of outcome measures and endpoints, including those that incorporate alterations in chemotherapy dosing, which may affect the rate of CIPN development and its severity; (3) potential effects of the investigational therapy on the efficacy of chemotherapy; and (4) sample size estimation. Our hope is that attention to the design considerations and recommendations outlined in this article will improve the quality and assay sensitivity of CIPN prevention trials and thereby accelerate the identification of efficacious therapies.
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Affiliation(s)
- Jennifer S Gewandter
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle.
| | - Joanna Brell
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Guido Cavaletti
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Patrick M Dougherty
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Scott Evans
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Lynn Howie
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Michael P McDermott
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Ann O'Mara
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - A Gordon Smith
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Daniela Dastros-Pitei
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Lynn R Gauthier
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Simon Haroutounian
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Matthew Jarpe
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Nathaniel P Katz
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Charles Loprinzi
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Paul Richardson
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Ellen M Lavoie-Smith
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Patrick Y Wen
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Dennis C Turk
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Robert H Dworkin
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
| | - Roy Freeman
- From the University of Rochester (J.S.G., M.P.M., R.H.D.), NY; MetroHealth Medical Center (J.B.), Case Western Reserve University, Cleveland, OH; University of Milano-Bicocca (G.C.), Monza, Italy; MD Anderson Cancer Center (P.M.D.), Houston, TX; Milkin Institute School of Public Health (S.E.), George Washington University, Washington, DC; Division of Oncology Products (L.H.), US Food and Drug Administration, Silver Spring; National Institutes of Health (A.O.), Bethesda, MD; Virginia Commonwealth University (A.G.S.), Richmond; Mundipharma R&D Limited (D.D.-P.), Cambridge, UK; Université Laval (L.R.G.), Québec, Canada; Washington University (S.H.), St. Louis, MO; Regenacy Pharmaceuticals (M.J.), Boston; Analgesic Solutions (N.P.K.), Natick; Tufts University (N.P.K.), Boston, MA; Mayo Clinic (C.L.), Rochester, MN; Dana-Farber/Brigham and Women's Cancer Center (P.R., P.Y.W.) and Beth Israel Deaconess Medical Center (R.F.), Harvard Medical School, Boston, MA; University of Michigan (E.M.L.S.), Ann Arbor; and University of Washington (D.C.T.), Seattle
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Berger MJ, Ettinger DS, Aston J, Barbour S, Bergsbaken J, Bierman PJ, Brandt D, Dolan DE, Ellis G, Kim EJ, Kirkegaard S, Kloth DD, Lagman R, Lim D, Loprinzi C, Ma CX, Maurer V, Michaud LB, Nabell LM, Noonan K, Roeland E, Rugo HS, Schwartzberg LS, Scullion B, Timoney J, Todaro B, Urba SG, Shead DA, Hughes M. NCCN Guidelines Insights: Antiemesis, Version 2.2017. J Natl Compr Canc Netw 2018; 15:883-893. [PMID: 28687576 DOI: 10.6004/jnccn.2017.0117] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Antiemesis address all aspects of management for chemotherapy-induced nausea and vomiting. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Antiemesis, specifically those regarding carboplatin, granisetron, and olanzapine.
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Simmons B, Wysokinski W, Saadiq RA, Bott-Kitslaar D, Henkin S, Casanegra A, Lenz C, Daniels P, Bjarnason H, Vargas E, Hodge D, Holton SJ, Cerhan JR, Loprinzi C, McBane R. Efficacy and safety of rivaroxaban compared to enoxaparin in treatment of cancer-associated venous thromboembolism. Eur J Haematol 2018; 101:136-142. [PMID: 29617053 DOI: 10.1111/ejh.13074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low molecular weight heparin (LMWH) is the guideline-endorsed treatment for cancer-associated venous thromboembolism (cVTE). Study objectives were to compare the efficacy and safety of rivaroxaban and enoxaparin in cVTE. METHODS Using a cohort study design, consecutive patients with cVTE (3/1/2013-7/31/2016), enrolled in the Mayo Thrombophilia Clinic Direct Oral Anticoagulants Registry, were compared to contemporary cancer patients receiving enoxaparin. The cumulative incidence of venous thromboembolism (VTE) recurrence, major and clinically relevant non-major bleeding, and survival were assessed at 3 and 12 months. RESULTS Ninety-eight patients received rivaroxaban (51% female, mean age 63 ± 12 years) and 168 enoxaparin (34.5% female, mean age 62 ± 15 years). The most common cancers included gastrointestinal/pancreatic, genitourinary and hematologic cancers. More than half of patients had pulmonary emboli at presentation. More than half had metastases, and two-thirds were receiving chemotherapy. At 3 months, there were no differences in VTE recurrence (rivaroxaban 1.0% vs enoxaparin 4.2%; P = .15), major bleeding (rivaroxaban 5.1% vs enoxaparin 3.6%; P = .55), or all-cause mortality (rivaroxaban 4.1% vs enoxaparin 8.9%; P = .14). At 12 months, these outcomes did not differ by treatment strategy. CONCLUSION The results of this "real-world" experience with cVTE suggest that rivaroxaban may offer a safe and effective alternative to LMWH.
