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Cascone T, Kar G, Spicer JD, García-Campelo R, Weder W, Daniel DB, Spigel DR, Hussein M, Mazieres J, Oliveira J, Yau EH, Spira AI, Anagnostou V, Mager R, Hamid O, Cheng LY, Zheng Y, Blando J, Tan TH, Surace M, Rodriguez-Canales J, Gopalakrishnan V, Sellman BR, Grenga I, Soo-Hoo Y, Kumar R, McGrath L, Forde PM. Neoadjuvant Durvalumab Alone or Combined with Novel Immuno-Oncology Agents in Resectable Lung Cancer: The Phase II NeoCOAST Platform Trial. Cancer Discov 2023; 13:2394-2411. [PMID: 37707791 PMCID: PMC10618740 DOI: 10.1158/2159-8290.cd-23-0436] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/21/2023] [Revised: 07/14/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
Neoadjuvant chemoimmunotherapy improves pathologic complete response rate and event-free survival in patients with resectable non-small cell lung cancer (NSCLC) versus chemotherapy alone. NeoCOAST was the first randomized, multidrug platform trial to examine novel neoadjuvant immuno-oncology combinations for patients with resectable NSCLC, using major pathologic response (MPR) rate as the primary endpoint. Eighty-three patients received a single cycle of treatment: 26 received durvalumab (anti-PD-L1) monotherapy, 21 received durvalumab plus oleclumab (anti-CD73), 20 received durvalumab plus monalizumab (anti-NKG2A), and 16 received durvalumab plus danvatirsen (anti-STAT3 antisense oligonucleotide). MPR rates were higher for patients in the combination arms versus durvalumab alone. Safety profiles for the combinations were similar to those of durvalumab alone. Multiplatform immune profiling suggested that improved MPR rates in the durvalumab plus oleclumab and durvalumab plus monalizumab arms were associated with enhanced effector immune infiltration of tumors, interferon responses and markers of tertiary lymphoid structure formation, and systemic functional immune cell activation. SIGNIFICANCE A neoadjuvant platform trial can rapidly generate clinical and translational data using candidate surrogate endpoints like MPR. In NeoCOAST, patients with resectable NSCLC had improved MPR rates after durvalumab plus oleclumab or monalizumab versus durvalumab alone and tumoral transcriptomic signatures indicative of augmented immune cell activation and function. See related commentary by Cooper and Yu, p. 2306. This article is featured in Selected Articles from This Issue, p. 2293.
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Affiliation(s)
- Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gozde Kar
- AstraZeneca, Translational Medicine, Research and Early Development, Oncology Research and Development, Cambridge, United Kingdom
| | - Jonathan D. Spicer
- Department of Thoracic Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Walter Weder
- Thoracic Surgery, Clinic Bethanien, Zurich, Switzerland
| | - Davey B. Daniel
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - David R. Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - Maen Hussein
- Sarah Cannon Research Institute, Florida Cancer Specialists, Leesburg, Florida
| | - Julien Mazieres
- Thoracic Oncology Department, Toulouse University Hospital, Toulouse, France
| | - Julio Oliveira
- Medical Oncology Department, Portuguese Oncology Institute (IPO-PORTO), Porto, Portugal
| | - Edwin H. Yau
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alexander I. Spira
- Virginia Cancer Specialists, US Oncology Research, NEXT Oncology Virginia, Fairfax, Virginia
| | - Valsamo Anagnostou
- Bloomberg–Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Patrick M. Forde
- Bloomberg–Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Schwartzberg LS, Yu E, Meyer CS, Shah A, Price R, Szado T, Vaena DA, Daniel DB, Slater D, Staszewski H, Fang B, Seneviratne L, Ma E. Evolution of biomarker testing in advanced non-small cell lung cancer (aNSCLC) and metastatic breast cancer (mBC) in U.S. community practices. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18778] [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
e18778 Background: Biomarker testing has advanced from single-gene to NGS. This study examined aNSCLC and mBC biomarker testing ≤ 90d of advanced (adv) or metastatic (met) diagnosis (Dx) and treatment (tx) patterns at US practices. Methods: A retrospective observational study used Flatiron Health electronic health-record-derived de-identified database at OneOncology (OO) community and non-OO Flatiron Health nationwide (NAT) sites (̃90% community, ̃10% academic). Patients (Pts) ≥ 18y, with Dx of aNSCLC or mBC from 1/1/18 - 4/30/21, with ≥ 1 visit ≤ 90d after adv/met Dx and ≥ 90d follow-up were evaluated. Descriptive analyses and logistic regression were used. Results: A total of 16,882 pts with aNSCLC (2366 OO; 14,516 NAT), and 6500 pts with mBC (1026 OO; 5474 NAT) were included. Overall testing was high and stable (OO: 85% aNSCLC, 98% mBC; NAT: 84%, 97%) with higher NGS testing at OO (58% aNSCLC; 28% mBC) vs NAT (49%; 16%) (Table), which reflected more pts with aNSCLC tested for all 6 mutations (ALK, BRAF, KRAS, ROS-1, EGFR, PD-L1; 54% OO vs 50% NAT, p<0.001) and more pts with mBC tested for PIK3CA (27% OO vs 16% NAT, p<0.001). In aNSCLC, NGS testing increased similarly for OO and NAT over time (p>0.05); mBC NGS testing increased faster at NAT vs OO (p<0.05). Of pts tested and treated, 16% aNSCLC (1945 OO; 11,376 NAT) and < 3% mBC (14 OO; 108 NAT) received tx before test results were available. For pts with aNSCLC with ≥ 1 actionable mutation (ALK, BRAF, ROS-1, EGFR), 18% OO and 22% NAT had tx before test results. Cancer immunotherapy plus chemotherapy was the most common tx (36 % OO vs 40 % NAT); after test results, 33% vs 56% OO and 45% vs 44% NAT pts stayed on tx vs switched to targeted tx. For pts with aNSCLC with ≥ 1 aforementioned actionable mutations who waited until test results were available, 65% received targeted tx at OO and NAT. Conclusions: Biomarker testing has become standard of care in aNSCLC and mBC in US community settings. NGS rates increased over time and were higher at OO vs NAT. Differences in pts treated before test results reflects the need to wait for NGS results to inform initial tx in aNSCLC vs non-NGS results for mBC. This study shows NGS testing in US community practices has increased since 2018, particularly in mBC, but opportunities remain to optimize NGS results into tx decisions.[Table: see text]
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Affiliation(s)
| | - Elaine Yu
- Genentech, Inc., South San Francisco, CA
| | | | - Anuj Shah
- Genentech, Inc., South San Francisco, CA
| | | | | | | | | | - Dennis Slater
- Eastern Connecticut Hematology & Oncology Associates, Norwich, CT
| | | | | | | | - Esprit Ma
- Genentech, Inc., South San Francisco, CA
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Yardley DA, Young RR, Adelson KB, Silber AL, Najera JE, Daniel DB, Peacock N, Finney L, Hoekstra SJ, Shastry M, Hainsworth JD, Burris HA. A Phase II Study Evaluating Orteronel, an Inhibitor of Androgen Biosynthesis, in Patients With Androgen Receptor (AR)-Expressing Metastatic Breast Cancer (MBC). Clin Breast Cancer 2021; 22:269-278. [PMID: 34824002 DOI: 10.1016/j.clbc.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AR is a targetable pathway with AR modulation inhibiting estrogen- and androgen-mediated cell proliferation. Orteronel is an oral, selective, nonsteroidal inhibitor of 17, 20-lyase, a key enzyme in androgen biosynthesis. This study evaluated single-agent orteronel in AR+ metastatic breast cancer (MBC). METHODS Male/female patients with AR+ MBC were grouped in Cohort 1: AR+ TNBC with l-3 prior chemotherapy regimens or Cohort 2: AR+ HR+ (estrogen [ER+]/ progesterone receptor [PR+] positive) HER2+/- with 1 to 3 prior hormonal and at least 1 prior chemotherapy regimen. Patients with HER2+ MBC must have received at least 2 lines of HER2-targeted therapy. Orteronel was administered at 300 mg BID; response rate was the primary endpoint. RESULTS Seventy patients were enrolled (Cohort 1, n = 26 and Cohort 2, n = 44). Median treatment duration was 7.1 weeks. Seven patients were on treatment for ≥6 months. One of the 21 evaluated patients in Cohort 1 (4.8%) had an objective response. In Cohort 2, none of the first 23 patients to be evaluated had a response and accrual was stopped. Median progression-free and overall survival were 1.8 and 8.3 months, respectively. Toxicities were predominantly Grade 1 or 2 nausea/vomiting (36%) and fatigue (31%). Grade 3 or 4 events in ≥5% of patients included increased amylase/lipase (10%) and hypertension (6%). CONCLUSIONS Orteronel demonstrated limited clinical activity in heavily pre-treated AR+ MBC. Further development of orteronel in MBC is not recommended. Further efforts to validate the AR as a therapeutic target should focus on identifying new markers predictive of sensitivity to AR-targeted agents.
