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Clark AS, Hong F, Finn RS, DeMichele AM, Mitchell EP, Zwiebel J, Arnaldez FI, Gray RJ, Wang V, McShane LM, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Copur MS, Kasbari SS, Thind R, Conley BA, Arteaga CL, O'Dwyer PJ, Harris LN, Chen AP, Flaherty KT. Phase II Study of Palbociclib (PD-0332991) in CCND1, 2, or 3 Amplification: Results from the NCI-MATCH ECOG-ACRIN Trial (EAY131) Subprotocol Z1B. Clin Cancer Res 2023; 29:1477-1483. [PMID: 36853016 PMCID: PMC10102836 DOI: 10.1158/1078-0432.ccr-22-2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Cyclin D/CDK4/6 is critical in controlling the G1 to S checkpoint. CCND, the gene encoding cyclin D, is known to be amplified in a variety of solid tumors. Palbociclib is an oral CDK4/6 inhibitor, approved in advanced breast cancer in combination with endocrine therapy. We explored the efficacy of palbociclib in patients with nonbreast solid tumors containing an amplification in CCND1, 2, or 3. PATIENTS AND METHODS Patients with tumors containing a CCND1, 2, or 3 amplification and expression of the retinoblastoma protein were assigned to subprotocol Z1B and received palbociclib 125 mg once daily for 21 days of a 28-day cycle. Tumor response was assessed every two cycles. RESULTS Forty patients were assigned to subprotocol Z1B; 4 patients had outside assays identifying the CCND1, 2, or 3 amplification and were not confirmed centrally; 3 were ineligible and 2 were not treated (1 untreated patient was also ineligible), leaving 32 evaluable patients for this analysis. There were no partial responses; 12 patients (37.5%) had stable disease as best response. There were seven deaths on study, all during cycle 1 and attributable to disease progression. Median progression-free survival was 1.8 months. The most common toxicities were leukopenia (n = 21, 55%) and neutropenia (n = 19, 50%); neutropenia was the most common grade 3/4 event (n = 12, 32%). CONCLUSIONS Palbociclib was not effective at treating nonbreast solid tumors with a CCND1, 2, or 3 amplification in this cohort. These data do not support further investigation of single-agent palbociclib in tumors with CCND1, 2, or 3 amplification.
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Affiliation(s)
- Amy S. Clark
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fangxin Hong
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Richard S. Finn
- University of California, Los Angeles, Los Angeles, California
| | | | - Edith P. Mitchell
- Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - James Zwiebel
- Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Fernanda I. Arnaldez
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Robert J. Gray
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Victoria Wang
- Dana Farber Cancer Institute – ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | - Lisa M. McShane
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - Larry V. Rubinstein
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
| | - David Patton
- Center for Biomedical Informatics and Information Technology, NCI, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | | | - Alice P. Chen
- Early Clinical Trials Development Program, Division of Cancer Treatment and Diagnosis, NCI, Bethesda, Maryland
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Wisinski KB, Flamand Y, Wilson MA, Luke JJ, Tawbi HA, Hong F, Mitchell EP, Zwiebel JA, Chen H, Gray RJ, Li S, McShane LM, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Behrens RJ, Pennington KP, Conley BA, Arteaga CL, Harris LN, O'Dwyer PJ, Chen AP, Flaherty KT. Trametinib in Patients With NF1-, GNAQ-, or GNA11-Mutant Tumors: Results From the NCI-MATCH ECOG-ACRIN Trial (EAY131) Subprotocols S1 and S2. JCO Precis Oncol 2023; 7:e2200421. [PMID: 37053535 PMCID: PMC10309549 DOI: 10.1200/po.22.00421] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/13/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE NCI-MATCH is a precision medicine trial using genomic testing to allocate patients with advanced malignancies to targeted treatment subprotocols. This report combines two subprotocols evaluating trametinib, a MEK1/2 inhibitor, in patients with Neurofibromatosis 1 (NF1[S1] or GNA11/Q [S2]) altered tumors. METHODS Eligible patients had tumors with deleterious inactivating NF1 or GNA11/Q mutations by the customized Oncomine AmpliSeq panel. Prior MEK inhibitor treatment was excluded. Glioblastomas (GBMs) were permitted, including malignancies associated with germline NF1 mutations (S1 only). Trametinib was administered at 2 mg once daily over 28-day cycles until toxicity or disease progression. Primary end point was objective response rate (ORR). Secondary end points included progression-free survival (PFS) at 6 months, PFS, and overall survival. Exploratory analyses included co-occurring genomic alterations and PTEN loss. RESULTS Fifty patients were eligible and started therapy: 46 with NF1 mutations (S1) and four with GNA11 mutations (S2). In the NF1 cohort, nonsense single-nucleotide variants were identified in 29 and frameshift deletions in 17 tumors. All in S2 had nonuveal melanoma and GNA11 Q209L variant. Two partial responses (PR) were noted in S1, one patient each with advanced lung cancer and GBM for an ORR of 4.3% (90% CI, 0.8 to 13.1). One patient with melanoma in S2 had a PR (ORR, 25%; 90% CI, 1.3 to 75.1). Prolonged stable disease (SD) was also noted in five patients (four in S1 and one in S2) with additional rare histologies. Adverse events were as previously described with trametinib. Comutations in TP53 and PIK3CA were common. CONCLUSION Although these subprotocols did not meet the primary end point for ORR, significant responses or prolonged SD noted in some disease subtypes warrants further investigation.