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Affiliation(s)
- Benjamin Simmons
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Waldemar Wysokinski
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Rayya A Saadiq
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dalene Bott-Kitslaar
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Stanislav Henkin
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Ana Casanegra
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Charles Lenz
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Paul Daniels
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Haraldur Bjarnason
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Emily Vargas
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - David Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Sara J Holton
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Robert McBane
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
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Ma CX, Suman V, Goetz MP, Northfelt D, Burkard ME, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tevaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Barnell EK, Skidmore ZL, Feng YY, Krysiak K, Hoog J, Guo Z, Nehring L, Wisinski KB, Mardis E, Hagemann IS, Vij K, Sanati S, Al-Kateb H, Griffith OL, Griffith M, Doyle L, Erlichman C, Ellis MJ. A Phase II Trial of Neoadjuvant MK-2206, an AKT Inhibitor, with Anastrozole in Clinical Stage II or III PIK3CA-Mutant ER-Positive and HER2-Negative Breast Cancer. Clin Cancer Res 2017; 23:6823-6832. [PMID: 28874413 PMCID: PMC6392430 DOI: 10.1158/1078-0432.ccr-17-1260] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 05/02/2017] [Revised: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 02/01/2023]
Abstract
Purpose: Hyperactivation of AKT is common and associated with endocrine resistance in estrogen receptor-positive (ER+) breast cancer. The allosteric pan-AKT inhibitor MK-2206 induced apoptosis in PIK3CA-mutant ER+ breast cancer under estrogen-deprived condition in preclinical studies. This neoadjuvant phase II trial was therefore conducted to test the hypothesis that adding MK-2206 to anastrozole induces pathologic complete response (pCR) in PIK3CA mutant ER+ breast cancer.Experimental Design: Potential eligible patients with clinical stage II/III ER+/HER2- breast cancer were preregistered and received anastrozole (goserelin if premenopausal) for 28 days in cycle 0 pending tumor PIK3CA sequencing. Patients positive for PIK3CA mutation in the tumor were eligible to start MK-2206 (150 mg orally weekly, with prophylactic prednisone) on cycle 1 day 2 (C1D2) and to receive a maximum of four 28-day cycles of combination therapy before surgery. Serial biopsies were collected at preregistration, C1D1 and C1D17.Results: Fifty-one patients preregistered and 16 of 22 with PIK3CA-mutant tumors received study drug. Three patients went off study due to C1D17 Ki67 >10% (n = 2) and toxicity (n = 1). Thirteen patients completed neoadjuvant therapy followed by surgery. No pCRs were observed. Rash was common. MK-2206 did not further suppress cell proliferation and did not induce apoptosis on C1D17 biopsies. Although AKT phosphorylation was reduced, PRAS40 phosphorylation at C1D17 after MK-2206 persisted. One patient acquired an ESR1 mutation at surgery.Conclusions: MK-2206 is unlikely to add to the efficacy of anastrozole alone in PIK3CA-mutant ER+ breast cancer and should not be studied further in the target patient population. Clin Cancer Res; 23(22); 6823-32. ©2017 AACR.
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Affiliation(s)
- Cynthia X Ma
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Vera Suman
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Donald Northfelt
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | - Mark E Burkard
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Foluso Ademuyiwa
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Naughton
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Julie Margenthaler
- Section of Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Rebecca Aft
- Section of Endocrine and Oncologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Richard Gray
- Department of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Amye Tevaarwerk
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lee Wilke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tufia Haddad
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Tina Hieken
- Department of General Surgery, Mayo Clinic, Rochester, Minnesota
| | - Erica K Barnell
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Zachary L Skidmore
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Yan-Yang Feng
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Kilannin Krysiak
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | - Jeremy Hoog
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Zhanfang Guo
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Leslie Nehring
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kari B Wisinski
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Elaine Mardis
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Ian S Hagemann
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Kiran Vij
- Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Souzan Sanati
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Hussam Al-Kateb
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Obi L Griffith
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Malachi Griffith
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri
| | - Laurence Doyle
- Cancer Therapy Evaluation Program, NCI, Bethesda, Maryland
| | | | - Matthew J Ellis
- Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, Texas.
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Jatoi A, Steen PD, Atherton PJ, Moore DF, Rowland KM, Le-Lindqwister NA, Adonizio CS, Jaslowski AJ, Sloan J, Loprinzi C. A double-blind, placebo-controlled randomized trial of creatine for the cancer anorexia/weight loss syndrome (N02C4): an Alliance trial. Ann Oncol 2017; 28:1957-1963. [PMID: 28475678 PMCID: PMC5808669 DOI: 10.1093/annonc/mdx232] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Multiple pilot studies, including one in colorectal cancer patients, suggest that creatine, an amino acid derivative, augments muscle, improves strength, and thereby could palliate the cancer anorexia/weight loss syndrome. PATIENTS AND METHODS In this randomized, double-blind, placebo-controlled trial, incurable patients with this syndrome were assigned creatine (20 g/day load×5 days followed by 2 g/day orally) versus identical placebo. Patients were weighed once a week for 1 month and then monthly. Patients were also assessed over 1 month for appetite and quality of life (validated questionnaires), fist grip strength, body composition (bioelectrical impedance), and adverse events. The primary endpoint was 10% or greater weight gain from baseline during the first month. RESULTS Within this combined cohort of 263 evaluable patients (134 received creatine and 129 placebo), only 3 gained ≥10% of their baseline weight by 1 month: two creatine-treated and the other placebo-exposed (P = 1.00). Questionnaire data on appetite, quality of life, and activities of daily living showed no statistically significant differences between groups. Similarly, no statistically significant differences between groups were observed for fist-grip strength or body composition. Rates and severity of adverse events were comparable between groups. Finally, a median survival of 230 and 239 days were observed in the creatine and placebo groups, respectively (P = 0.70). CONCLUSION Creatine, as prescribed in this trial, had no effect on the cancer anorexia/weight loss syndrome.
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Affiliation(s)
- A. Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester
| | | | | | - D. F. Moore
- Wichita Community Clinical Oncology Program, Wichita
| | | | | | | | | | - J. Sloan
- Division of Medical Oncology, Mayo Clinic, Rochester
| | - C. Loprinzi
- Division of Medical Oncology, Mayo Clinic, Rochester
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Navari R, Nagy C, Le-Rademacher J, Loprinzi C. Olanzapine versus fosaprepitant for the prevention of concurrent chemotherapy radiotherapy-induced nausea and vomiting. J Community Support Oncol 2016; 14:141-7. [DOI: 10.12788/jcso.0245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/20/2022]
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Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. Abstract P5-13-04: A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-13-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Activating mutations in PIK3CA occur in approximately 40% ER+BC. MK-2206 (M), a pan-AKT inhibitor, induced apoptosis of ER+ BC under estrogen deprivation in preclinical studies. We conducted this neoadjuvant trial to determine the pathologic complete response (pCR) rate of M plus anastrozole (A) for PIK3CA mutant (Mut) ER+ BC.
Methods
This single arm open label study of M+A used a 2-stage Simon phase II design (stage 1, n=16; stage 2, n=13, alpha=0.10, power=0.90) to test whether pCR rate <1% (based on historical data with A alone), against the alternative that pCR rate ≥15% in PIK3CA Mut ER+ BC. At least 1 pCR in stage 1 was required to proceed to stage 2.
Eligible patients (pts) with clinical stage II or III ER+HER2- BC were pre-registered and proceeded to a research tumor biopsy for PIK3CA sequencing, followed by treatment with daily A monotherapy for 28 days (cycle 0). Pts with PIK3CA Mut BC were subsequently registered, underwent a second biopsy, and started M (150mg PO weekly) with daily A on cycle 1 day 1 (C1D1) for a maximum of four 28-day cycles followed by surgery. Goserelin was added for premenopausal pts. A tumor biopsy on C1D17, 17 days post the start of M, was performed. Those with C1D17 Ki67 >10% discontinued study treatment. pCR was defined as no invasive cancer in the breast and the lymph nodes. Tumor specimens collected at all timepoints are being analyzed for markers of proliferation, apoptosis, and PI3K pathway activity, gene expression microarray, intrinsic subtypes, and next generation sequencing of 83 genes.