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Affiliation(s)
- Denise A Yardley
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN.
| | - Robyn R Young
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | | | | | | | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Chattanooga, TN
| | - Nancy Peacock
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, TN; Tennessee Oncology, PLLC, Nashville, TN
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Bedrose S, Miller KC, Altameemi L, Ali MS, Nassar S, Garg N, Daher M, Eaton KD, Yorio JT, Daniel DB, Campbell M, Bible KC, Ryder M, Chintakuntlawar AV, Habra MA. Combined lenvatinib and pembrolizumab as salvage therapy in advanced adrenal cortical carcinoma. J Immunother Cancer 2021; 8:jitc-2020-001009. [PMID: 32737143 PMCID: PMC7394183 DOI: 10.1136/jitc-2020-001009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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] [Accepted: 06/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background There is no effective systemic therapy for metastatic adrenal cortical carcinoma (ACC) after failure of platinum-based chemotherapy. The efficacies of single-agent oral multikinase inhibitors (MKIs) or salvage immune checkpoint inhibitors (CPIs) have been very limited. It is unknown whether combining CPIs, such as pembrolizumab (PEM), with other therapies, such as MKIs, could yield higher response rates in ACC, yet this combination has shown promise in other cancers. Herein, we describe the first case series using PEM in combination with the MKI lenvatinib (LEN) in patients with progressive, metastatic ACC. Methods A retrospective case series describing the use of LEN/PEM as salvage therapy in patients with progressive/metastatic ACC. Results Eight patients were treated with the LEN/PEM combination therapy. Half were female, and the median age at time of diagnosis was 38 years (range 21–49). Three (37.5%) patients had hormonally active ACC. The median number of prior lines of systemic therapy was 4 (range 2–9). Six (75%) patients had had disease progression on prior CPIs and five (62.5%) patients had progressed on prior MKI therapy. The median progression-free survival was 5.5 months (95% CI 1.8–not reached) and median duration of therapy was 8.5 months (range 2–22). Two (25%) patients had a partial response, one (12.5%) patient had stable disease, and five (62.5%) patients had progressive disease. None of the eight patients stopped therapy because of adverse events. Conclusions In our small cohort of heavily pretreated patients with ACC, the combination of LEN/PEM was associated with objective responses in a subset of patients without significant toxicity. This combination should be formally investigated in phase II clinical trial with robust correlative studies to identify predictors for response.
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Affiliation(s)
- Sara Bedrose
- Department of Endocrine Neoplasia and Hormonal Disorders, Unit 1461, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Section of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | | | - Lina Altameemi
- Department of Endocrine Neoplasia and Hormonal Disorders, Unit 1461, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed S Ali
- Section of Endocrinology, Diabetes and Metabolism, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sameh Nassar
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naveen Garg
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marilyne Daher
- Department of Endocrine Neoplasia and Hormonal Disorders, Unit 1461, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keith D Eaton
- Department of Medical Oncology, University of Washington, Seattle, Washington, USA
| | | | | | - Matthew Campbell
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Keith C Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, Unit 1461, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Page RD, Drusbosky L, Dada HI, Raymond VM, Daniel DB, Divers SG, Reckamp KL, Villalona-Calero MA, Odegaard JI, Lanman RB, Papadimitrakopoulou V, Leighl NB. Clinical outcomes for plasma-based comprehensive genomic profiling versus tissue testing in advanced lung adenocarcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9027] [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
9027 Background: Somatic genomic testing is recommended by numerous expert guidelines to inform targeted therapy treatment for patients with advanced lung adenocarcinoma (aLUAD). The NILE study was a prospective observational study that demonstrated non-inferiority of cell-free circulating tumor DNA (cfDNA)-based tumor genotyping compared to tissue-based genotyping to find targetable genomic alterations in patients with newly diagnosed aLUAD. As the cohort has matured, clinical outcomes data can now be reported. Methods: This prospective, multicenter North American study (NCT03615443) enrolled patients with previously untreated aLUAD who had standard of care (SOC) tissue genotyping performed and concurrent comprehensive cfDNA analysis using the commercially available Guardant360 assay (Guardant Health, Redwood City, CA). After 12 months of study enrollment, objective response rates, disease control rate, and time to treatment data were collected for patients with targetable genomic alterations, as defined by NCCN guidelines, who were treated with physician’s choice of therapy. Results: Among 282 patients on the study, 89 (31.6%) had an actionable biomarker detected by tissue (21.3%) and/or cfDNA (27.3%) analysis. Sixty-one (68.5%) of these patients were treated with an FDA-approved targeted therapy guided by somatic genotyping results ( EGFR, ALK, ROS1). Thirty-three patients were eligible for clinical response evaluation and demonstrated an objective response rate of 58% and disease control rate of 94%. Twenty-five (76%) achieved a durable response > 6 months; 17 (52%) achieved a durable response > 12 months. Patients responded to targeted therapy regardless of the variant allele frequency of the target alteration. The time to treatment (TtT) was significantly faster for cfDNA-informed biomarker detection as compared to tissue genotyping (median 18 vs 31 days, respectively; p = 0.0008). Conclusions: This is the first prospective community-based study to find that cfDNA detects guideline-recommended biomarkers at a rate similar to tissue genotyping, and therapeutic outcomes based on plasma-based comprehensive genomic profiling are comparable to published tissue-based targeted therapy clinical outcomes. The NILE study complements and confirms findings in the prospective FLAURA and SLLIP studies, which exclusively enrolled at academic sites. Clinical trial information: NCT03615443.
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Affiliation(s)
- Ray D. Page
- The Center for Cancer and Blood Disorders, Fort Worth, TX
| | | | | | | | - Davey B. Daniel
- Sarah Cannon Research Institute, Tennessee Oncology-Chattanooga, Chattanooga, TN
| | | | | | | | | | | | | | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Young G, Bilbrey LE, Arrowsmith E, Blakely LJ, Daniel DB, Yue A, Chaudhry BI, Spigel DR, Lyss AJ, Dickson NR, Fox J, Schleicher SM, Schwartzberg LS. Impact of clinical trial enrollment on episode costs in the Oncology Care Model (OCM). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6513] [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
6513 Background: Clinical trials are critical for improving outcomes for patients with cancer. However, there is some concern from health insurers that clinical trial participation can increase total cost of care for cancer patients. We investigated the impact of clinical trial participation on total costs paid by Medicare during the OCM program in a large community-based practice. Methods: Tennessee Oncology (TO) is a community oncology practice comprising over 90 oncologists across 30 sites of care. We linked TO trial data and electronic medical record data with OCM data for episodes of care from 2016-2018. To assess the impact of trial participation on total cost relative to routine care, we created matched comparator groups for each OCM episode based on cancer type, metastatic status, number of comorbidities, performance status, and age. Patients with breast cancer receiving hormone therapy only were excluded. Absolute and percent cost differences between groups were calculated for episodes that had a comparator group size of five or greater. Differences in total cost for trial episodes were compared to non-trial episodes, and significance was assessed using the Mann–Whitney U test. We also studied the impact of trial participation on receipt of active treatment in the last 14 days of life (TxEOL), hospice use, and hospitalizations. Results: During the study period, 8,026 completed OCM episodes met study criteria. Patients were enrolled in a clinical trial for 459 of these episodes. On average, episodes during which patients were on trial cost $5,973 less than matched non-trial episodes (Table), independent of early versus late-phase trial. Most savings resulted from decreased drug costs. There were no differences in rates of TxEOL (15% vs. 14% p=1.0), rates of hospitalizations (31% vs. 30% p=0.54), or hospice use (52% vs. 62% p=0.08) between trial and non-trial episodes. Median difference from comparator group average cost was significantly lower for clinical trial episodes (-18% vs. -6%, p<0.01). Conclusions: In the community setting, total costs paid by Medicare for patients participating in clinical trials during OCM episodes were lower than costs for similar patients receiving routine care. Clinical trial participation did not adversely impact end-of-life care or likelihood of hospitalization. These findings suggest that patient participation in clinical trials does not increase total cost of care nor enhance financial risk to payers.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN
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Stevens AD, Daniel DB, Goldschmidt JH, Fields PA, Banbury B, Wolfe S, Glass J, Horton JK, Sorrentino J. Effects of trilaciclib prior to chemotherapy ± atezolizumab on T-cell activation in patients with newly diagnosed extensive-stage small cell lung cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e20582] [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
e20582 Background: Chemotherapy ± immunotherapy has demonstrated meaningful clinical benefit to patients (pts) with extensive-stage small cell lung cancer (ES-SCLC); however, chemotherapy-induced damage to the immune system can potentially diminish treatment efficacy. Trilaciclib (T) is an intravenous cyclin-dependent kinase 4/6 inhibitor that protects hematopoietic stem and progenitor cells from chemotherapy-induced damage (myeloprotection) and may directly enhance antitumor immunity. Here, we evaluated the immune effects of T in pts with ES-SCLC receiving T or placebo (P) prior to first-line etoposide plus carboplatin (E/C) or E/C plus atezolizumab (E/C/A) in two phase 2 clinical trials. Methods: Genomic DNA, extracted from peripheral blood mononuclear cells (baseline and on treatment) and archival tumor tissue (baseline), was analyzed using the immunoSEQ® Assay (Adaptive Biotechnologies). T-cell receptor (TCR) β CDR3 regions were amplified and sequenced to identify and quantitate the abundance of each unique TCRβ CDR3. Clonal frequencies were compared at baseline and on treatment, and statistical differences between T and P were determined by Wilcoxon rank sum test. Antitumor response was defined as complete/partial response. Results: In both studies, peripheral T-cell clonal expansion was greater among pts receiving T versus P. Among pts receiving E/C, those in the T/E/C group with an antitumor response had significantly more peripheral clonal expansion than P responders (median 23 vs 12 clones; P= 0.04) and a greater number of tumor-associated expanded clones ( P= 0.03). T responders had more newly detected expanded peripheral clones compared with P responders (6 vs 1.5 clones; P= 0.06) and T nonresponders ( P= 0.02). Increased clonal expansion in T responders was more evident after two cycles of E/C versus four, suggesting that T results in a rapid T-cell response. Similarly, among pts receiving E/C/A, those in the T/E/C/A group with an antitumor response had significantly more peripheral clonal expansion than P responders (median 90 vs 43 clones; P= 0.002) and T nonresponders ( P= 0.016). T responders also had more newly expanded peripheral clones compared with P responders (68 vs 11 clones; P= 0.003) and T nonresponders ( P= 0.02). There was no increase in tumor-associated expanded clones among T responders compared to P responders, possibly due to the time point at which clonal expansion was assessed (after four cycles) or the addition of atezolizumab. Associations between peripheral and tumor-associated clonal expansion and survival will be presented. Conclusions: The data suggest that, among pts treated with T/E/C or T/E/C/A, increased clonal expansion is associated with clinical response, indicating that T may enhance antitumor immunity in pts with ES-SCLC treated with chemotherapy.