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Affiliation(s)
- Kari B. Wisinski
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Yael Flamand
- Dana Farber Cancer Institute—ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Melissa A. Wilson
- Department of Oncology, Division of Hematology/Medical Oncology, St Luke's University Health Network, Easton, PA
| | - Jason J. Luke
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA
| | | | - Fangxin Hong
- Dana Farber Cancer Institute—ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - James A. Zwiebel
- Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Helen Chen
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Robert J. Gray
- Dana Farber Cancer Institute—ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Shuli Li
- Dana Farber Cancer Institute—ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Lisa M. McShane
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Lawrence V. Rubinstein
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - David Patton
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD
| | | | | | | | | | - Barbara A. Conley
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Lyndsay N. Harris
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Alice P. Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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Rutherford SC, Yin J, Pederson L, Perez Burbano G, LaPlant B, Shadman M, Li H, LeBlanc ML, Kenkre VP, Hong F, Blum KA, Dockter T, Martin P, Jung SH, Grant B, Rosenbaum C, Ujjani C, Barr PM, Unger JM, Cheson BD, Bartlett NL, Kahl B, Friedberg JW, Mandrekar SJ, Leonard JP. Relevance of Bone Marrow Biopsies for Response Assessment in US National Cancer Institute National Clinical Trials Network Follicular Lymphoma Clinical Trials. J Clin Oncol 2023; 41:336-342. [PMID: 35787017 PMCID: PMC9839232 DOI: 10.1200/jco.21.02301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Bone marrow biopsies (BMB) are performed before/after therapy to confirm complete response (CR) in patients with lymphoma on clinical trials. We sought to establish whether BMB add value in assessing response or predict progression-free survival (PFS) or overall survival (OS) outcomes in follicular lymphoma (FL) subjects in a large, multicenter, multitrial cohort. METHODS Data were pooled from seven trials of 580 subjects with previously untreated FL through Alliance for Clinical Trials in Oncology (Alliance) and SWOG Cancer Research Network (SWOG) completing enrollment from 2008 to 2016. RESULTS Only 5/580 (0.9%) had positive baseline BMB, CR on imaging, and subsequent positive BMB (P < .0001). Therefore, BMB were irrelevant to response in 99% of subjects. A sensitivity analysis of 385 FL subjects treated on an Eastern Cooperative Oncology Group study was included. In the Eastern Cooperative Oncology Group cohort, 5/385 (1.3%) had BMB that affected response assessment. Since some subjects do not undergo confirmatory BMB, we performed a landmark survival analysis from first radiologic CR with data from 580 subjects from Alliance and SWOG. Of subjects with CR on imaging (n = 187), PFS and OS were not significantly different among those with negative BMB to confirm CR (n = 47) versus those without repeat BMB (n = 140; PFS: adjusted hazard ratio, 1.10, 95% CI, 0.62 to 1.94, log-rank P = .686; OS: hazard ratio, 0.59, 95% CI, 0.23 to 1.53, log-rank P = .276). CONCLUSION We conclude that BMB add little value to response assessment in subjects with FL treated on clinical trials and we recommend eliminating BMB from clinical trial requirements. BMB should also be removed from diagnostic guidelines for FL except in scenarios in which it may change management including confirmation of limited stage and assessment of cytopenias. This would reduce cost, patient discomfort, resource utilization, and potentially remove a barrier to trial enrollment.
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Affiliation(s)
- Sarah C. Rutherford
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
| | | | | | | | | | | | - Hongli Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | | | | | | | - Peter Martin
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
| | | | | | - Cara Rosenbaum
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
| | | | - Paul M. Barr
- University of Rochester, Wilmot Cancer Institute, Rochester, NY
| | | | - Bruce D. Cheson
- Scientific Advisor, Lymphoma Research Foundation, New York, NY
| | - Nancy L. Bartlett
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | - Brad Kahl
- Washington University School of Medicine, Siteman Cancer Center, St Louis, MO
| | | | | | - John P. Leonard
- Weill Department of Medicine, Division of Hematology and Medical Oncology, Meyer Cancer Center, Weill Cornell Medicine and NewYork-Presbyterian Hospital, New York, NY
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Capoferri A, Wiegand A, Hong F, Shao W, Sobolewski M, Kearney M, Hoh R, Deeks S, Coffin J, Mellors J. OP 1.3 – 00017 The fraction of cells with unspliced HIV RNA is not associated with plasma viremia. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Pozzar RA, Xiong N, Hong F, Wright AA, Goff BA, Underhill-Blazey ML, Tulsky JA, Hammer MJ, Berry DL. How does patient-centered communication in ovarian cancer care enhance patient well-being? A mixed methods study. Gynecol Oncol 2022; 167:261-268. [PMID: 36057465 DOI: 10.1016/j.ygyno.2022.08.019] [Citation(s) in RCA: 1] [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: 05/31/2022] [Revised: 07/15/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Greater perceived patient-centered communication (PCC) is associated with better health-related quality of life (HRQoL) in patients with ovarian cancer. Quantitative measures of PCC and HRQoL do little to explain this association. We interviewed patients with high and low ratings of PCC to understand how it is associated with HRQoL. METHODS Explanatory sequential mixed methods study. Participants were English-speaking U.S. adults with ovarian cancer. We assessed PCC with the Patient-Centered Communication - Cancer (PCC-Ca)-36 (possible score range 1-5; higher scores represent greater patient-centeredness), and purposively sampled 14 participants with total scores in the top and bottom quartiles. Participants completed individual, semi-structured interviews about their communication experiences. Guided by the National Cancer Institute Framework for PCC in Cancer Care, we analyzed interview transcripts using directed content analysis. We integrated survey and interview findings in a joint display. RESULTS Among 176 survey respondents, PCC-Ca-36 total scores ranged from 1.7 to 5.0. Participants with scores in the top quartile (4.8-5.0) perceived clinicians as proactive and attentive to psychosocial concerns. Those with scores in the bottom quartile (1.7-3.5) described not feeling known as an individual and receiving limited support for self-management. CONCLUSIONS The association between PCC and QoL may be partially explained by differences in perceived support for psychosocial concerns and self-management. PCC may facilitate receipt of proactive, personalized care.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alexi A Wright