Results
Of the 51 pts pre-registered, 35 pts did not register due to no PIK3CA mutation (n=22), inadequate specimen for testing (n=6), physician/pt decision (n=7). The remaining 16 pts (median age: 58, range: 40-77 years) received combination therapy. Three pts did not complete 4 cycles due to C1D17 Ki67 >10% (n=2) and intolerability (grade (Gr) 4 transaminase elevation in C1, n=1). Other severe toxicities possibly related to M included Gr 3 rash (25%) and pruritus (12.5%). Of the 13 pts completed study therapy and underwent surgery, all had residual disease in the breast and 7 also had positive nodes. Table 1 summarized changes in Ki67 during treatment.
ComparisonsnAbsolute changes in Ki67 median (range)Wilcoxon signed rank p-valueC1D1 relative to pre-registration11-17.0% (-49.8 to 4.1%)0.0020C1D17 relative to pre-registration14-16.4% (-51.4 to 4.1%)0.0004C1D17 relative to C1D112-1.5% (-18.6 to 15.8%)0.9697C1D1, biopsy post 28 days of A alone; C1D17 biopsy post 17 days on combination therapy
Although Ki67 levels post A monotherapy (C1D1) or M+A (C1D17) were significantly lower than that of pre-registration samples, Ki67 did not differ between C1D17 and C1D1 samples. Other correlative studies are ongoing and results will be presented.
Conclusion
Despite the small sample size, biomarker analysis on serial biopsy specimens demonstrated that M+A is unlikely to be more effective than A alone in PIK3CA Mut ER+ BC. This trial demonstrated the feasibility of genomic sequencing for pt selection and the value of a small, well-designed proof-of-principle neoadjuvant trial for the evaluation of targeted agents.
Citation Format: Ma CX, Suman VJ, Goetz M, Northfelt D, Burkard M, Ademuyiwa F, Naughton M, Margenthaler J, Aft R, Gray R, Tavaarwerk A, Wilke L, Haddad T, Moynihan T, Loprinzi C, Hieken T, Hoog J, Guo Z, Han J, Vij K, Mardis E, Sanati S, Al-Kateb H, Doyle L, Erlichman C, Ellis MJ. A phase II neoadjuvant trial of MK-2206, an AKT inhibitor, in combination with anastrozole for clinical stage 2 or 3 PIK3CA mutant estrogen receptor positive HER2 negative (ER+HER2-) breast cancer (BC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-04.
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Affiliation(s)
- CX Ma
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - VJ Suman
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Goetz
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - D Northfelt
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Burkard
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - F Ademuyiwa
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - M Naughton
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Margenthaler
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - R Aft
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - R Gray
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - A Tavaarwerk
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - L Wilke
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Haddad
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Moynihan
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - C Loprinzi
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - T Hieken
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Hoog
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - Z Guo
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - J Han
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - K Vij
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - E Mardis
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - S Sanati
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - H Al-Kateb
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - L Doyle
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - C Erlichman
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
| | - MJ Ellis
- Washington University, Saint Louis, MO; Mayo Clinic, Rochester, MN; Mayo Clinic, Scottsdale, AZ; Universtiy of Wisconsin, Madison, WI; National Cancer Institute, Bethesda, MD; Baylor College of Medicine, Houston, TX
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Smith EML, Pang H, Ye C, Cirrincione C, Fleishman S, Paskett ED, Ahles T, Bressler LR, Le-Lindqwister N, Fadul CE, Loprinzi C, Shapiro CL. Predictors of duloxetine response in patients with oxaliplatin-induced painful chemotherapy-induced peripheral neuropathy (CIPN): a secondary analysis of randomised controlled trial - CALGB/alliance 170601. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26603828 DOI: 10.1111/ecc.12421] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 01/22/2023]
Abstract
Duloxetine is an effective treatment for oxaliplatin-induced painful chemotherapy-induced peripheral neuropathy (CIPN). However, predictors of duloxetine response have not been adequately explored. The objective of this secondary and exploratory analysis was to identify predictors of duloxetine response in patients with painful oxaliplatin-induced CIPN. Patients (N = 106) with oxaliplatin-induced painful CIPN were randomised to receive duloxetine or placebo. Eligible patients had chronic CIPN pain and an average neuropathic pain score ≥4/10. Duloxetine/placebo dose was 30 mg/day for 7 days, then 60 mg/day for 4 weeks. The Brief Pain Inventory-Short Form and the EORTC QLQ-C30 were used to assess pain and quality of life, respectively. Univariate and multiple logistic regression analyses were performed to identify demographic, physiologic and psychological predictors of duloxetine response. Higher baseline emotional functioning predicted duloxetine response (≥30% reduction in pain; OR 4.036; 95% CI 0.999-16.308; p = 0.050). Based on the results from a multiple logistic regression using patient data from both the duloxetine and placebo treatment arms, duloxetine-treated patients with high emotional functioning are more likely to experience pain reduction (p = 0.026). In patients with painful, oxaliplatin-induced CIPN, emotional functioning may also predict duloxetine response. ClinicalTrials.gov, Identifier NCT00489411.
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Affiliation(s)
- E M L Smith
- PhD program, University of Michigan School of Nursing, Ann Arbor, MI
| | - H Pang
- Alliance Statistics and Data Center, Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.,School of Public Health, Li Ka Shing Faculty of Medicine, Hong Kong SAR, China
| | - C Ye
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | - C Cirrincione
- Alliance Statistics and Data Center, Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - S Fleishman
- Cancer Supportive Services program, Continuum Cancer Centers of New York: Beth Israel and St. Luke's-Roosevelt, New York, NY, USA
| | - E D Paskett
- The Ohio State University Comprehensive Cancer Center, College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - T Ahles
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - L R Bressler
- University of Illinois College of Pharmacy (Emeritus Faculty), Chicago, IL, USA
| | | | - C E Fadul
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - C Loprinzi
- Mayo Clinic, Rochester, Rochester, MN, USA
| | - C L Shapiro
- Mount Sinai Medical Center, Division of Hematology/Medical Oncology: Tisch Cancer Institute, New York, NY, USA
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Lustberg MB, Orchard T, Pan X, Reinbolt R, Logan A, Lester J, Layman RM, Macrae E, Mrozek E, Ramaswamy B, Wesolowski R, Berger M, Knopp M, Loprinzi C, Shapiro CL, Yee L. Abstract P1-09-03: Prevention of aromatase Inhibitor (AI)-induced joint symptoms with omega-3 fatty acid supplementation: A randomized placebo-controlled pilot study. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p1-09-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: AI-induced joint symptoms negatively impact drug adherence and quality of life. Based on observations that n-3 polyunsaturated fatty acids (PUFAs) have anti-inflammatory effects and that the mechanism of AI-induced joint symptoms may be partly due to inflammation, we hypothesized that women taking more n-3 PUFAs are less likely to develop AI-induced joint symptoms.