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Affiliation(s)
| | - Davey B. Daniel
- Sarah Cannon Research Institute, Tennessee Oncology-Chattanooga, Chattanooga, TN
| | | | | | | | - Steven Wolfe
- G1 Therapeutics, Inc., Research Triangle Park, NC
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Yardley DA, Young RR, Adelson KB, Silber AL, Kommor MD, Najera JE, Daniel DB, Peacock NW, Shastry M, Hainsworth JD, Burris HA. Abstract PS11-29: A phase 2 study evaluating orteronel, an inhibitor of androgen biosynthesis, in patients with androgen receptor (AR)-expressing metastatic triple-negative breast cancer (TNBC). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps11-29] [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: Treatment options for TNBC are limited by the lack of estrogen and progesterone receptors as well as the absence of HER2 overexpression. AR is present in all breast cancer subtypes and up to 40% of TNBC have AR overexpression (AR+). Thus AR positivity in TNBC represents a potential targetable signaling pathway. Preclinical studies demonstrated that AR modulation inhibits cell proliferation, and clinical activity with anti-androgen monotherapy has been reported in breast cancer. Orteronel is a novel, oral, selective, nonsteroidal inhibitor of 17, 20-lyase, a key enzyme in androgen biosynthesis under evaluation as a potential therapeutic strategy in hormone-sensitive cancers. In this phase 2 study, we evaluated androgen blockade with single agent orteronel in AR+ metastatic breast cancer (MBC). Methods: Male or female pts with AR+ MBC (≥10% staining by central immunohistochemistry) were eligible. Pts were grouped into 2 cohorts for analysis: Cohort 1-TNBC (AR+/ER-/PR-/HER2-) and Cohort 2-ER+ (AR+/ER+/HER2 +/-). Results in Cohort 2 (ER+) have been previously reported; here we report results in the AR+ TNBC cohort. TNBC pts must have been previously treated with standard therapy (1-3 chemotherapy regimens for MBC). All pts received 300 mg orteronel PO BID over a 4 week cycle and underwent response assessment every 2 cycles. Treatment continued until disease progression or unacceptable toxicity. The hypothesized response rate for pts with previously treated metastatic AR+ TNBC was 11%. Results: From 7/2014 to 2/2019 a total of 26 AR+ TNBC pts were enrolled on cohort 1. The trial closed early due to slow accrual. Median age was 57 years (range, 33-92); 96% ECOG 0-1; all pts had ≥ 1 prior chemotherapy; 42% prior targeted therapy; 8% prior immunotherapy. All tumors were ER and PR negative per institutional standards. PI3K was mutated in 16% (3/19) tumors tested and 65% (13/20) were PTEN-negative. Median duration of treatment was 8 weeks (range 0.7-35.7) with 15% of pts on treatment ≥ 6 months (mo). All pts have discontinued treatment, 85% due to disease progression, and 15% due to AEs. Nausea and fatigue [8 pts each (31%)] were the most common AEs noted. G 3/4 AEs included hypertension, increased amylase and lipase [2 pts each (8%)] with 4 patients reporting SAEs (G2 pneumonitis, G2 chest pain and G2 peripheral edema, G4 prolonged QT and G4 hypokalemia). The ORR was 4% and DCR was 15%. Median PFS was 2.0 mo and median OS was 10.2 mo. Conclusions: Orteronel monotherapy was well tolerated but demonstrated limited clinical activity in this heavily pre-treated metastatic AR+ TNBC patient population. As novel AR targeting agents are being developed, future studies are needed to identify AR+ breast cancer patients most likely to benefit from AR inhibition.
Citation Format: Denise A Yardley, Robyn R Young, Kerin B Adelson, Andrea L Silber, Michael D Kommor, Jose E Najera, Davey B Daniel, Nancy W Peacock, Mythili Shastry, John D Hainsworth, Howard A Burris, III. A phase 2 study evaluating orteronel, an inhibitor of androgen biosynthesis, in patients with androgen receptor (AR)-expressing metastatic triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-29.
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Affiliation(s)
- Denise A Yardley
- 1Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | - Robyn R Young
- 2The Center for Cancer and Blood Disorders, Forth Worth, TX
| | | | | | | | | | - Davey B Daniel
- 6Sarah Cannon Research Institute/Tennessee Oncology, Chattanooga, TN
| | - Nancy W Peacock
- 1Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
| | | | | | - Howard A Burris
- 1Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN
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Daniel DB, Blakely J, Schleicher SM, Allen D, Marsden MC, Arrowsmith MM, Grothey A, Schwartzberg LS. Finding value in social media: A collaborative online communication platform linking providers to education and an online tumor board across a large community of oncology practices. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.305] [Citation(s) in RCA: 1] [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
305 Background: Clinical collaboration across fragmented and often small clinic sites can be challenging. As a potential solution, OneOncology, a national community oncology network, launched OneCommunity, a secure, interactive online platform used across our network of six practices and over 130 clinic sites. One feature is a “virtual” tumor board where physicians can post complex cases at any time and obtain input from disease-specific experts from within the network. Members can also post, comment and disseminate information about policy and education updates affecting oncology. Methods: OneCommunity launched on December 15, 2019 and all 442 members of OneOncology were allowed access. We tracked numbers of membership, tumor board cases, policy updates and questions, views and responses per post, and response time for tumor board and policy posts during the study period from launch through June 11, 2020. Results: In the first six months of use, 277 providers signed up and logged into the platform. 71 individual patient cases were presented across 10 specialty tumor boards. The mean time to first response was 35 hours ( < 1 hour, 297 hours), median time was 20 hours, and 73% of postings had a response within 48 hours of original posting. The most robust tumor boards were breast, GI, and lung cancers. There was also a set of general posts that was nonspecific to patients including policy, COVID updates, and educational reviews. The average number of responses for tumor boards was significantly greater than general posts (3.5 vs. 1.8, p < 0.05). The number of views for both types of posts, however, were high (406 vs. 346, p < 0.05). Conclusions: An online communication platform is feasible and allows physicians to receive treatment suggestions for complex cases relatively quickly and across geographies. Tumor board cases received more interaction than policy and education updates. The platform lends itself to rapidly adding other aspects of cancer care such as COVID-19. Future applications include a network wide real-time molecular tumor board.
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10
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Mitchell RL, Blakely LJ, Schleicher SM, Poole SL, Dickson NR, Patton J, Daniel DB. Maintaining treatment volumes during the COVID-19 pandemic. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.103] [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
103 Background: Uninterrupted care is essential for optimal outcomes in cancer care. The COVID-19 pandemic presented numerous challenges in providing continuity of care for many facilities. Our practice was able to deliver ongoing treatment for a large volume of our patients while maintaining a safe environment. Methods: A practice-wide effort to continue therapy in cancer patients undergoing active treatment began in March 2020 as the peak of the pandemic was beginning in Tennessee. Those patients who were receiving active treatment continued the planned treatment while reducing non-acute treatment visits. We assessed the volume of patients receiving treatments in our facilities for two periods: JanuaryDecember 2019 and January-May 2020. We compared the aggregate number of chemotherapy infusions, therapeutic infusions and injections as well as total treatments. Results: Overall, treatments remained relatively stable without a significant change in treatment volumes. There was a 3.69% decline in total treatment with therapeutic infusions (-9.68%) and injections (-7.85%) which accounted for the majority of deferred treatments. Chemotherapy infusions remained stable with an average increase (1.90%) in treatments. Conclusions: During the COVID-19 pandemic, our facility was able to maintain stable treatment numbers while providing safe care to our patients. We had no known diagnosed COVID-19 cases from potential exposures in our clinics. Decreases in treatment reflected less critical therapies. There did seem to be a delay for chemotherapy/immunotherapy that seemed to resolve as the peak passed for this region. Offloading of less critical treatments can result in continued treatment of cancer patients during a pandemic. [Table: see text]
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11
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Waterhouse DM, Garon EB, Chandler J, McCleod M, Hussein M, Jotte R, Horn L, Daniel DB, Keogh G, Creelan B, Einhorn LH, Baker J, Kasbari S, Nikolinakos P, Babu S, Couture F, Leighl NB, Reynolds C, Blumenschein G, Gunuganti V, Li A, Aanur N, Spigel DR. Continuous Versus 1-Year Fixed-Duration Nivolumab in Previously Treated Advanced Non-Small-Cell Lung Cancer: CheckMate 153. J Clin Oncol 2020; 38:3863-3873. [PMID: 32910710 PMCID: PMC7676888 DOI: 10.1200/jco.20.00131] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Limited data exist on the optimal duration of immunotherapy, including for non–small-cell lung cancer (NSCLC). We present an exploratory analysis of CheckMate 153, a largely community-based phase IIIb/IV study, to evaluate the impact of 1-year fixed-duration versus continuous therapy on the efficacy and safety of nivolumab.