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Pozzar RA, Xiong N, Hong F, Filson CP, Chang P, Halpenny B, Berry DL. Concordance between influential adverse treatment outcomes and localized prostate cancer treatment decisions. BMC Med Inform Decis Mak 2022; 22:223. [PMID: 36002847 PMCID: PMC9404592 DOI: 10.1186/s12911-022-01972-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although treatment decisions for localized prostate cancer (LPC) are preference-sensitive, the extent to which individuals with LPC receive preference-concordant treatment is unclear. In a sample of individuals with LPC, the purpose of this study was to (a) assess concordance between the influence of potential adverse treatment outcomes and treatment choice; (b) determine whether receipt of a decision aid predicts higher odds of concordance; and (c) identify predictors of concordance from a set of participant characteristics and influential personal factors. Methods Participants reported the influence of potential adverse treatment outcomes and personal factors on treatment decisions at baseline. Preference-concordant treatment was defined as (a) any treatment if risk of adverse outcomes did not have a lot of influence, (b) active surveillance if risk of adverse outcomes had a lot of influence, or (c) radical prostatectomy or active surveillance if risk of adverse bowel outcomes had a lot of influence and risk of other adverse outcomes did not have a lot of influence. Data were analyzed using descriptive statistics and logistic regression. Results Of 224 participants, 137 (61%) pursued treatment concordant with preferences related to adverse treatment outcomes. Receipt of a decision aid did not predict higher odds of concordance. Low tumor risk and age ≥ 60 years predicted higher odds of concordance, while attributing a lot of influence to the impact of treatment on recreation predicted lower odds of concordance. Conclusions Risk of potential adverse treatment outcomes may not be the foremost consideration of some patients with LPC. Assessment of the relative importance of patients’ stated values and preferences is warranted in the setting of LPC treatment decision making. Clinical trial registration: NCT01844999 (www.clinicaltrials.gov). Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01972-w.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | | | - Peter Chang
- Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Barbara Halpenny
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Donna L Berry
- University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
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Alessi JV, Wei Z, Ricciuti B, Lindsay J, Vaz VR, Barrichello A, Sharma B, Felt KD, Hong F, Sholl LM, Rodig SJ, Awad MM. Abstract 506: Dissecting the genomic and tumor immune microenvironment factors associated with disease recurrence in resected stage I NSCLC. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-506] [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: Patients with early-stage non-small cell lung cancer (NSCLC) are at substantial risk for disease recurrence after surgical resection, and the discovery of biomarkers that predict disease recurrence has been challenging. We sought to identify genomic and immunologic factors associated with recurrence after surgery in stage I NSCLC.
Methods: We collected clinicopathologic data from patients with resected stage I NSCLC (AJCC 8th Edition) which underwent multiplexed immunofluorescence for CD8+, FOXP3+, PD-1+, and PD-L1. A subset of these samples also had next-generation sequencing performed to identify genomic alterations and tumor mutational burden (TMB). A bidirectional stepwise elimination was applied on variables with a univariable disease-free survival (DFS) p-value <0.25. The final multivariable Cox model was validated with internal bootstrapping (B=300).
Results: A total of 252 cases were included. After a median follow-up of 25.6 months from the time of surgery, 47 cases (18.7%) experienced recurrence, with a 2-year DFS rate of 82.9%, and a 2-year overall survival (OS) rate of 97.9%. Shorter DFS was associated with higher TMB, increased PD-L1 expression, and greater numbers of intratumoral (IT) CD8+, PD-1+, and PD-1+CD8+ immune cells, as well as increased CD8+ and FOXP3+ T cells at the tumor stroma interface (TSI) in univariable analyses (p<0.05). Multivariable analysis showed that shorter DFS was associated with increasing TMB and higher PD-L1 tumor cell expression. We observed a difference by immune cell localization and risk of recurrence: shorter DFS was associated with higher IT but lower TSI PD-1+ immune cells, and higher IT but lower TSI FOXP3+ T cells (Table). Internal bootstrap validation showed good model performance (C-index = 0.74).
Conclusion: Genomic analysis and immunophenotyping of stage I NSCLCs can identify cases at greatest risk of disease recurrence after surgical resection.
Table. Univariable and multivariable analysis Disease-free survival Univariable HR [95%CI] p-value Multivariable HR [95%CI] p-value Stage at diagnosis - 0.10 – – IA1 1.52 [0.58, 3.97] IA2 2.61 [0.95, 7.20] IA3 2.61 [1.03, 6.63] IB Histology - 0.42 Adenocarcinoma 1.38 [0.65, 2.97] Squamous Age* 1.02 [0.99, 1.06] 0.19 – – TMB* 1.09 [1.05, 1.12] <0.001 1.09 [1.05, 1.13] <0.001 Smoking* (pack-years) 1.01 [1.00, 1.02] 0.008 – – Smoking history - 0.012 – – Never 5.24 [1.27, 21.7] Former Current 4.92 [0.82, 29.5] Surgical treatment - 0.084 - 0.074 Lobectomy 1.80 [0.89, 3.62] 2.18 [0.93, 5.14] Sublobar Intratumoral** 1.09 [1.03, 1.16] 0.015 - – CD8+ 1.22 [1.10, 1.36] 0.002 1.80 [1.13, 2.87] 0.014 PD-1+ 1.51 [1.20, 1.90] 0.004 - – 0.004 PD-1+ CD8+ 1.22 [1.04, 1.44] 0.053 0.15 [0.04, 0.55] FOXP3+ Tumor-Stroma Interface** 1.06 [1.01, 1.11] 0.033 - - CD8+ 1.10 [1.01,1.20] 0.056 0.71 [0.56, 0.91] 0.007 PD-1+ 1.21 [0.99, 1.48] 0.100 - - PD-1+ CD8+ 1.28 [1.03, 1.59] 0.037 2.42 [1.49, 3.95] <0.001 FOXP3+ PD-L1 expression* 1.02 [1.01, 1.03] <0.001 1.03 [1.01, 1.04] <0.001 Tumor Proportion Score (TPS) 1.02 [1.01, 1.04] - - Immune cells 0.011 *Per unit increase. ** Per 100 units increase. Intratumoral, is defined as the region of the slide consisting of tumor beyond the tumor-stroma interface. Tumor-Stroma Interface is defined as the region within 40 microns to either side of the defined border between tumor and stroma.