Methods: We conducted a randomized, double-blind, placebo-controlled study comparing n-3 PUFA vs placebo in postmenopausal breast cancer patients starting adjuvant AIs. Participants were randomized to n-3 supplements [2.58 g eicosapentaenoic acid + 1.74 g docosahexaenoic acid/day; Marine Nutriceuticals, Mt. Bethel, PA] vs matched placebo for 24 weeks (wks). Primary endpoints was feasibility; secondary outcomes were self-reported symptoms as assessed by the Brief Pain Inventory short form (BPI-SF), Functional Assessment of Cancer Treatment, Breast & Endocrine Symptoms (FACTB-ES), and Stanford's Health Assessment and Disability Index (HAQ) at baseline prior to AI receipt, 12 and 24 wks. Compliance and toxicity were evaluated monthly. Serial peripheral blood n-3 PUFA levels and inflammatory cytokines (IL-6, TNFR2, IL-17) were drawn. MRI of hands/wrists was performed in selected patients using a 3 Tesla dedicated wrist coil at baseline and treatment end.
Results: Forty-four women were enrolled and randomized to study drug; 42 received ≥1 cycle (4 wks) of treatment; 36 had ≥1 post treatment evaluation at wk 12 or 24. Median age was 59.5 (range 43-76); history of prior taxane (n=15, 34%). The two groups’ baseline characteristics were similar. Overall, 93% and 88% of patients took >80% of the placebo and n-3 PUFA doses, respectively. Baseline erythrocyte n-3 PUFA was similar for both groups (6.6% ± 1.6%, 7.2% ±1.9%, p=0.20), but higher in the n-3 PUFA arm by wk 24 (6.5%±1.0% vs 15.0%±3.3%, p<0.001). Most toxicities were grade 1; the n-3 PUFA arm had only 1 (2.5%) grade 3 toxicity (diarrhea). The n-3 PUFA arm reported lower mean BPI-SF scores after treatment [(-.0.28/ -0.25 at week 12/24); but not statistically significant compared to placebo (p=0.494 and 0.601)]. Based on BPI-SF, the n-3 PUFA arm reported less interference of pain symptoms compared to placebo at 12 weeks (-.72, p=0.08). This arm also had a decreased walking, activity and working (WAW) score on BPI-SF at 12 weeks (-.81 p=0.05), and reported significantly greater pain relief from medications at 12 (p=0.043) and 24 weeks (p=0.011). Both arms had similar baseline and wk 24 serum IL-6 levels; levels decreased from baseline to wk 24 in the n-3 PUFA arm (-0.54±0.25, p=0.048). There was a non-significant trend (p= 0.2) toward decreased wrist inflammation by MRI imaging at 24 wks in the n-3 PUFA arm.
Conclusions: This is the first randomized pilot study to show that n-3 PUFA supplementation to prevent AI-induced joint symptoms is feasible and well tolerated. There is preliminary evidence that this intervention may help reduce the burden of AI-induced arthralgias.
OSU Study #11022; ClinicalTrials.gov Identifier: NCT01478477. Grants from the National Cancer Institute (CA037447-26) to the Alliance for Clinical Trials in Oncology supported this pilot study.
Citation Format: Maryam B Lustberg, Tonya Orchard, Xueliang Pan, Raquel Reinbolt, Amanda Logan, Joanne Lester, Rachel M Layman, Erin Macrae, Ewa Mrozek, Bhuvaneswari Ramaswamy, Robert Wesolowski, Michael Berger, Michael Knopp, Charles Loprinzi, Charles L Shapiro, Lisa Yee. Prevention of aromatase Inhibitor (AI)-induced joint symptoms with omega-3 fatty acid supplementation: A randomized placebo-controlled pilot study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-03.
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Affiliation(s)
- Maryam B Lustberg
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | | | | | - Raquel Reinbolt
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Amanda Logan
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | | | - Rachel M Layman
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Erin Macrae
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Ewa Mrozek
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Bhuvaneswari Ramaswamy
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Robert Wesolowski
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Michael Berger
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | | | | | - Charles L Shapiro
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
| | - Lisa Yee
- 1Ohio State University Comprehensive Cancer Center & The Stefanie Spielman Comprehensive Breast Center
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Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a problematic, treatment-induced toxicity that has the potential to impact quality of life and limit the doses of curative intent therapy. This therapy-induced side effect is one of the most troublesome in oncology clinical practices, considering the morbidity, the frequency, and the potential irreversibility of this problem. Patients with breast cancer are particularly impacted by this side effect as multiple agents commonly used for this disease can cause neuropathy. In this chapter, we provide an overview of CIPN, including: clinical predictors, frequency, and its impact on quality of life. Further, we highlight the pathophysiology and review the literature to date for agents designed to prevent or treat CIPN. We also highlight the most important ongoing clinical and translational research questions that hope to help better predict and prevent this toxicity. This includes optimizing the methods of assessment, using host specific factors (Race and genetics) to predict those more likely to experience CIPN, and determining how CIPN might impact clinical decisions toward therapy.