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Affiliation(s)
| | - Edward B Garon
- David Geffen School of Medicine at UCLA/Translational Research in Oncology-US Network, Los Angeles, CA
| | | | - Michael McCleod
- Sarah Cannon Research Institute/Florida Cancer Specialists, Cape Coral, FL
| | - Maen Hussein
- Sarah Cannon Research Institute/Florida Cancer Specialists, The Villages, FL
| | - Robert Jotte
- The US Oncology Network/Rocky Mountain Cancer Centers, Denver, CO
| | - Leora Horn
- Vanderbilt University Medical Center, Nashville, TN
| | - Davey B Daniel
- Sarah Cannon Research Institute/Tennessee Oncology, Chattanooga, TN
| | | | | | | | | | | | - Petros Nikolinakos
- Hematology and Medical Oncology, University Cancer and Blood Center, LLC, Athens, GA
| | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, IN
| | | | - Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Craig Reynolds
- Sarah Cannon Research Institute/Florida Cancer Specialists, Ocala, FL
| | - George Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ang Li
- Bristol Myers Squibb Company, Princeton, NJ
| | | | - David R Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, TN
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12
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Weiss J, Goldschmidt J, Zoran A, Dragnev KH, Pritchett Y, Morris SR, Malik RK, Daniel DB. Myelopreservation and reduced use of supportive care with trilaciclib in patients with small cell lung cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12096] [Citation(s) in RCA: 5] [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] [Indexed: 11/20/2022] Open
Abstract
12096 Background: Chemotherapy (CT) is a mainstay of cancer treatment; however, its side effects, notably myelosuppression, cause significant suffering. Trilaciclib (T) is an IV CDK4/6 inhibitor that protects hematopoietic stem and progenitor cells by preventing proliferation during CT administration. Results from three randomized, double-blind, placebo (P)-controlled phase II trials in patients (pts) with extensive-stage small cell lung cancer (ES-SCLC) have previously been reported. Data from these studies were pooled to understand the effects of T on specific myelosuppression endpoints with greater statistical precision. Methods: All pts received standard CT (etoposide/carboplatin [E/C], E/C/atezolizumab, or topotecan) plus T or P. Analyses were conducted on pooled intent-to-treat datasets from three ES-SCLC studies (NCT02499770; NCT03041311; NCT02514447). Results: 123 pts were treated with T and 119 with P. Median age in both groups was 64 years. Addition of T decreased measures of myelosuppression and the need for supportive care interventions (Table). From the pooled dataset, median OS and PFS (months [95% CI]) were comparable between pts treated with T vs P (OS: 10.6 [9.1, 11.7] vs 10.6 [7.9, 12.8]; PFS: 5.3 [4.6, 6.1] vs 5.0 [4.4, 5.5], respectively). Fewer pts on T had grade 3/4 hematologic events (54 [44.3%]) vs P (91 [77.1%]). Among pts who continued after cycle 1, 11 pts (9.2%) treated with T had ≥1 CT dose reduction vs 36 (30.8%) with P. Conclusions: T significantly and meaningfully reduced both CT-induced myelosuppression and its consequences, with no detrimental effect on PFS or OS, thus improving the patient experience with CT in ES-SCLC. T has potential to become a new standard of care for preventing myelosuppression in SCLC. [Table: see text]
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Affiliation(s)
- Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Andric Zoran
- University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
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13
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Planchard D, Cho BC, Gray JE, Paz-Ares LG, Ozguroglu M, Villegas AE, Daniel DB, Vicente D, Murakami S, Hui R, Kurata T, Chiappori A, Lee KH, De Wit M, Gu Y, Wadsworth C, Dennis PA, Antonia SJ. First subsequent treatment after discontinuation of durvalumab in unresectable, stage III NSCLC patients from PACIFIC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9054 Background: In the phase 3 PACIFIC trial of unresectable, stage III NSCLC patients (pts) without progression after concurrent chemoradiotherapy (cCRT), durvalumab (durva) significantly improved PFS and OS with similar safety compared to placebo (pbo). We performed exploratory analyses to characterize first subsequent treatment (Tx) after discontinuation of durva. Methods: Pts with WHO PS 0/1 and any tumor PD-L1 status were randomized (2:1) 1–42 days after ≥2 cycles of platinum-based cCRT to durva 10 mg/kg IV or pbo Q2W up to 12 months, stratified by age, sex and smoking history. Pts were classified by the use or not of first subsequent Tx and category of first systemic Tx (platinum doublet CT [PDCT], single-agent CT [SCT], immunotherapy [IT] or targeted therapy [TT]). Results: As of Mar 22, 2018, 216/476 (45.4%) and 153/237 (64.6%) in the durva and pbo arms, respectively, had a RECIST-based PFS event per BICR (5.7% and 8.4% due to death). 195 (41.0%) and 128 (54.0%) received first subsequent Tx, most of which were systemic Tx (158 [33.2%] and 109 [46.0%]): PDCT (16.4% and 19.0%), SCT (8.6% and 8.4%), IT (4.2% and 13.5%) or TT (3.8% and 5.1%); 7.8% and 8.0% received RT only. Time to first subsequent therapy or death (TFST) was longer with durva vs pbo (HR 0.58; 95% CI 0.47–0.72; median 21.0 vs 10.4 months). Baseline characteristics of pts with or without first subsequent Tx were similar, and similar across durva or pbo arms. Among pts with systemic Tx, baseline characteristics (including pre-cCRT PD-L1 status) were generally similar, except pts on TT, more of whom were EGFR+ (70.0% vs 0–6.6% of other systemic Tx groups) with commonly associated phenotypes (more females, Asians, non-smokers and non-squamous pts). Best overall response to first systemic Tx will be presented. Conclusions: Due to longer PFS and fewer progression events with durva vs pbo, fewer pts on durva required subsequent Tx and, per TFST, much later. With the exception of IT, use of each subsequent Tx was similar between the durva and pbo arms with PDCT the most common. Baseline characteristics were similar for pts with or without first subsequent Tx and pts who received first systemic Tx, except for pts who received TT, as expected due to their molecular profile.
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Affiliation(s)
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Luis G. Paz-Ares
- Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and CNIO, Madrid, Spain
| | - Mustafa Ozguroglu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | | | | | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Rina Hui
- Westmead Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Takayasu Kurata
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Japan
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | | | - Yu Gu
- MedImmune, Gaithersburg, MD
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14
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Spigel DR, McCleod M, Jotte RM, Einhorn L, Horn L, Waterhouse DM, Creelan B, Babu S, Leighl NB, Chandler JC, Couture F, Keogh G, Goss G, Daniel DB, Garon EB, Schwartzberg LS, Sen R, Korytowsky B, Li A, Aanur N, Hussein MA. Safety, Efficacy, and Patient-Reported Health-Related Quality of Life and Symptom Burden with Nivolumab in Patients with Advanced Non-Small Cell Lung Cancer, Including Patients Aged 70 Years or Older or with Poor Performance Status (CheckMate 153). J Thorac Oncol 2019; 14:1628-1639. [PMID: 31121324 DOI: 10.1016/j.jtho.2019.05.010] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [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: 02/14/2019] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION CheckMate 153 (NCT02066636) is a phase 3B/4 study assessing nivolumab in previously treated patients with advanced NSCLC. Eligibility criteria allowed enrollment of patients with poor prognostic features of advanced age or diminished Eastern Cooperative Oncology Group performance status (ECOG PS), which are typically underrepresented in or excluded from randomized controlled trials. METHODS Patients with stage IIIB or IV NSCLC and an ECOG PS of 0 to 2 with disease progression after at least one systemic therapy received nivolumab (3 mg/kg every 2 weeks) until progression, unacceptable toxicity, or consent withdrawal. The primary end point was the incidence of grade 3 to 5 select treatment-related adverse events (TRAEs). RESULTS Among 1426 treated patients, 556 (39%) were aged 70 years or older and 128 (9%) had an ECOG PS of 2. The median treatment duration was 3.2 months. Across subgroups and the overall population, the incidences of select grade 3 to 5 TRAEs (6%-9%) and grade 3 or 4 TRAEs (12%-14%) were similar. One grade 5 TRAE was documented. The median overall survival time was comparable in the overall population (9.1 months) and patients aged 70 years or older (10.3 months) but shorter in patients with an ECOG PS of 2 (4.0 months). Patient-reported outcomes generally improved. CONCLUSIONS Data from this large predominantly community-based study, which included patients aged 70 years or older and with an ECOG PS of 2, are consistent with registrational studies. As expected, the median overall survival for patients with an ECOG PS of 2 was lower than for the overall population but comparable with historical data.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, Tennessee.