Citation Format: Joao Victor Alessi, Zihan Wei, Biagio Ricciuti, James Lindsay, Victor R. Vaz, Adriana Barrichello, Bijaya Sharma, Kristen D. Felt, Fangxin Hong, Lynette M. Sholl, Scott J. Rodig, Mark M. Awad. Dissecting the genomic and tumor immune microenvironment factors associated with disease recurrence in resected stage I NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 506.
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Affiliation(s)
| | - Zihan Wei
- 1Dana-Farber Cancer Institute, Boston, MA
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Sornasse T, Cai F, Hong F, Anyanwu S, Song IH, Bukhari M. POS0541 PREDICTORS OF REMISSION IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH UPADACITINIB OR ADALIMUMAB IN THE SELECT-COMPARE PHASE 3 STUDY: CLINICAL STATUS AT WEEK 12, BUT NOT STANDARD LABORATORY MEASURES, PROVIDES THE BEST CURRENT PREDICTOR OF REMISSION AT WEEK 26. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUpadacitinib (UPA, 15 mg QD), an oral JAK1 selective inhibitor, showed greater efficacy compared to adalimumab (ADA, 40 mg EOW) at week 12 in patients with active rheumatoid arthritis (RA) on background methotrexate (MTX) in the SELECT-COMPARE phase 3 study1. Treatment with UPA compared to ADA resulted in a larger proportion of patients reaching CDAI Remission (REM) at week 26 (23% vs. 14%, p-value ≤ 0.001). Because remission is the goal in managing RA, it is of clinical relevance to identify early during the treatment course who might be able to achieve this state. It has been reported that early response to therapy with UPA was associated with achieving CDAI REM at week 262. In parallel, it has been reported that reduction in monocyte can predict DAS28-ESR REM in RA patients treated with anti-TNF therapy3. However, the relative predictive values of clinical and standard laboratory measures have not been compared side-by-side.ObjectivesTo determine post-hoc the relative predictive values of selected clinical and standard laboratory measures collected at week 12 for identifying RA patients who will be in CDAI REM at week 26 upon treatment with UPA or ADA.MethodsClinical (CDAI, SDAI, and DAS28-CRP) and laboratory data (CRP, ESR, CBC with differential, and Lipids) for all available patients enrolled in the SELECT-COMPARE phase 3 study were included in this post-hoc analysis (UPA: n =623 [CDAI REM at wk26 = 23.8%]; ADA: n = 316 [CDAI REM at wk 26 = 14.2%]). Patients who switched treatment between weeks 14 and 22 due to not reaching at least 20% improvement in tender and swollen joints were classified as non-responders for CDAI REM at week 26. The predictive value of clinical and laboratory endpoints recorded at week 12 for determining CDAI REM status at week 26 was assessed by univariate logistic regression. We report the performance of each model as ROC AUC with a cutoff of 0.75 for meaningful predictive value.ResultsFor both patients treated with UPA and those treated with ADA, clinical disease activity status measures (CDAI, SDAI, and DAS28-CRP) and relative change in disease activity measures (Percent Change [PCHG] in CDAI, PCHG in DAS28-CRP, and PCHG in SDAI) at week 12 resulted in the highest predictive performance for determining CDAI REM status at week 26 (Figure 1). In contrast, none of the selected standard laboratory measures (CRP, ESR, CBC with differential, and Lipids) reached a meaningful predictive value (ROC AUC < 0.75). Of note, cell numbers and changes in cell numbers (including Neutrophils Lymphocytes, Basophils, Eosinophils, and Monocytes) at week 12 had no meaningful predictive value for determining CDAI REM at week 26.Figure 1.Univariate Logistic Models to Predict CDAI REM at Week 26 in Active RA Patients who had an Inadequate Response to MTX: ROC Analysis AUC.Legend: All evaluated parameters were recorded at Week 12; CHG = Change from Baseline to Week 12; PCHG = Percent Change from Baseline to Week 12ConclusionThis analysis suggests that standard laboratory measures (CRP, ESR, CBC with differential, and Cholesterol) at week 12 do not represent useful predictors for REM at week 26 in csDMARD-IR RA patients. In particular, blood cell numbers and the changes in these measures at week 12 do not provide additional predictive value in our analyses, contrasting with the results from Amarnani and colleagues3. Hence, clinical disease activity levels and changes in these measures at week 12 remain adequate predictors of CDAI REM at week 26. Still, the absolute predictive performance of clinical measures remains suboptimal, highlighting the need to dedicate continued efforts to identify and validate improved predictors of long-term REM in RA.References[1]Fleischmann, R. et al. Arth Rheumatol71, 1788-1800 (2019).[2]Kavanaugh, A. et al. J Clin Rheumatol27, S81-S81 (2021).[3]Amarnani, R. et al. Ann Rheum Dis80, 448-449 (2021).AcknowledgementsAbbVie, Inc was the study sponsor, contributed to the study design, data collection, analysis & interpretation, and writing, reviewing, and approval of the final version.Disclosure of InterestsThierry Sornasse Shareholder of: AbbVie, Employee of: AbbVie, Fang Cai Shareholder of: AbbVie, Employee of: AbbVie, Feng Hong Shareholder of: AbbVie, Employee of: AbbVie, Samuel Anyanwu Shareholder of: AbbVie, Employee of: AbbVie, In-Ho Song Shareholder of: AbbVie, Employee of: AbbVie, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen, Novartis and Gilead, Paid instructor for: honoraria from educational groups revalidaid and TREG consultants.