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Affiliation(s)
- Bryan P Schneider
- Medicine & Medical/Molecular Genetics, Indiana University Simon Cancer Center, Indianapolis, IN, USA,
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Grothey A, Qin R, Dakhil S, Fehrenbacher L, Stella P, Atherton P, Seisler D, Qamar R, Lewis G, Loprinzi C. Phase III Randomized, Placebo(Pl)-Controlled, Double-Blind Study of Intravenous Calcium/Magnesium (CaMg) to Prevent Oxaliplatin-Induced Sensory Neurotoxicity (sNT), N08CB: an Alliance for Clinical Trials in Oncology Study1. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt201.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Roeland E, Loprinzi C, Moynihan TJ, Smith TJ, Temel J. In Chemotherapy for Lung Cancer, Sometimes Less is More. J Natl Compr Canc Netw 2013; 11:232-5. [DOI: 10.6004/jnccn.2013.0034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Limburg PJ, Mandrekar SJ, Aubry MC, Ziegler KLA, Zhang J, Yi JE, Henry M, Tazelaar HD, Lam S, McWilliams A, Midthun DE, Edell ES, Rickman OB, Mazzone P, Tockman M, Beamis JF, Lamb C, Simoff M, Loprinzi C, Szabo E, Jett J. Randomized phase II trial of sulindac for lung cancer chemoprevention. Lung Cancer 2012; 79:254-61. [PMID: 23261228 DOI: 10.1016/j.lungcan.2012.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Sulindac represents a promising candidate agent for lung cancer chemoprevention, but clinical trial data have not been previously reported. We conducted a randomized, phase II chemoprevention trial involving current or former cigarette smokers (≥30 pack-years) utilizing the multi-center, inter-disciplinary infrastructure of the Cancer Prevention Network (CPN). METHODS At least 1 bronchial dysplastic lesion identified by fluorescence bronchoscopy was required for randomization. Intervention assignments were sulindac 150mg bid or an identical placebo bid for 6 months. Trial endpoints included changes in histologic grade of dysplasia (per-participant as primary endpoint and per lesion as secondary endpoint), number of dysplastic lesions (per-participant), and Ki67 labeling index. RESULTS Slower than anticipated recruitment led to trial closure after randomizing participants (n=31 and n=30 in the sulindac and placebo arms, respectively). Pre- and post-intervention fluorescence bronchoscopy data were available for 53/61 (87%) randomized, eligible participants. The median (range) of dysplastic lesions at baseline was 2 (1-12) in the sulindac arm and 2 (1-7) in the placebo arm. Change in dysplasia was categorized as regression:stable:progression for 15:3:8 (58%:12%:31%) subjects in the sulindac arm and 15:2:10 (56%:7%:37%) subjects in the placebo arm; these distributions were not statistically different (p=0.85). Median Ki67 expression (% cells stained positive) was significantly reduced in both the placebo (30 versus 5; p=0.0005) and sulindac (30 versus 10; p=0.0003) arms, but the difference between arms was not statistically significant (p=0.92). CONCLUSIONS Data from this multi-center, phase II squamous cell lung cancer chemoprevention trial do not demonstrate sufficient benefits from sulindac 150mg bid for 6 months to warrant additional phase III testing. Investigation of pathway-focused agents is necessary for lung cancer chemoprevention.
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Affiliation(s)
- Paul J Limburg
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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Sood A, Loprinzi C, Sharma V, Prasad K. P02.155. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a randomized trial. BMC Complement Altern Med 2012. [PMCID: PMC3373525 DOI: 10.1186/1472-6882-12-s1-p211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gill S, Loprinzi C, Kennecke H, Grothey A, Nelson G, Woods R, Speers C, Alberts SR, Bardia A, O'Connell MJ, Sargent DJ. Prognostic web-based models for stage II and III colon cancer: A population and clinical trials-based validation of numeracy and adjuvant! online. Cancer 2011; 117:4155-65. [PMID: 21365628 DOI: 10.1002/cncr.26003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/25/2010] [Accepted: 01/04/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND Numeracy and Adjuvant! are 2 web-based calculators that are used widely to estimate the prognosis and potential benefit of adjuvant 5-fluorouracil (5-FU)-based therapy for patients with stage II and III colon cancer. In this study, the authors compared the predicted survival estimates from these models with the actual observed estimates in independent datasets that were derived from a population cohort and from clinical trials. METHODS The population cohort was derived from the British Columbia Colorectal Cancer Outcomes Unit database, which identified referred patients with stage II and III colon cancer from 1995 to 1996 and from 1999 to 2003. Patients who were enrolled in North Central Cancer Trials Group (NCCTG) trials NCCTG 94651 and NCCTG 914653 were included in the trials dataset. Patient and disease data were used to predict 5-year relapse-free and overall survival using both tools. RESULTS In the population-based dataset (N = 2033), Adjuvant! offered more reliable predictions of prognosis for patients who underwent surgery alone, but it had reliability similar to that of Numeracy for predicting the prognosis for patients who received adjuvant 5-FU. Both models tended to overestimate survival for patients with stage II disease who received 5-FU. In the trials dataset of patients who underwent and received 5-FU (N = 1729), Numeracy and Adjuvant! demonstrated similar performance and improved correctness. CONCLUSIONS This independent validation analysis demonstrated that both Numeracy and Adjuvant! had similar predictive performance and acceptable reliability for patients with stage III disease. Survival outcomes of patients with stage II colon cancer who received adjuvant 5-FU were slightly lower than estimated by either model.
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Affiliation(s)
- Sharlene Gill
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia.
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Bardia A, Loprinzi C, Grothey A, Nelson G, Alberts S, Menon S, Thome S, Gill S, Sargent D. Adjuvant chemotherapy for resected stage II and III colon cancer: comparison of two widely used prognostic calculators. Semin Oncol 2010; 37:39-46. [PMID: 20172363 DOI: 10.1053/j.seminoncol.2009.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two Web-based prognostic calculators (Adjuvant! and Numeracy) are widely used to individualize decisions regarding adjuvant therapy among patients with resected stage II and III colon cancer. However, these tools have not been directly compared. Hypothetical scenarios were formulated for the Numeracy calculator based on all potential combinations of age, lymph nodes status, tumor stage, and grade of tumor. These were then applied to three postsurgical therapy choices: observation, 5-fluorouracil (5-FU), or FOLFOX (5-FU, leucovorin, and oxaliplatin chemotherapy) to obtain the predicted 5-year disease-free survival (DFS) and overall survival (OS). Wilcoxon signed rank tests were used to compare the numerical predictions between the Adjuvant! and Numeracy calculators for each combination. A total of 192 hypothetical patient scenarios were obtained. For these patients, DFS and OS predictions from Adjuvant! were statistically significantly different than Numeracy (P <.05), except for four of 144 categories. While the estimated benefit in DFS and OS for 5-FU compared to surgery obtained from Adjuvant! and Numeracy were similar, the benefit in DFS and OS for FOLFOX over 5-FU, obtained from the Adjuvant! tool was slightly lower than that estimated from Numeracy. Among patients with resected stage II and III colon cancer, the DFS and OS estimates obtained from Numeracy and Adjuvant!, regarding the benefit of 5-FU over surgery, are similar, but the benefits of FOLFOX over 5-FU differ. Validation studies are needed to clarify the discrepancy and to assess the accuracy of these tools for predicting actual patient outcomes.