| | - Michael McCleod
- Sarah Cannon Research Institute/Florida Cancer Specialists, Fort Myers, Florida
| | - Robert M Jotte
- Rocky Mountain Cancer Centers, Denver, Colorado; US Oncology Research, Houston, Texas
| | | | - Leora Horn
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Sunil Babu
- Fort Wayne Medical Oncology and Hematology, Fort Wayne, Indiana
| | - Natasha B Leighl
- The Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | | | - George Keogh
- Charleston Hematology Oncology Associates, Charleston, South Carolina
| | - Glenwood Goss
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Edward B Garon
- Translational Research In Oncology-US, Inc. (TRIO-US), Los Angeles, California
| | | | | | | | - Ang Li
- Bristol-Myers Squibb, Princeton, New Jersey
| | | | - Maen A Hussein
- Sarah Cannon Research Institute/Florida Cancer Specialists, Leesburg, Florida
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15
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Gray JE, Villegas AE, Daniel DB, Vicente D, Murakami S, Hui R, Kurata T, Chiappori A, Lee KH, Cho BC, Planchard D, Paz-Ares LG, Faivre-Finn C, Vansteenkiste JF, Spigel DR, Wadsworth C, Taboada M, Dennis PA, Ozguroglu M, Antonia SJ. Three-year overall survival update from the PACIFIC trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8526] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8526 Background: In the phase 3 PACIFIC study of patients with unresectable, Stage III NSCLC without progression after chemoradiotherapy (CRT), durvalumab demonstrated significant improvements versus placebo in the primary endpoints of progression-free survival (HR, 0.52; 95% CI, 0.42–65; P < 0.0001) and overall survival (OS; HR, 0.68; 95% CI, 0.53–0.87; P = 0.00251). Safety was similar and durvalumab had no detrimental effect on patient-reported outcomes. Here, we report 3-year OS rates for all patients randomized in the PACIFIC study. Methods: Patients with WHO PS 0/1 (any tumor PD-L1 status) who received ≥2 cycles of platinum-based CRT were randomized (2:1), 1–42 days following CRT, to receive durvalumab 10 mg/kg intravenously every 2 weeks or placebo, up to 12 months, and stratified by age, sex, and smoking history. OS was analyzed using a stratified log-rank test in the ITT population. Medians and OS rates at 12, 24 and 36 months were estimated by Kaplan-Meier method. Results: In total, 713 patients were randomized of whom 709 received treatment (durvalumab, n = 473; placebo, n = 236). The last patient had completed the protocol-defined 12 months of study treatment in May 2017. As of January 31, 2019 (data cutoff), 48.2% of patients had died (44.1% and 56.5% in the durvalumab and placebo groups, respectively). The median duration of follow-up was 33.3 months (range, 0.2–51.3). Updated OS remained consistent with that previously reported (stratified HR 0.69, 95% CI, 0.55–0.86), with the median not reached (NR; 95% CI, 38.4 months–NR) with durvalumab versus 29.1 months (95% CI, 22.1–35.1) with placebo. The 12-, 24- and 36-month OS rates with durvalumab and placebo were 83.1% versus 74.6%, 66.3% versus 55.3%, and 57.0% versus 43.5%, respectively. After discontinuation, 43.3% and 57.8% in the durvalumab and placebo groups, respectively, received subsequent anticancer therapy (9.7% and 26.6% subsequently received immunotherapy). OS subgroup results will be presented. Conclusions: Updated OS data from PACIFIC, including 3-year survival rates, underscore the long-term clinical benefit with durvalumab following CRT and further establish the PACIFIC regimen as the standard of care in this population. Clinical trial information: NCT02125461.
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Affiliation(s)
| | | | - Davey B. Daniel
- Medical Oncology, Tennessee Oncology and Sarah Cannon Research Institute (Nashville), Chattanooga, TN
| | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Rina Hui
- Westmead Hospital and the University of Sydney, Sydney, NSW, Australia
| | | | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Luis G. Paz-Ares
- Hospital Universitario 12 de Octubre, CiberOnc, Universidad Complutense and CNIO, Madrid, Spain
| | - Corinne Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | | | - Mustafa Ozguroglu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
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16
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Flinn IW, Erter J, Daniel DB, Mace JR, Berdeja JG. Phase II Study of Bendamustine and Ofatumumab in Elderly Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma Who Are Poor Candidates for R-CHOP Chemotherapy. Oncologist 2019; 24:1035-e623. [PMID: 31073022 PMCID: PMC6693706 DOI: 10.1634/theoncologist.2019-0286] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/06/2019] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. The combination of ofatumumab and bendamustine in elderly patients with diffuse large B‐cell lymphoma demonstrated modest efficacy compared with standard of care. The poor response may have been due to patient age and the high rate of treatment discontinuation.
Background. This phase II trial evaluated the efficacy of bendamustine and ofatumumab in elderly patients with newly diagnosed diffuse large B‐cell lymphoma (DLBCL) who were not candidates for rituximab cyclophosphamide, doxorubicin, vincristine, and prednisone (R‐CHOP). Methods. Patients received IV 90 mg/m2 bendamustine on days 1 and 2 of cycles 1 through 6 and IV 1,000 mg ofatumumab on days 1 and 8 of cycle 1 and on day 1 of cycles 2 through 6. Both drugs were administered at the U.S. Food and Drug Administration‐approved dose for combination therapy. All patients received premedications before each infusion of ofatumumab and hematopoietic growth factors. Treatment was administered in 21‐day cycles, with restaging after cycle 3 and cycle 6. The primary endpoint was complete response rate (CRR). Results. Twelve of 21 enrolled patients completed treatment; median age was 83 years. The most common reasons for treatment discontinuation were disease progression (three patients), intercurrent illness (two patients), and death (one patient due to drug‐related sepsis and bowel necrosis and one patient due to unknown cause). Thrombocytopenia (14%), neutropenia (10%), diarrhea (10%), vomiting (10%), and dehydration (10%) were the most common grade ≥3 treatment‐related adverse events. The overall response rate was 90.5% and the CRR was 33.3%. Median progression‐free survival (PFS) and overall survival (OS) were 8.6 and 12.0 months, respectively. Conclusion. The combination of ofatumumab and bendamustine is feasible in elderly patients with DLBCL.
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MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/standards
- Bendamustine Hydrochloride/administration & dosage
- Bendamustine Hydrochloride/adverse effects
- Cyclophosphamide/adverse effects
- Disease Progression
- Disease-Free Survival
- Doxorubicin/adverse effects
- Drug Administration Schedule
- Feasibility Studies
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Male
- Prednisone/adverse effects
- Rituximab/adverse effects
- Standard of Care
- Vincristine/adverse effects
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Affiliation(s)
- Ian W Flinn
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
| | - Jack Erter
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
| | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
| | - Joseph R Mace
- Florida Cancer Specialists, St. Petersburg, Florida, USA
| | - Jesus G Berdeja
- Sarah Cannon Research Institute, Nashville, Tennessee, USA
- Tennessee Oncology, PLLC, Nashville, Tennesse, USA
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17
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Leighl NB, Page RD, Raymond VM, Daniel DB, Divers SG, Reckamp KL, Villalona-Calero MA, Dix D, Odegaard JI, Lanman RB, Papadimitrakopoulou VA. Clinical Utility of Comprehensive Cell-free DNA Analysis to Identify Genomic Biomarkers in Patients with Newly Diagnosed Metastatic Non–small Cell Lung Cancer. Clin Cancer Res 2019; 25:4691-4700. [DOI: 10.1158/1078-0432.ccr-19-0624] [Citation(s) in RCA: 279] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/31/2019] [Accepted: 04/11/2019] [Indexed: 11/16/2022]
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18
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McKenzie A, Dilks HH, Jones SF, Daniel DB, Arrowsmith E, Tucker K, Spigel DR, Burris HA. Impact of a community-based molecular cancer conference on physician practice and clinical care. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - David R. Spigel
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN
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19
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Dilks HH, McKenzie A, Jones SF, Daniel DB, Arrowsmith E, Stipanov MA, Anz BM, Johnson D, Tran A, Nadeau BR, Krueger SL, Daniel BR, Holland DW, Tucker K, Correll M, Spigel DR, Burris HA. Identifying and interpreting actionable molecular alterations from next-generation sequencing results in the community: A Sarah Cannon molecular cancer conference. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.6601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David R. Spigel
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN
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20
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Spigel DR, Burris HA, Greco FA, Shih KC, Gian VG, Lipman AJ, Daniel DB, Waterhouse DM, Finney L, Heymach JV, Hainsworth JD. Erlotinib plus either pazopanib or placebo in patients with previously treated advanced non-small cell lung cancer: A randomized, placebo-controlled phase 2 trial with correlated serum proteomic signatures. Cancer 2018; 124:2355-2364. [PMID: 29645086 DOI: 10.1002/cncr.31290] [Citation(s) in RCA: 9] [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: 08/09/2017] [Revised: 11/06/2017] [Accepted: 11/14/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study compared the efficacy and safety of treatment with erlotinib plus pazopanib versus erlotinib plus placebo in patients with previously treated advanced non-small cell lung cancer (NSCLC). METHODS Patients with progressive-stage IV NSCLC after either 1 or 2 previous chemotherapy regimens were randomized to receive erlotinib (150 mg by mouth daily) with either pazopanib (600 mg by mouth daily) or placebo. During treatment, patients were evaluated every 8 weeks until disease progression or unacceptable toxicity. After a study amendment, pretreatment serum specimens for the VeriStrat assay were collected. The predictive value of the VeriStrat score (good vs poor) for progression-free survival (PFS) and overall survival (OS) was assessed in the overall population and in each treatment group. RESULTS One hundred ninety-two eligible patients were randomized between February 2010 and February 2011. PFS was prolonged with erlotinib plus pazopanib versus erlotinib plus placebo (median, 2.6 vs 1.8 months; hazard ratio, 0.58; P = .001). There was no difference in the OS of the 2 groups. A good VeriStrat score predicted longer PFS and OS in the entire group and predicted longer PFS in the subgroup receiving erlotinib plus pazopanib. The addition of pazopanib increased toxicity, and this was consistent with the known toxicity profile. CONCLUSIONS The addition of pazopanib to erlotinib in an unselected group of patients with previously treated NSCLC improved PFS and increased treatment-related toxicity, but it had no influence on OS. The efficacy of both regimens was modest. Patients receiving erlotinib plus pazopanib had longer PFS if they had a good VeriStrat score versus a poor one. Cancer 2018;124:2355-64. © 2018 American Cancer Society.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - F Anthony Greco