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Jabaley T, Xiong N, Conley S, Mazeika T, Johnson D, Biggins B, Hilton N, Hong F. Transitioning from Heparin to Saline Locks for Central Venous Access Devices in Oncology: An Evidence-Based Practice Approach. Can Oncol Nurs J 2022; 32:286-293. [DOI: 10.5737/23688076322286293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Central vascular access devices (CVADs) are often essential to the care of patients undergoing long-term cancer treatment. CVAD maintenance is an essential oncology nurse competency. Evidence-based practice (EBP) in flushing and locking help to prevent intraluminal occlusion, a common complication. Heparinized saline (HS) has been the standard locking solution for CVADs. However, research indicates no superiority of HS over normal saline (NS). The objectives of this EBP project were 1) to evaluate whether a significant difference in intraluminal occlusion was associated with the change from HS to NS use for locking CVADs in ambulatory oncology care, and 2) to evaluate the effects of peer nurse mentoring on nurses’ and patients’ perspectives about the practice change. Analysis of data revealed decreases in alteplase usage after transitioning to NS locking. Patient and nurse surveys indicated that peer nurse mentoring increased nurse and patient confidence and competence in making the practice transition.
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10
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Jabaley T, Xiong N, Conley S, Mazeika T, Johnson D, Biggins B, Hilton N, Hong F. Transition de l’héparine au sérum physiologique pour fermer les cathéters veineux centraux en oncologie : pratique fondée sur la recherche. Can Oncol Nurs J 2022; 32:294-302. [DOI: 10.5737/23688076322294302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Les patients recevant un traitement à long terme contre le cancer doivent très souvent se faire poser un cathéter veineux central (CVC). L’entretien du CVC est donc une compétence fondamentale des infirmières en oncologie. Les pratiques d’irrigation et de fermeture du CVC fondées sur la recherche aident à prévenir l’occlusion intraluminale, une complication fréquente. Les normes recommandent l’utilisation d’un soluté physiologique hépariné pour fermer le CVC; toutefois, selon la recherche, le soluté hépariné n’est pas plus efficace que le seul sérum physiologique. Les objectifs du présent projet de pratique fondée sur la recherche étaient : 1) d’évaluer si la fermeture au sérum physiologique plutôt qu’au soluté hépariné était liée à une différence significative du nombre de cas d’occlusion intraluminale chez les patients suivis en clinique d’oncologie externe; et 2) d’évaluer les effets du mentorat entre pairs sur le point de vue des infirmières et des patients quant au changement de pratique. L’analyse des données a révélé une diminution de l’utilisation d’altéplase après l’adoption du sérum physiologique pour fermer les CVC. Les sondages réalisés auprès des patients et des infirmières montrent que le mentorat entre pairs accroît la confiance des infirmières et des patients, ainsi que l’habileté à procéder au changement de pratique.
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11
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Obeng-Gyasi S, Graham N, Kumar S, Lee JW, Jacobus S, Weiss M, Cella D, Zhao F, Ip EH, O'Connell N, Hong F, Peipert DJ, Gareen IIF, Timsina LR, Gray R, Wagner LI, Carlos RC. Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients. Blood Cancer J 2022; 12:53. [PMID: 35365604 PMCID: PMC8975964 DOI: 10.1038/s41408-022-00648-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study is to examine the association between neighborhood socioeconomic status (nSES) and baseline allostatic load (AL) and clinical trial endpoints in patients enrolled in the E1A11 therapeutic trial in multiple myeloma (MM). Study endpoints were symptom burden (pain, fatigue, and bother) at baseline and 5.5 months, non-completion of induction therapy, overall survival (OS) and progression-free survival (PFS). Multivariable logistic and Cox regression examined associations between nSES, AL and patient outcomes. A 1-unit increase in baseline AL was associated with greater odds of high fatigue at baseline (adjusted OR [95% CI] = 1.21 [1.08–1.36]) and a worse OS (adjusted hazard ratio, [95% CI] = 1.21 [1.06–1.37]). High nSES was associated with worse baseline bother (middle OR = 4.22 [1.11–16.09] and high 4.49 [1.16–17.43]) compared to low nSES. There was no association between AL or nSES and symptom burden at 5.5 months, non-completion of induction therapy or PFS. Additionally, there was no association between nSES and OS. AL may have utility as a predictive marker for OS among patients with MM and may allow individualization of treatment. Future studies should standardize and validate AL patients with MM.
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Affiliation(s)
| | - Noah Graham
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Susanna Jacobus
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Fengmin Zhao
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Edward H Ip
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Nathaniel O'Connell
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Fangxin Hong
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Devin J Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - IIana F Gareen
- Brown University Department of Epidemiology and Center for Statistical Sciences, Providence, RI, USA
| | - Lava R Timsina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Robert Gray
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Lynne I Wagner
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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12
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Cooley ME, Mazzola E, Xiong N, Hong F, Lobach DF, Braun IM, Halpenny B, Rabin MS, Johns E, Finn K, Berry D, McCorkle R, Abrahm JL. Clinical Decision Support for Symptom Management in Lung Cancer Patients: A Group RCT. J Pain Symptom Manage 2022; 63:572-580. [PMID: 34921934 PMCID: PMC9194912 DOI: 10.1016/j.jpainsymman.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve the quality of cancer care. OBJECTIVES Clinical decision support offers an innovative approach to integrate guideline-based symptom management into oncology care. This study evaluated the effect of clinical decision support-based recommendations on clinical management of symptoms and health-related quality of life (HR-QOL) among outpatients with lung cancer. METHODS Twenty providers and 179 patients were allotted in group randomization to attention control (AC) or Symptom Assessment and Management Intervention (SAMI) arms. SAMI entailed patient-report of symptoms and delivery of recommendations to manage pain, fatigue, dyspnea, depression, and anxiety; AC entailed symptom reporting prior to the visit. Outcomes were collected at baseline, two, four and six-months. Adherence to recommendations was assessed through masked chart review. HR-QOL was measured by the Functional Assessment of Cancer Therapy-Lung questionnaire. Descriptive statistics with linear and logistic regression accounting for the clustering structure of the design and a modified chi-square test were used for analyses. RESULTS Median age of patients was 63 years, 58% female, 88% white, and 32% ≤high school education. Significant differences in clinical management were evident in SAMI vs. AC for all target symptoms that passed threshold. Patients in SAMI were more likely to receive sustained-release opioids for constant pain, adjuvant medications for neuropathic pain, opioids for dyspnea, stimulants for fatigue and mental health referrals for anxiety. However, there were no statistically significant differences in HR-QOL at any time point. CONCLUSION SAMI improved clinical management for all target symptoms but did not improve patient outcomes. A larger study is warranted to evaluate effectiveness.