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Affiliation(s)
- Aditya Bardia
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
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Hines S, Sloan J, Atherton P, Perez E, Dakhil S, Johnson D, Reddy P, Dalton R, Mattar B, Loprinzi C. Zoledronic Acid for Treatment of Osteopenia and Osteoporosis in Women with Primary Breast Cancer (BC) Undergoing Adjuvant Aromatase Inhibitor (AI) Therapy. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-2103] [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: Postmenopausal women with significant osteopenia/osteoporosis are at increased risk of fracture, a risk that is exacerbated by the use of Aromatase Inhibitors (AIs). Bisphosphonates may be used for these patients because there is no known interaction with estrogen and/or progesterone receptors (ER, PR). This study evaluated the concurrent use of zoledronic acid in patients with significant osteopenia or osteoporosis who received initial adjuvant letrozole therapy for primary BC, to determine if further bone mineral density (BMD) loss could be prevented.Methods: Postmenopausal women with Stage I-IIIa, ER and/or PR + BC, no evidence of metastatic disease, and a BMD T-score < -2.0 were treated with daily letrozole 2.5 mg/d, vitamin D 400 international units/d, calcium 500 mg twice daily, and 4 mg I.V. zoledronic acid every 6 months (for 5 years). The BMD was measured at baseline and at one year. Kruskall-Wallis p-value methodology was used as the method of statistical analysis. Since this was a single-arm study, the analysis plan was primarily descriptive. The primary endpoint was the mean change in lumbar spine (LS) BMD at 1 year.Results: 60 patients were enrolled; 46 completed 1 year of treatment. Mean patient age was 67 years, with 44% having taken prior tamoxifen. At 1 year (see figure 1), LS BMD increased 2.66% (p=0.01), femoral neck (FN) BMD increased 4.81% (p=0.01), and any measured endpoint (within the LS or FN) increased 4.55% (p=0.0052). 7% of patients experienced a fracture vs.13% with a pre-existing history of fracture before enrollment. No patients had disease recurrence during year 1. Toxicity was minimal with arthralgia as the most common complaint. There were no reports of osteonecrosis of the jaw.Conclusion: Zoledronic acid prevents additional bone loss in postmenopausal women with significant osteopenia or osteoporosis initiating letrozole. Treatment with zoledronic acid was associated with an improvement in BMD.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2103.
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Affiliation(s)
| | | | | | | | - S. Dakhil
- 3 Wichita Community Clinical Oncology, KS,
| | - D. Johnson
- 3 Wichita Community Clinical Oncology, KS,
| | - P. Reddy
- 3 Wichita Community Clinical Oncology, KS,
| | - R. Dalton
- 4 Immanuel-St. Joseph Hospital Mayo Health System, MN,
| | - B. Mattar
- 3 Wichita Community Clinical Oncology, KS,
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Katipamula R, Degnim AC, Hoskin T, Boughey JC, Loprinzi C, Grant CS, Brandt KR, Pruthi S, Chute CG, Olson JE, Couch FJ, Ingle JN, Goetz MP. Trends in mastectomy rates at the Mayo Clinic Rochester: effect of surgical year and preoperative magnetic resonance imaging. J Clin Oncol 2009; 27:4082-8. [PMID: 19636020 DOI: 10.1200/jco.2008.19.4225] [Citation(s) in RCA: 280] [Impact Index Per Article: 18.7] [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 Recent changes have occurred in the presurgical planning for breast cancer, including the introduction of preoperative breast magnetic resonance imaging (MRI). We sought to analyze the trends in mastectomy rates and the relationship to preoperative MRI and surgical year at Mayo Clinic, Rochester, MN. PATIENTS AND METHODS We identified 5,405 patients who underwent surgery between 1997 and 2006. Patients undergoing MRI were identified from a prospective database. Trends in mastectomy rate and the association of MRI with surgery type were analyzed. Multiple logistic regression was used to assess the effect of surgery year and MRI on surgery type, while adjusting for potential confounding variables. RESULTS Mastectomy rates differed significantly across time (P < .0001), and decreased from 45% in 1997% to 31% in 2003, followed by increasing rates for 2004 to 2006. The use of MRI increased from 10% in 2003% to 23% in 2006 (P < .0001). Patients with MRI were more likely to undergo mastectomy than those without MRI (54% v 36%; P < .0001). However, mastectomy rates increased from 2004 to 2006 predominantly among patients without MRI (29% in 2003% to 41% in 2006; P < .0001). In a multivariable model, both MRI (odds ratio [OR], 1.7; P < .0001) and surgical year (compared to 2003 OR: 1.4 for 2004, 1.8 for 2005, and 1.7 for 2006; P < .0001) were independent predictors of mastectomy. CONCLUSION After a steady decline, mastectomy rates have increased in recent years with both surgery year and MRI as significant predictors for type of surgery. Further studies are needed to evaluate the role of MRI and other factors influencing surgical planning.
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Affiliation(s)
- Rajini Katipamula
- Department of Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Bardia A, Loprinzi C, Grothey A, Nelson G, Alberts S, Patiyil S, Thome S, Gill S, Sargent D. Adjuvant chemotherapy for resected stage II and III colon cancer: Comparison of widely used two prognostic calculators. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15031] [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
e15031 Background: Two web based prognostic calculators, Adjuvant! and Numeracy (JCO 22:1797–1806, 2004) are widely used to provide individual patient outcome predictions to aid decisions regarding adjuvant therapy for colon cancer. The comparability of these tools has not been studied yet. The aim of this project was to assess whether the Numeracy and Adjuvant! Colon cancer prognostic tools produced similar results for patients with resected stage II and III colon cancer based on a set of hypothetical patients. Methods: All possible hypothetical scenarios were formulated for the Numeracy calculator based on all potential combinations of age, lymph nodes status, tumor stage, and grade of tumor. These were applied to three post- surgical therapy choices: observation, 5-FU (5-fluorouracil), or FOLFOX (5-FU, leucovorin and oxaliplatin). Predictions for these hypothetical scenarios (N= 192 for males and 192 for females) were also entered into the Adjuvant! Program. Predicted relapse free survival (RFS) and overall survival (OS) were obtained using both calculators. Wilcoxon signed rank tests were used to compare the numerical predictions between the calculators for each outcome. Results: In the majority of the 384 hypothetical patient scenarios, predictions for RFS and OS from Adjuvant! were statistically significantly higher than from Numeracy (p value < 0.05), except for age≥70 for FOLFOX, and the number of positive nodes of 0 and 1–4 using FOLFOX, among males. The net estimate of benefit for RFS and OS for 5-FU over surgery, obtained from Adjuvant! and Numeracy, were similar (for both males and females), but the benefit in RFS and OS for FOLFOX over 5-FU obtained from Adjuvant! was significantly lower than the estimate obtained from Numeracy (p value < 0.05). Conclusions: Based on a hypothetical set of patients with resected stage II and III colon cancer, the estimated benefit in RFS and OS of FOLFOX over 5-FU based chemotherapy is lower in Adjuvant! than in the Numeracy tool (but benefit for 5-FU over surgery alone is similar). Further studies are needed to clarify the discrepancy and to assess which of these tools most accurately reflects actual patient outcome. No significant financial relationships to disclose.