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Kent C Shih
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Victor G Gian
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
| | - Andrew J Lipman
- Sarah Cannon Research Institute, Nashville, Tennessee.,Florida Cancer Specialists, Naples, Florida
| | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Chattanooga, Tennessee
| | | | | | - John V Heymach
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John D Hainsworth
- Sarah Cannon Research Institute, Nashville, Tennessee.,Tennessee Oncology, Nashville, Tennessee
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Spigel DR, Hainsworth JD, Shipley DL, Mekhail TM, Zubkus JD, Waterhouse DM, Daniel DB, Burris HA, Greco FA. Amrubicin and carboplatin with pegfilgrastim in patients with extensive stage small cell lung cancer: A phase II trial of the Sarah Cannon Oncology Research Consortium. Lung Cancer 2018; 117:38-43. [PMID: 29496254 DOI: 10.1016/j.lungcan.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE First-line treatment for patients with extensive-stage small cell lung cancer (SCLC) includes treatment with platinum-based combination chemotherapy. Amrubicin is a synthetic anthracycline with single-agent activity in relapsed/refractory SCLC. In an attempt to improve treatment efficacy, we evaluated amrubicin/carboplatin as first-line therapy for extensive-stage SCLC. PATIENTS AND METHODS In this multicenter phase II trial, patients received amrubicin (30 mg/m2 daily on Days 1, 2, and 3) and carboplatin (AUC = 5 on Day 1); cycles were repeated every 21 days for 4 cycles. Pegfilgrastim (6 mg subcutaneously) was administered on Day 4 of all cycles. Overall survival (OS) proportion at 1 year was the primary endpoint. The target 1-year OS rate was 47%, an improvement of 35% from historical results with carboplatin/etoposide. RESULTS Eighty patients received study treatment, and 62% completed the planned 4 courses. The overall response rate was 74% (13% complete responses). The 1-year survival rate was 38% (95% CI: 25, 50). The median survival was 10 months. Myelosuppression was severe but manageable. CONCLUSIONS The combination of amrubicin/carboplatin was an active first-line treatment for extensive stage SCLC, but showed no indication of increased efficacy compared to standard treatments. Severe myelosuppression was common with this regimen, in spite of prophylactic pegfilgrastim. These results are consistent with those of other trials in showing no role for amrubicin in the first-line treatment of SCLC.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | | | - Dianna L Shipley
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | | | - John D Zubkus
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | | | - Davey B Daniel
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Chattanooga Oncology Hematology Associates, Chattanooga, TN, 37404, USA.
| | - Howard A Burris
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
| | - F Anthony Greco
- Sarah Cannon Research Institute, Nashville, TN, 37203, USA; Tennessee Oncology, PLLC, Nashville, TN, 37203, USA.
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Spigel DR, Ervin TJ, Ramlau RA, Daniel DB, Goldschmidt JH, Blumenschein GR, Krzakowski MJ, Robinet G, Godbert B, Barlesi F, Govindan R, Patel T, Orlov SV, Wertheim MS, Yu W, Zha J, Yauch RL, Patel PH, Phan SC, Peterson AC. Randomized phase II trial of Onartuzumab in combination with erlotinib in patients with advanced non-small-cell lung cancer. J Clin Oncol 2013; 31:4105-14. [PMID: 24101053 DOI: 10.1200/jco.2012.47.4189] [Citation(s) in RCA: 382] [Impact Index Per Article: 34.7] [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 Increased hepatocyte growth factor/MET signaling is associated with poor prognosis and acquired resistance to epidermal growth factor receptor (EGFR) -targeted drugs in patients with non-small-cell lung cancer (NSCLC). We investigated whether dual inhibition of MET/EGFR results in clinical benefit in patients with NSCLC. PATIENTS AND METHODS Patients with recurrent NSCLC were randomly assigned at a ratio of one to one to receive onartuzumab plus erlotinib or placebo plus erlotinib; crossover was allowed at progression. Tumor tissue was required to assess MET status by immunohistochemistry (IHC). Coprimary end points were progression-free survival (PFS) in the intent-to-treat (ITT) and MET-positive (MET IHC diagnostic positive) populations; additional end points included overall survival (OS), objective response rate, and safety. RESULTS There was no improvement in PFS or OS in the ITT population (n = 137; PFS hazard ratio [HR], 1.09; P = .69; OS HR, 0.80; P = .34). MET-positive patients (n = 66) treated with erlotinib plus onartuzumab showed improvement in both PFS (HR, .53; P = .04) and OS (HR, .37; P = .002). Conversely, clinical outcomes were worse in MET-negative patients treated with onartuzumab plus erlotinib (n = 62; PFS HR, 1.82; P = .05; OS HR, 1.78; P = .16). MET-positive control patients had worse outcomes versus MET-negative control patients (n = 62; PFS HR, 1.71; P = .06; OS HR, 2.61; P = .004). Incidence of peripheral edema was increased in onartuzumab-treated patients. CONCLUSION Onartuzumab plus erlotinib was associated with improved PFS and OS in the MET-positive population. These results combined with the worse outcomes observed in MET-negative patients treated with onartuzumab highlight the importance of diagnostic testing in drug development.
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Affiliation(s)
- David R Spigel
- David R. Spigel, Thomas J. Ervin, and Davey B. Daniel, Sarah Cannon Research Institute; David R. Spigel, Tennessee Oncology, Nashville; Davey B. Daniel, Chattanooga Oncology Hematology Associates, Chattanooga, TN; Thomas J. Ervin, Florida Cancer Specialists, Fort Myers; Michael S. Wertheim, Hematology/Oncology Associates, Port St Lucie, FL; Rodryg A. Ramlau, Poznan University of Medical Sciences, Poznan; Maciej J. Krzakowski, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Jerome H. Goldschmidt Jr, Blue Ridge Cancer Care, Christianburg, VA; George R. Blumenschein Jr, The University of Texas MD Anderson Cancer Center, Houston, TX; Gilles Robinet, University Hospital Morvan, Brest; Benoit Godbert, Centre Hospitalier Universitaire Nancy, Vandoeuvre-lès-Nancy; Fabrice Barlesi, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France; Ramaswamy Govindan, Washington University School of Medicine, St Louis, MO; Taral Patel, Mid Ohio Oncology/Hematology, Columbus, OH; Sergey V. Orlov, St Petersburg Pavlov State Medical University, St Petersburg, Russia; Wei Yu, Robert L. Yauch, Premal H. Patel, and See-Chun Phan, Genentech; Amy C. Peterson, Medivation, San Francisco, CA; and Jiping Zha, Crown Bioscience, Taicang City, China
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Waterhouse DM, Stults DM, Daniel DB, Griner PL, Greco FA, Burris HA, Hainsworth JD, Spigel DR. KRAS subset analysis from randomized phase II trials of erlotinib versus erlotinib plus sorafenib or pazopanib in refractory non-small cell lung cancer (NSCLC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8091] [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
8091 Background: KRAS mutations are among the most common genetic alterations in NSCLC; however no targeted therapies have been approved to benefit this lung cancer subset. Between 2/2008 and 2/2011 our center conducted two consecutive multicenter randomized phase II trials in patients (pts) with refractory NSCLC comparing erlotinib/placebo versus erlotinib + either sorafenib or pazopanib, both oral multikinase inhibitors (Spigel et al, JCO 2011; Chicago MSTO 2012). Progression-free survival (PFS) was improved with the multikinase regimens in the EGFR wild-type (WT) subsets, but not in the overall populations. An unplanned analysis of the combined KRAS subset data is the subject of this report. Methods: Eligibility criteria for both trials included: stage IIIB/IV NSCLC; 1 to 2 prior regimens; ECOG performance status 0–2; measurable disease. PFS was the primary endpoint of each trial. Treatment groups included: erlotinib/placebo (N=121), erlotinib/sorafenib (N=112), and erlotinib/pazopanib (N=127). 168 pts (47%) in these three groups had sufficient tumor specimens for KRAS analysis. Results: The PFS and OS results based on KRAS results are shown in the Table below. Conclusions: Patients in whom the KRAS mutation status was known achieved a significantly longer PFS with erlotinib and a multikinase inhibitor than with erlotinib alone. Although this unplanned combined analysis has several limitations, the greater PFS and OS benefits in pts with KRAS mutations warrant further study. Clinical trial information: NCT00600015; NCT01027598. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Howard A. Burris
- Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN
| | | | - David R. Spigel
- Sarah Cannon Research Institute; Tennessee Oncology, Nashville, TN
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Shipley D, Hainsworth JD, Mekhail T, Zubkus JD, Flora DB, Daniel DB, Waterhouse DM, Gravenor D, Burris HA, Greco FA, Spigel DR. Amrubicin and carboplatin with pegfilgrastim in patients with extensive-stage small-cell lung cancer (ES-SCLC): A phase II study of the Sarah Cannon Research Institute (SCRI). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7100] [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
7100 Background: Amrubicin is a novel anthracycline associated with high objective response rates (ORR) in patients (pts) with relapsed SCLC. Amrubicin improved the ORR and progression-free survival (PFS) in relapsed SCLC vs. topotecan, but not overall survival (OS) in a phase III study. Amrubicin with cisplatin/carboplatin for elderly Japanese pts was safe and active. We conducted a multicenter phase II study evaluating amrubicin and carboplatin in newly diagnosed ES-SCLC. Methods: Eligible pts had untreated ES-SCLC, measurable/evaluable disease (RECIST v. 1.1) and an ECOG PS <2. Pts received 4 cycles of amrubicin 30 mg/m2 on days 1-3 and carboplatin AUC=5 both IV day 1 every 21 days with restaging every 6 weeks. Pegfilgrastim 6 mg sq was administered on day 4 of each cycle. The primary endpoint was 1-year OS. Secondary endpoints included ORR, PFS, OS, and toxicity. Results: 78 pts were enrolled from 3/2010 to 7/2011. Baseline characteristics included: median age 65 yrs (range 45-84); 56% female. 64% completed 4 cycles of treatment. Eleven (14%) pts showed complete responses and 47 (60%) pts partial responses, for an ORR of 74% (95% confidence interval 65%-82%). Twelve (15%) pts had stable disease. Median PFS and OS were 5.3 and 9.5 months, respectively. The 1-year OS was 36%. Grade 3/4 myelosuppression was the most common toxicity (thrombocytopenia 44%, neutropenia 34%, febrile neutropenia 12%, anemia 26%), but was manageable. Severe non-hematologic toxicities (>5%) included hypokalemia 17%, fatigue 13%, dehydration 10%, hyponatremia 10%, pneumonia 9%, and nausea/vomiting 8%. 1 pt died from sepsis and another from aspiration pneumonia. Conclusions: First-line ES-SCLC treatment with amrubicin and carboplatin induced several complete responses and is considered highly active. Myelosuppression was managed effectively with growth factor support. These results are comparable to historical data with platinum-doublet chemotherapy. A larger randomized study would be required to best assess this regimen’s impact on survival.