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Affiliation(s)
- Mary E Cooley
- Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | - Emanuele Mazzola
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Niya Xiong
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Fangxin Hong
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Ilana M Braun
- Psychosocial Oncology and Palliative Care (I.M.B., J.L.A.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barbara Halpenny
- Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael S Rabin
- Lowe Center for Thoracic Oncology (M.S.R.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ellis Johns
- Family Medicine (E.J.), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kathleen Finn
- Clinical Research (K.F.), City of Hope, Duarte, California, USA
| | - Donna Berry
- Biobehavioral Nursing and Health Informatics (D.B.), University of Washington, Seattle, Washington, USA
| | - Ruth McCorkle
- School of Nursing (R.M.), Yale University, New Haven, Connecticut, USA
| | - Janet L Abrahm
- Psychosocial Oncology and Palliative Care (I.M.B., J.L.A.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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13
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Zhang X, Hong F, Liu L, Nie F, Du L, Guan H, Wang Z, Zeng Q, Yang J, Wang J, Li X, Zhang J, Luo P. Lipid accumulation product is a reliable indicator for identifying metabolic syndrome: the China Multi-Ethnic Cohort (CMEC) Study. QJM 2022; 115:140-147. [PMID: 33367838 DOI: 10.1093/qjmed/hcaa325] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 10/14/2020] [Revised: 11/13/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous studies have shown that lipid accumulation product (LAP) was associated with the risk of cardiometabolic disease. It is not clear whether LAP could be used as a marker to identify metabolic syndrome (MetS) among Chinese ethnic groups. AIM To assess the reliability of LAP as a maker to identify MetS among Dong adults. DESIGN Population-based cross-sectional study. METHOD We included 6494 Dong individuals (1403 patients) aged 30-79 years from southwest China. MetS was established by Chinese Diabetes Society. Logistic regression model was utilized to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Receiver operating characteristic (ROC) curve was utilized to calculate area under the ROC curve (AUC) and 95% CIs to obtain the identification ability for MetS. RESULTS The risk of MetS was increased with per 5 units increase of LAP (OR 1.37 [95% CI, 1.34-1.39]). Similar results were found in subgroup analyses and sensitivity analyses. Clustered metabolic risk associated with per 5 units increase of LAP was observed for people with 1 (OR 1.59 [95% CI, 1.53-1.65]), 2 (2.15 [2.06-2.24]), 3 (2.59 [2.48-2.71]), 4 (2.81 [2.69-2.95]) and 5 (3.03 [2.87-3.21]) MetS components. LAP presented higher AUC (0.915 [95% CI, 0.907-0.923]) than other included obesity indices (P < 0.05). CONCLUSION These data support evidence that LAP was related to the risk of MetS, had a high AUC and could be a reliable index for identifying MetS patients among Dong adults in Chinese.
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Affiliation(s)
- X Zhang
- School of Public Health, Guizhou Medical University, Dongqing Road, Guiyang, 550025, People's Republic of China
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - F Hong
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - L Liu
- School of Public Health, Guizhou Medical University, Dongqing Road, Guiyang, 550025, People's Republic of China
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - F Nie
- School of Public Health, Guizhou Medical University, Dongqing Road, Guiyang, 550025, People's Republic of China
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - L Du
- School of Public Health, Guizhou Medical University, Dongqing Road, Guiyang, 550025, People's Republic of China
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - H Guan
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - Z Wang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - Q Zeng
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - J Yang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - J Wang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - X Li
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
| | - J Zhang
- School of Public Health, Guizhou Medical University, Dongqing Road, Guiyang, 550025, People's Republic of China
- Health Bureau of Yunyan District, Beijing East Road, Guiyang 550003, People's Republic of China
| | - P Luo
- School of Public Health, Guizhou Medical University, Dongqing Road, Guiyang, 550025, People's Republic of China
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guiyang 550025, People's Republic of China
- State Key Laboratory of Function and Application of Medicinal Plants, Guizhou Medical University, Dongqing Road, Guiyang 550014, People's Republic of China
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14
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Kobayashi Y, Chhoeu C, Li J, Price KS, Kiedrowski LA, Hutchins JL, Hardin AI, Wei Z, Hong F, Bahcall M, Gokhale PC, Jänne PA. Silent mutations reveal therapeutic vulnerability in RAS Q61 cancers. Nature 2022; 603:335-342. [PMID: 35236983 DOI: 10.1038/s41586-022-04451-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/20/2022] [Indexed: 12/26/2022]
Abstract
RAS family members are the most frequently mutated oncogenes in human cancers. Although KRAS(G12C)-specific inhibitors show clinical activity in patients with cancer1-3, there are no direct inhibitors of NRAS, HRAS or non-G12C KRAS variants. Here we uncover the requirement of the silent KRASG60G mutation for cells to produce a functional KRAS(Q61K). In the absence of this G60G mutation in KRASQ61K, a cryptic splice donor site is formed, promoting alternative splicing and premature protein termination. A G60G silent mutation eliminates the splice donor site, yielding a functional KRAS(Q61K) variant. We detected a concordance of KRASQ61K and a G60G/A59A silent mutation in three independent pan-cancer cohorts. The region around RAS Q61 is enriched in exonic splicing enhancer (ESE) motifs and we designed mutant-specific oligonucleotides to interfere with ESE-mediated splicing, rendering the RAS(Q61) protein non-functional in a mutant-selective manner. The induction of aberrant splicing by antisense oligonucleotides demonstrated therapeutic effects in vitro and in vivo. By studying the splicing necessary for a functional KRAS(Q61K), we uncover a mutant-selective treatment strategy for RASQ61 cancer and expose a mutant-specific vulnerability, which could potentially be exploited for therapy in other genetic contexts.