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Affiliation(s)
- A. Bardia
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - C. Loprinzi
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - A. Grothey
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - G. Nelson
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - S. Alberts
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - S. Patiyil
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - S. Thome
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - S. Gill
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
| | - D. Sargent
- SKCCC at Johns Hopkins, Baltimore, MD; Mayo Clinic, Rochester, MN; Oncology Hematology West, Omaha, NE; University of British Columbia, Vancouver, BC, Canada
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Gill S, Loprinzi C, Kennecke H, Grothey A, Nelson G, Woods R, Speers C, Alberts S, Bardia A, Sargent D. Analysis of prognostic (prog) Web-based models for stage II and III colon cancer (CC): A population-based validation of Numeracy (NUM) and ADJUVANT! Online (ADJ!). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4044 Background: To aid in decisions regarding adjuvant therapy (AT) for resected high-risk CC, two prog models are in common use: the Mayo Clinic NUM calculator developed from a pooled data analysis of 7 randomized 5FU-based AT trials, and ADJ! developed using SEER data. This study examines the accuracy of NUM and ADJ! utilizing a cohort of patients (pts) referred to the BC Cancer Agency (BCCA). Methods: Demographic, disease and treatment data for pts with stage II/III CC referred to the BCCA from 1995–1996 + 1999–2003 were collected. Observed (obs) 5-year relapse free survival (RFS) and overall survival (OS) were compared to predicted estimates (pred) using NUM and ADJ!, both overall and for all prog subgroups with ≥ 10pts, as stratified by T stage, N stage, tumor grade and age. Data are presented in a descriptive manner and using confidence intervals. Results: Median follow-up was 5.6 yrs for 2,033 pts - 53% male, median age 68y, 40% N0. The mean percentages of 5 year pred outcomes for each of the two models and the actual Kaplan Meier mean survivals are presented in the table . The percentage correct predictions of 5 y status is also presented, with correctness deemed accurate if the pt was alive and predicted to be alive by ≥ 50% as determined by each model or dead while the respective tool predicted < 50% possibility of being alive. For surgery alone pts, ADJ!pred were more often closer to what was observed, as compared to NUMpred, in the prog subgroups (for RFS 56%, OS 88%). For surgery + 5-FU pts, within these subgroups, NUMpred were more often closer to what was observed, as compared to ADJ!pred, for RFS (62%) and for OS (55%). Conclusions: In this independent population-based validation, NUM and ADJ! have acceptable and similar reliability with modest over-estimations of 5y RFS and OS. Both models thus appear to be useful adjuvant decision-aids. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- S. Gill
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - C. Loprinzi
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - H. Kennecke
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - A. Grothey
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - G. Nelson
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - R. Woods
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - C. Speers
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - S. Alberts
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - A. Bardia
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
| | - D. Sargent
- BC Cancer Agency, Vancouver, BC, Canada; Mayo Clinic, Rochester, MN
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Barton DL, Wos E, Qin R, Mattar B, Green N, Lanier K, Bearden J, Kugler J, Rowland K, Loprinzi C. A randomized controlled trial evaluating a topical treatment for chemotherapy-induced neuropathy: NCCTG trial N06CA. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9531 Background: Chemotherapy induced peripheral neuropathy (CIPN) is a prevalent dose limiting toxicity for several important cancer treatment agents. CIPN can impair function and cause distress. There are no proven pharmacologic treatments for established CIPN currently. This double blind randomized placebo controlled trial evaluated a compounded topical gel for this problem. The novelty of this treatment is that it might incorporate several agents with different mechanisms of action to provide relief locally without negative systemic effects. Methods: Patients with CIPN (rated ≥4 out of 10) for at least one month, related to previous and/or concurrent exposure to neurotoxic agents, were randomized to baclofen 10 mg, amitriptyline HCL 40 mg and ketamine 20 mg in a pluronic lecithin organogel (BAK-PLO) vs placebo (PLO) to determine its effect on numbness, tingling, pain, and motor function. Exclusion criteria included other causes and/or current treatment for peripheral neuropathy. The primary endpoint was the baseline adjusted sensory subscale of the EORTC QLQ-CIPN20, at 4 weeks. Results: Between February and May 2008, 208 patients were enrolled onto this trial. Four week data are shown in the table below, higher numbers being better. The percentage of patients that had improvements of at least 10, on a 100 point scale, in the motor subscale was statistically significantly higher in the BAK-PLO arm, p=.04. There were no unwanted toxicities associated with the BAK-PLO that were significantly different from placebo and no evidence of CNS or systemic toxicity. Conclusions: Topical treatment with BAK-PLO appears to moderately improve symptoms of CIPN. This topical gel was well tolerated without systemic side effects. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- D. L. Barton
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - E. Wos
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - R. Qin
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - B. Mattar
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - N. Green
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - K. Lanier
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - J. Bearden
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - J. Kugler
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - K. Rowland
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
| | - C. Loprinzi
- Mayo Clinic, Rochester, MN; Medcenter One Health System, Bismarck, ND; Mayo Clinic, Rochester, MN; Wichita Community Clinical Oncology Program, Wichita, KS; Missouri Valley Cancer Consortium CCOP, Omaha, NE; Providence Oncology and Hematology Care Clinic, Portland, OR; Gibbs Cancer Center, Spartanburg, SC; Illinois Cancer Care, Peoria, IL; Carle Cancer Center, Urbana, IL
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Wolf S, Barton D, Kottschade L, Grothey A, Loprinzi C. Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Eur J Cancer 2008; 44:1507-15. [PMID: 18571399 DOI: 10.1016/j.ejca.2008.04.018] [Citation(s) in RCA: 416] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 04/29/2008] [Indexed: 11/16/2022]
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is a major dose limiting side effect of many commonly used chemotherapeutic agents, including platinum drugs, taxanes, epothilones and vinca alkaloids, and also newer agents such as bortezomib and lenolidamide. Symptom control studies have been conducted looking at ways to prevent or alleviate established CIPN. This manuscript provides a review of studies directed at both of these areas. New evidence strongly suggests that intravenous calcium and magnesium therapy can attenuate the development of oxaliplatin-induced CIPN, without reducing treatment response. Accumulating data suggest that vitamin E may also attenuate the development of CIPN, but more data regarding its efficacy and safety should be obtained prior to its general use in patients. Other agents that look promising in preliminary studies, but need substantiation, include glutamine, glutathione, N-acetylcysteine, oxcarbazepine, and xaliproden. Effective treatment of established CIPN, however, has yet to be found. Lastly, paclitaxel causes a unique acute pain syndrome which has been hypothesised to be caused by neurologic injury. No drugs, to date, have been proven to prevent this toxicity.