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Affiliation(s)
- Dianna Shipley
- Tennessee Oncology, PLLC/Sarah Cannon Research Institute, Nashville, TN
| | | | | | - John D. Zubkus
- Tennessee Oncology, PLLC/Sarah Cannon Research Institute, Nashville, TN
| | | | - Davey B. Daniel
- Chattanooga Oncology Hematology Associates/SCRI, Chattanooga, TN
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Waterhouse DM, Hainsworth JD, Greco FA, Barnes EK, Lobo CF, Gian V, Joseph MJ, Peyton JD, Huh SY, Daniel DB, Quinn R, Burris HA, Spigel DR. Adjuvant carboplatin, docetaxel, bevacizumab, and erlotinib versus chemotherapy alone in patients with resected non-small cell lung cancer: A randomized phase II study of the Sarah Cannon Research Institute (SCRI). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.7035] [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
7035 Background: Adjuvant chemotherapy improves overall survival (OS) in patients (pts) with resected non small cell lung cancer (NSCLC). Bevacizumab and erlotinib improve survival in pts with advanced unresectable NSCLC. This randomized phase II multicenter pilot study examined the safety and efficacy of chemotherapy and bevacizumab followed by bevacizumab and erlotinib vs. chemotherapy alone in pts with resected NSCLC. Methods: Eligible pts had completely resected (R0) stage IB, II, or IIIA NSCLC (TNM 6th Ed.), any NSCLC histology, and an ECOG PS 0-1. Pts were excluded for preoperatively confirmed N2 disease; N2 disease found at surgery was allowed. Pts were randomized 1:1 to carboplatin AUC=5, docetaxel 60 mg/m2, and bevacizumab 15 mg/kg IV d1 q 21 days x 4, followed by maintenance bevacizumab 15 mg/kg d1 and erlotinib 150 mg PO daily x 8 cycles (Arm A) or carboplatin AUC=6 and docetaxel 75 mg/m2 IV d1 q 21 days x 4 (Arm B). The primary endpoint was 1-year disease-free survival (DFS); safety, 2-year DFS, and OS were secondary endpoints. Results: 106 pts were enrolled from 2/2008 to trial closure 1/2012 (A=54; B=52). Baseline features were balanced: age 63 yrs (42–87); 54% male; IB (46%), IIA (8%), IIB (27%), IIIA (18%); adenocarcinoma (61%), squamous (31%). Arm A received a median of 7 cycles (1-12); Arm B 4 cycles (1-4). 1- and 2-year DFS by stage are shown in the table. The 1-year DFS for all stages were 78% (A) and 88% (B) (p=.66). The 3-year OS for all stages were 81% (A) and 63% (B). Neutropenia was the most common grade 3/4 hematologic toxicity (A 18%; B 29%). Severe non-hematologic toxicity was rare: fatigue (A 6%), diarrhea (B 6%). Bronchopleural fistulae occurred in 2 pts (1 per arm), and grade 3 gastrointestinal hemorrhage was seen in 1 pt (A). Conclusions: This pilot study demonstrated that bevacizumab and erlotinib could be safely added to platinum-doublet chemotherapy in the adjuvant setting in all histologies. Larger randomized studies will best define the roles of these agents in pts with resectable NSCLC. [Table: see text]
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Affiliation(s)
| | | | | | - Edward K. Barnes
- Tennessee Oncology, PLLC/Sarah Cannon Research Institute, Nashville, TN
| | | | - Victor Gian
- Tennessee Oncology, PLLC/Sarah Cannon Research Institute, Nashville, TN
| | | | - James D. Peyton
- Tennessee Oncology, PLLC/Sarah Cannon Research Institute, Nashville, TN
| | | | - Davey B. Daniel
- Chattanooga Oncology Hematology Associates/SCRI, Chattanooga, TN
| | - Raven Quinn
- Sarah Cannon Research Institute, Nashville, TN
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Spigel DR, Burris HA, Greco FA, Shipley DL, Friedman EK, Waterhouse DM, Whorf RC, Mitchell RB, Daniel DB, Zangmeister J, Bass JD, Hainsworth JD. Randomized, double-blind, placebo-controlled, phase II trial of sorafenib and erlotinib or erlotinib alone in previously treated advanced non-small-cell lung cancer. J Clin Oncol 2011; 29:2582-9. [PMID: 21576636 DOI: 10.1200/jco.2010.30.7678] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [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
PURPOSE Sorafenib, an oral multikinase inhibitor, has shown preliminary activity in non-small-cell lung cancer (NSCLC). Patients with advanced NSCLC were treated with erlotinib with or without sorafenib in this multicenter phase II trial. PATIENTS AND METHODS Key eligibility criteria included the following: stage IIIB or IV NSCLC; one to two prior regimens; Eastern Cooperative Oncology Group performance status of 0 to 2; and measurable disease. Patients were randomly assigned 2:1 to sorafenib (400 mg orally twice a day) plus erlotinib (150 mg orally daily) or placebo plus erlotinib and stratified by squamous/nonsquamous histology and prior bevacizumab. Treatment efficacy, measured by progression-free survival (PFS) and overall response rate (ORR), was compared. Treatment of 168 patients allowed detection of 40% improvement in the historical PFS of 2.2 months with single-agent erlotinib. RESULTS One hundred sixty-eight patients enrolled from February 2008 to February 2009. Clinical characteristics of the two groups were similar. ORRs for sorafenib/erlotinib and placebo/erlotinib were 8% and 11%, respectively (P = .56); disease control rates were 54% and 38%, respectively (P = .056). Median PFS was 3.38 months for sorafenib/erlotinib versus 1.94 months for placebo/erlotinib (hazard ratio, 0.86; 95% CI, 0.60 to 1.22; P = .196). Seventy-two patients consented to analyses of tumor epidermal growth factor receptor (EGFR). In 67 patients with EGFR wild-type (WT) tumors, median PFS was 3.38 months for sorafenib/erlotinib versus 1.77 months for placebo/erlotinib (P = .018); median overall survival (OS) was 8 months for sorafenib/erlotinib versus 4.5 months for placebo/erlotinib (P = .019). An OS advantage for sorafenib/erlotinib was suggested among 43 patients with fluorescent in situ hybridization (FISH) EGFR-negative tumors (P = .064). Both regimens were tolerable, with modest toxicity increase with sorafenib. CONCLUSION Although there was little difference in ORR or PFS, subset analyses in EGFR WT and EGFR FISH-negative patients suggest a benefit for the combination of erlotinib/sorafenib compared with single-agent erlotinib with respect to PFS and OS.
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Affiliation(s)
- David R Spigel
- Sarah Cannon Research Institute, 250 25th Ave North, Ste 110, Nashville, TN 37203, USA.
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Spigel DR, Burris HA, Greco FA, Shipley DL, Friedman EK, Waterhouse DM, Whorf RC, Mitchell RB, Daniel DB, Zangmeister J, Hainsworth JD. Abstract LB-77: A randomized double-blind placebo-controlled phase II trial of sorafenib and erlotinib or erlotinib alone in previously treated advanced non-small cell lung cancer: Correlative analyses. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-lb-77] [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: Sorafenib is an oral multikinase inhibitor of angiogenesis and cellular proliferation which has shown preliminary activity in non-small-cell lung cancer (NSCLC). We conducted a multicenter phase II trial of erlotinib +/− sorafenib in 2nd/3rd line NSCLC.