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Affiliation(s)
- Yoshihisa Kobayashi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
| | - Chhayheng Chhoeu
- Experimental Therapeutics Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jiaqi Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristin S Price
- Department of Medical Affairs, Guardant Health, Redwood City, CA, USA
| | | | - Jamie L Hutchins
- Department of Medical Affairs, Guardant Health, Redwood City, CA, USA
| | - Aaron I Hardin
- Department of Medical Affairs, Guardant Health, Redwood City, CA, USA
| | - Zihan Wei
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Magda Bahcall
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Prafulla C Gokhale
- Experimental Therapeutics Core, Dana-Farber Cancer Institute, Boston, MA, USA.,Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pasi A Jänne
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA, USA. .,Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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15
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Liu L, Han M, Qie R, Li Q, Zhang X, Zhang J, Zhan S, Zhang L, Xu Z, Zhang C, Hong F. A dose-response meta-analysis to evaluate the relationship between high-density lipoprotein cholesterol and all-cause and cardiovascular disease mortality. J Endocrinol Invest 2022; 45:551-562. [PMID: 34676492 DOI: 10.1007/s40618-021-01690-6] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies have not fully described the relationship between high-density lipoprotein cholesterol (HDL-C) and death risks from all cause and cardiovascular disease (CVD). This study quantitatively evaluates HDL-C-mortality associations. METHODS Embase and PubMed databases were searched for relevant articles published up to 1 June 2019. Random-effects models were used to pool relative risks (RRs) and 95% confidence intervals (CIs). We used restricted cubic splines to model the dose-response association. RESULTS We identified 32 prospective cohort studies including 369,904 participants and 33,473 total deaths (9426 CVD deaths). Compared to the lowest HDL-C levels, all cause and CVD mortality risks were reduced by 18% (RR 0.82; 95% CI, 0.73-0.93) and 36% (0.64, 0.46-0.89), respectively, for the highest HDL-C levels. All cause and CVD mortality risks were reduced by 15% (0.85, 0.79-0.92) and 23% (0.77, 0.69-0.87), respectively, with each 1 mmol/L increment of HDL-C. We found evidence of nonlinear and negative dose-response associations of HDL-C with all cause and CVD mortality (Pnonlinearity < 0.001), and the lowest death risks from all cause and CVD were observed at approximately 1.34 and 1.55 mmol/L, respectively. CONCLUSION HDL-C is inversely associated with all cause and CVD mortality risks under approximately 2.05 and 2.33 mmol/L, respectively. Optimal doses require investigation via clinical practice or high-quality research.
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Affiliation(s)
- L Liu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China
| | - M Han
- College of Public Health, Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - R Qie
- College of Public Health, Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Q Li
- College of Public Health, Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - X Zhang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China
- Center for Diseases Control and Prevention of Yunyan District, Guiyang, 550004, People's Republic of China
| | - J Zhang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China
- Guiyang Center for Diseases Control and Prevention, Guiyang, 550001, People's Republic of China
| | - S Zhan
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China
- Guizhou Provincial Hospital of Maternal and Child Health Care, Guiyang, 550004, People's Republic of China
| | - L Zhang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China
| | - Z Xu
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China
| | - C Zhang
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China
| | - F Hong
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Dongqing Road, Guian New Area, Guiyang, 550025, Guizhou, People's Republic of China.