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Affiliation(s)
- Sherry Wolf
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
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Kottschade L, Loprinzi C, Rao R. Vitamin E for the Prevention of Chemotherapy-Induced Peripheral Neuropathy: Rationale for an Ongoing Clinical Trial. ACTA ACUST UNITED AC 2007; 4:251-3. [DOI: 10.3816/sct.2007.n.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thompson SL, Bardia A, Tan A, Barton D, Kottschade L, Sloan J, Christensen B, Smith D, Loprinzi C. Levetiracetam for the treatment of hot flashes: A pilot study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9116] [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
9116 Background: Hot flashes affect 75 % to 90 % of women transitioning to menopause and are a major cause of morbidity among breast cancer survivors. Levetiracetam, a popular anticonvulsant, is a centrally active agent that anecdotally appeared to reduce hot flashes in clinical practice. This phase II trial sought to evaluate the efficacy of levetiracetam in reducing hot flashes among women with a history of breast cancer or women who did not wish to take estrogen therapy for fear of an increased risk of breast cancer. Methods: Women who were experiencing bothersome hot flashes (≥ 14 times per week, for ≥ 1 month) were eligible. A single arm pilot study design based on previous work was used with a planned sample size of 30 patients. The patients did not receive any study medication during the first week (baseline week). At the beginning of the second week, patients were started on levetiracetam (500 mg), and were to increase the dose by 500 mg each week to a goal of 1,000 mg twice daily. Hot flash diaries were completed daily. The primary endpoint was hot flash score (frequency times average severity). The change from week 1 (baseline) to week 5, the last treatment week, was analyzed by paired t-test and related Wilcoxon procedures. Results: A total of 30 women were enrolled onto this study in eight months. All patients were eligible. 19 women completed all 4 weeks of the study treatment and provided complete data. After treatment with levetiracetam for 4 weeks, mean hot flash scores were reduced by 57% (95% CI 39%-75%), while mean hot flash frequencies were reduced by 53% (95% CI 38%-68%), reductions being greater than what would be expected with a placebo. There were significant improvements, compared to baseline week data, in sweating, hot flash distress, and satisfaction with hot flash control. Eight subjects stopped the study drug due to treatment related adverse events (grade I/II), with the most frequently reported being somnolence, fatigue and dizziness. Conclusions: While levetiracetam appears to be a promising therapy for the treatment of hot flashes, further study is needed to better substantiate the toxicity and efficacy of this drug before it can be more definitively recommended for use in clinical practice. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - A. Tan
- Mayo Clinic, Rochester, MN
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Abstract
PURPOSE/OBJECTIVES To present the state of knowledge and a suggested program of research related to one part of sexual functioning in female cancer survivors: libido. DATA SOURCES Journal articles, monographs, and book chapters. DATA SYNTHESIS Sexuality is a broadly defined term with many components. Libido is a component of sexuality and is reviewed with respect to definition, physiology, and measurement. Evidence-based interventions also are discussed. CONCLUSIONS Most of the evidence related to enhancing libido involves testosterone, but this has not been tested in cancer survivors. Several clinical questions are yet to be answered regarding physiology as well as nonpharmacologic and pharmacologic interventions for enhancing libido. IMPLICATIONS FOR NURSING Nurse researchers could add much to the evidence base on interventions for improving libido and, subsequently, sexual health. Implementing behavioral interventions to enhance libido would be an appropriate nursing function.
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Bordeleau L, Pritchard K, Goodwin P, Loprinzi C. Therapeutic options for the management of hot flashes in breast cancer survivors: An evidence-based review. Clin Ther 2007; 29:230-41. [PMID: 17472816 DOI: 10.1016/j.clinthera.2007.02.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Women with breast cancer may experience treatment-induced menopausal symptoms or natural menopause. Menopausal symptoms, particularly hot flashes, are reported at a high frequency in this group and tend to be more severe, distressing, and of greater duration than in controls. Because of the contribution of sex hormones to breast cancer, the use of hormonal agents for the control of hot flashes is problematic in these women. Safer nonhormonal alternatives are recommended for this patient group. OBJECTIVES This was a systematic review of the therapeutic options for the treatment of hot flashes in breast cancer survivors. METHODS MEDLINE was searched from 1990 to July 2006 using the disease-specific term breast neoplasms and the subheadings menopause and hot flashes. EMBASE was searched from 1990 to March 2006 using the disease-specific subject headings breast tumor/ breast cancer and menopause and the key word hot flashes. The reference lists of the identified articles and relevant review articles were examined for additional publications. Pertinent articles and abstracts of large randomized controlled trials focusing on the treatment of hot flashes in breast cancer survivors were selected for review. Pilot studies were excluded. RESULTS A number of nonpharmacologic approaches are available for the treatment of hot flashes in breast cancer survivors, although they appear to be of limited effectiveness. Complementary alternative medicine therapies and vitamin E have been found to have modest effectiveness at best, and data on their long-term safety are not available. Centrally active agents such as the antidepressants venlafaxine and paroxetine and the anti seizure agent gabapentin have shown clinical effectiveness and appear to be reasonably well tolerated in this population. CONCLUSIONS Centrally active agents (eg, venlafaxine, paroxetine, gabapentin) are regarded as the most promising nonhormonal treatments for hot flashes in breast cancer survivors. Nonpharmacologic and complementary alternative medicine therapies have limited effectiveness.
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Affiliation(s)
- Louise Bordeleau
- Department of Medical Oncology, University of Toronto, Toronto, Ontario, Canada.
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Abstract
OBJECTIVE Hot flashes are a significant problem in women going through the menopausal transition that can substantially affect quality of life. The world of estrogen therapy has been thrown into turmoil with the recent results of the Women's Health Initiative trial report. Pursuant to a growing interest in the use of alternative therapies to alleviate menopausal symptoms and a few pilot trials that suggested that acupuncture could modestly alleviate hot flashes, a prospective, randomized, single-blind, sham-controlled clinical trial was conducted in women experiencing hot flashes. DESIGN Participants, after being randomized to medical versus sham acupuncture, received biweekly treatments for 5 weeks after a baseline assessment week. They were then followed for an additional 7 weeks. Participants completed daily hot flash questionnaires, which formed the basis for analysis. RESULTS A total of 103 participants were randomized to medical or sham acupuncture. At week 6 the percentage of residual hot flashes was 60% in the medical acupuncture group and 62% in the sham acupuncture group. At week 12, the percentage of residual hot flashes was 73% in the medical acupuncture group and 55% in the sham acupuncture group. Participants reported no adverse effects related to the treatments. CONCLUSIONS The results of this study suggest that the used medical acupuncture was not any more effective for reducing hot flashes than was the chosen sham acupuncture.
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Affiliation(s)
- Ann Vincent
- Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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