Methods: Patients with previously treated stage IIIB/IV NSCLC were eligible (1-2 prior regimens). Additional eligibility criteria included: ECOG performance status 0-2, all NSCLC histologies, measurable disease, adequate organ function, and the absence of major cardiovascular disease. Patients with treated brain metastases and/or on stable anticoagulation were eligible. Patients were stratified according to squamous/non-squamous histology, prior bevacizumab use, and line of therapy and were randomized 2:1 to receive erlotinib 150mg orally once daily and sorafenib 400mg orally twice daily, or erlotinib and placebo. Patients were also consented for biomarker testing for epidermal growth factor receptor (EGFR) mutations, EGFR amplification, and K-ras mutations. The primary endpoint was to assess the efficacy of each arm in terms of objective response rate (ORR) and progression-free survival (PFS). The trial was designed to enroll 168 patients to demonstrate a 40% improvement on an historical 2.2 month PFS (> 80%, 1-sided 0.1).
Results: 168 patients were enrolled from February 2008 to February 2009. Baseline characteristics were well-matched between cohorts (median age, 65 years; 3rd line therapy, 39%; prior bevacizumab, 36%; squamous histology, 30%). The ORRs for the sorafenib/erlotinib and erlotinib/placebo cohorts were 8.1% v. 10.9%, respectively (p=.55). However, the disease control rates (ORR + proportion of patients with stable disease) were 54.1% (sorafenib/erlotinib) v. 38.2% (erlotinib/placebo) (p=.06). The median PFS was 3.25 months (sorafenib/erlotinib) v. 1.87 months (erlotinib/placebo) (HR 0.86 [95% CI 0.60, 1.22], p=.20). 72 (44%) patients had material assessable for EGFR mutation analysis. Among the 67 patients who were found to have EGFR wild-type (WT) tumors, the median PFS was 3.25 months (sorafenib/erlotinib) v. 1.71 months (erlotinib/placebo) (HR 0.55 [95% CI 0.32, 0.96], p=.02).
Conclusions: Additional preplanned subset analyses based on histology, EGFR amplification, K-ras mutation, prior bevacizumab treatment, and line of therapy will be presented, as well as updated overall response, PFS, survival, and toxicity data.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-77.
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Affiliation(s)
- David R. Spigel
- 1Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN
| | - Howard A. Burris
- 1Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN
| | - F. Anthony Greco
- 1Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN
| | | | | | | | | | | | - Davey B. Daniel
- 6Chattanooga Oncology and Hematology Associates, PC, Chattanooga, TN
| | | | - John D. Hainsworth
- 1Sarah Cannon Research Institute; Tennessee Oncology, PLLC, Nashville, TN
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Reed SD, Radeva JI, Daniel DB, Mody SH, Forlenza JB, McKenzie RS, Schulman KA. Economic evaluation of weekly epoetin alfa versus biweekly darbepoetin alfa for chemotherapy-induced anaemia: evidence from a 16-week randomised trial. Pharmacoeconomics 2006; 24:479-94. [PMID: 16706573 DOI: 10.2165/00019053-200624050-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION A 16-week, open-label, multicentre, randomised trial of weekly epoetin alfa 40 000 units versus biweekly darbepoetin alfa 200microg among 358 patients with solid-tumour cancers and chemotherapy-induced anaemia demonstrated superior haematological outcomes with epoetin alfa. We sought to compare resource use, costs and clinical outcomes between treatment groups and report the results using a cost-consequences framework. METHODS Pre-specified methods were used to assign costs (US dollars, year 2004-5 values) to medical resources and patient time using a societal perspective. Costs for inpatient care, outpatient care and physician services were based on US Medicare reimbursement rates. Indirect costs assigned to patient time spent receiving study medication were based on the mean hourly wage in the US. In the base-case analysis, the average wholesale price was used to assign costs to medications. Clinical outcomes included all haemoglobin levels and transfusions recorded throughout the trial. Sensitivity analyses were performed to evaluate the impact of different costing methods, cost sources, perspectives and methods to assign haemoglobin values following a blood transfusion. RESULTS Over a mean follow-up duration of 11.8 weeks, the average cost of study medications and their administration was the single largest component of total costs and was similar between groups (epoetin alfa 5979 US dollars and darbepoetin alfa 5935 US dollars, difference 44 US dollars; 95% CI -590, 692). There were no significant differences in the proportions of patients hospitalised (epoetin alfa 24.6%, darbepoetin alfa 22.0%; p = 0.57). Patients randomised to epoetin alfa experienced more inpatient days, on average, than patients randomised to darbepoetin alfa (2.6 vs 1.6, 95% CI for the difference, 0.07, 2.27). However, with regard to transfusions, patients in the epoetin alfa arm required fewer units of blood than patients in the darbepoetin alfa arm (0.46 vs 0.88, 95% CI for the difference -0.77, -0.08). Mean total costs, comprising costs for study medications and their administration, inpatient care, transfusions, unplanned radiation therapy, haematology and laboratory services, chemotherapy and non-chemotherapy drugs and indirect costs were 14,976 US dollars in the epoetin alfa arm compared with 14,101 US dollars in the darbepoetin alfa arm, a difference of 875 US dollars (95% CI for difference -849, 2607), of which 98% of the difference was attributable to higher inpatient costs in the epoetin alfa arm (2374 US dollars vs 1520 US dollars; 95% CI for difference -33, 1955). Assessments of multiple clinical measures demonstrated improved outcomes with epoetin alfa relative to darbepoetin alfa. CONCLUSION Most clinical outcome measures suggested greater improvement with epoetin alfa relative to darbepoetin alfa, but most costs for both agents appeared similar. Decision makers must evaluate the differences in costs and efficacy measures that are most relevant from their perspectives.
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Affiliation(s)
- Shelby D Reed
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina 27715, USA
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Daniel DB, Crawford J. Shifting guidelines for myeloid growth factors: applications in cancer chemotherapy. Curr Hematol Rep 2005; 4:441-5. [PMID: 16232380] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Neutropenia is a frequent dose-limiting complication of chemotherapy. Although myeloid growth factors decrease the risk of febrile neutropenia and the resulting complications of hospitalizations, dose delays, and dose reductions, not all patients need or benefit from the prophylactic administration of myeloid growth factors. A recent risk model showed that the predictors of febrile neutropenia include anthracycline use, poor performance status, and low pretreatment blood counts. These predictors may be used in addition to the intensity of the chosen chemotherapy regimen to determine whether a patient warrants primary prophylaxis with myeloid growth factors. The 2005 guidelines of the National Comprehensive Cancer Network call for primary prophylactic use in all patients with a risk of febrile neutropenia above 20%. Other recent studies show that pegylated filgrastim is also effective at preventing febrile neutropenia in patients receiving intermediate- risk chemotherapy.
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Affiliation(s)
- Davey B Daniel
- Division of Medical Oncology, Duke University Medical Center, Box 3476, Durham, NC 27710, USA
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Reed SD, Radeva JI, Daniel DB, Fastenau JM, Williams D, Schulman KA. Early hemoglobin response and alternative metrics of efficacy with erythropoietic agents for chemotherapy-related anemia. Curr Med Res Opin 2005; 21:1527-33. [PMID: 16238892 DOI: 10.1185/030079905x65394] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine associations between early hemoglobin response and alternative measures of efficacy following treatment with an erythropoietic agent for chemotherapy-related anemia. RESEARCH DESIGN AND METHODS Preliminary data from an ongoing randomized, multicenter, 16-week, open-label clinical trial of epoetin alfa versus darbepoetin alfa were used to dichotomize patients based on attainment of early hemoglobin response (> or = 1 g/dL increase in hemoglobin level within 4 weeks of treatment initiation). Measures of efficacy were compared between patients with early hemoglobin response and those without. Sensitivity analyses were then performed to evaluate the impact of various methods for handling censored data and hemoglobin values following blood transfusion. MAIN OUTCOME MEASURES Efficacy measures included: the proportion of patients with a > or = 1 g/dL increase in hemoglobin by 4 weeks or a > or = 2 g/dL increase by 8 weeks; mean hemoglobin levels at 4, 8, 12, and 16 weeks; area under the curve for change in hemoglobin level; proportion of patients who required a blood transfusion after 4 weeks; proportion of follow-up days on which patients had hemoglobin levels within the therapeutic range of 11 g/dL to 13 g/dL; and proportion of patients who never had a hemoglobin level within this range. RESULTS A total of 274 patients were included (66.1% female, mean age 62.4), of whom 48.9% had an early hemoglobin response and 51.1% did not. Mean duration of follow-up was 10.1 +/- 5.05 weeks. All metrics indicated superior longer-term response among patients with early hemoglobin response compared to patients without early response. The findings were robust across sensitivity analyses. Although the analysis establishes a significant relationship between early hemoglobin response and alternative efficacy metrics, causality cannot be inferred. CONCLUSIONS Early hemoglobin response is significantly associated with various metrics of clinical response to erythropoietic agents and is an appropriate measure for evaluating treatment effects.
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Affiliation(s)
- Shelby D Reed
- Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, North Carolina 27715, USA
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Abstract
The present study investigated recent reports of sex differences on the Stroop Color-Word Test by age. Present results indicate no sex differences at 7-8 years, 9-10 years, and 18-24 years. The two school-age samples reported similar amounts of interference and significantly more than the college-age sample. Inconsistencies in the literature may be a function of response modality rather than interference.
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Affiliation(s)
- D B Daniel
- Department of Psychology, University of Maine at Farmington 04938, USA.
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