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16
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Knoerl R, Mazzola E, Hong F, Salehi E, McCleary N, Ligibel J, Reyes K, Berry DL. Self-Reported Severity, Characteristics, and Functional Limitations of Chemotherapy-Induced Peripheral Neuropathy. Pain Manag Nurs 2021; 23:532-540. [PMID: 34972658 DOI: 10.1016/j.pmn.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/11/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The early identification of chemotherapy-induced peripheral neuropathy (CIPN) (e.g., numbness or tingling in the fingers or toes) is important due to its frequency and the few effective treatment options available. The identification of common patient-reported CIPN characteristics and associated functional limitations may help to facilitate patient-clinician discussions of CIPN in practice. AIMS To quantify the severity, duration, location, characteristics, and associated functional limitations of chemotherapy-induced peripheral neuropathy (CIPN) in patients receiving neurotoxic chemotherapy. DESIGN Exploratory secondary analysis of a prospective, two-phase study SETTING: Breast, gastrointestinal, and multiple myeloma clinics at Dana-Farber Cancer Institute. PARTICIPANTS 142 individuals who planned to receive at least three more cycles of neurotoxic chemotherapy after consent. METHODS Participants self-reported CIPN using standardized measures (i.e., PRO-CTCAE™ Numbness and Tingling Items or 0-10 numerical rating scale of worst CIPN pain intensity) and/or study team generated follow up questions about CIPN location, duration, characteristics, and functional limitations prior to three consecutive clinic visits (T1, T2, T3). Participants' responses to the CIPN self-report questionnaires were described by chemotherapy type and age. RESULTS Over approximately 36.5 days (T1-T3), the percentage of participants reporting at least mild CIPN increased from 59.3% to 71%. At T3, patients with non-painful (n = 98) or painful neuropathy (n = 34) frequently reported symptoms in the fingers (non-painful = 83.5%, painful = 76.5%) or toes (non-painful = 49.5%, painful = 41.2%) and characterized symptoms as numbness (non-painful = 54.1%, painful = 50%) or tingling (non-painful = 68.4%, painful = 82.4%). Self-reported CIPN functional limitations (n = 55) included difficulties with buttoning a shirt (38.2%) or walking (25.5%). Paclitaxel-related CIPN (n = 33) was frequently characterized as "continuous" (30.3%), whereas oxaliplatin-related CIPN (n = 51) was frequently characterized as "intermittent" (41.2%). Young adults (15-39 years old, n = 15) frequently reported moderate-severe non-painful CIPN (46.7%), painful CIPN (40%), and CIPN interference (33.3%). CONCLUSIONS Consistent with qualitative research, participants frequently described CIPN as numbness and/or tingling in the fingers and/or toes.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Fangxin Hong
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elahe Salehi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nadine McCleary
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jennifer Ligibel
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kaitlen Reyes
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna L Berry
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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17
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Bahcall M, Paweletz CP, Kuang Y, Taus LJ, Sim T, Kim ND, Dholakia KH, Lau CJ, Gokhale PC, Chopade PR, Hong F, Wei Z, Köhler J, Kirschmeier PT, Guo J, Guo S, Wang S, Janne PA. Combination of type I and type II MET tyrosine kinase inhibitors as therapeutic approach to prevent resistance. Mol Cancer Ther 2021; 21:322-335. [PMID: 34789563 DOI: 10.1158/1535-7163.mct-21-0344] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022]
Abstract
MET targeted therapies are clinically effective in MET amplified and MET exon 14 deletion mutant (METex14) non-small cell lung cancers (NSCLC) but their efficacy is limited by the development of drug resistance. Structurally distinct MET tyrosine kinase inhibitors (TKIs) (type I/II) have been developed or are under clinical evaluation, which may overcome MET mediated drug resistance mechanisms. In this study, we assess secondary MET mutations likely to emerge in response to treatment with single-agent or combinations of type I/type II MET TKIs using TPR-MET transformed Ba/F3 cell mutagenesis assays. We found that these inhibitors gave rise to distinct secondary MET mutant profiles. However, a combination of type I/II TKI inhibitors (capmatinib and merestinib) yielded no resistant clones in vitro. The combination of capmatinib/merestinib was evaluated in vivo and led to a significant reduction in tumor outgrowth compared to either MET inhibitor alone. Our findings demonstrate in vitro and in vivo that a simultaneous treatment with a type I and type II MET TKI may be a clinically viable approach to delay and/or diminish the emergence of on target MET mediated drug resistance mutations.
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Affiliation(s)
- Magda Bahcall
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute
| | - Cloud P Paweletz
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute and Harvard Medical School
| | - Yanan Kuang
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute
| | - Luke J Taus
- Medical Oncology, Dana-Farber Cancer Institute
| | - Taebo Sim
- Severance Biomedical Science Institute, Yonsei University College of Medicine
| | - Nam Doo Kim
- Daegu-Gyeongbuk Medical Innovation Foundation
| | | | - Christie J Lau
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute
| | | | - Pratik R Chopade
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute
| | | | - Zihan Wei
- Biostatistics, Dana-Farber Cancer Institute
| | - Jens Köhler
- Department of Medical Oncology, Dana-Farber Cancer Institute
| | | | | | - Sujuan Guo
- Fralin Biomedical Research Institute, Virginia Tech
| | - Stephen Wang
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute and Harvard Medical School
| | - Pasi A Janne
- Lowe Center for Thoracic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute
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18
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Sun R, McCaw Z, Tian L, Uno H, Hong F, Kim DH, Wei LJ. Moving beyond conventional stratified analysis to assess the treatment effect in a comparative oncology study. J Immunother Cancer 2021; 9:e003323. [PMID: 34799398 PMCID: PMC8606770 DOI: 10.1136/jitc-2021-003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/03/2022] Open
Abstract
In a comparative oncology study with progression-free or overall survival as the endpoint, the primary or key secondary analysis is routinely stratified by patients' baseline characteristics when evaluating the treatment difference. The validity of a conventional strategy such as a stratified HR analysis depends on stringent model assumptions that are unlikely to be met in practice, especially in immunotherapy studies. Thus, the resulting summary is generally neither valid nor interpretable. This article discusses issues with conventional stratified analyses and presents alternatives using data from KEYNOTE-189, a recent immunotherapy trial for treating patients with metastatic, non-squamous, non-small-cell lung cancer.
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Affiliation(s)
- Ryan Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Hajime Uno
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Fangxin Hong
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee-Jen Wei
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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19
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Lawrence MN, Tamen RM, Martinez P, Sable-Hunt A, Addario T, Barbour P, Shaffer T, Hosseini SA, Bertucci C, Lim LP, Hong F, Michael K, Simon GR, Riess JW, Awad MM, Oxnard GR. SPACEWALK: A Remote Participation Study of ALK Resistance Leveraging Plasma Cell-Free DNA Genotyping. JTO Clin Res Rep 2021; 2:100151. [PMID: 34590008 PMCID: PMC8474207 DOI: 10.1016/j.jtocrr.2021.100151] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Remote consent and enrollment offer a unique opportunity to provide rare cancer populations with access to clinical research. The genomic analysis of plasma cell-free DNA (cfDNA) permits remote characterization of the cancer genome. We hypothesized we could leverage these approaches to remotely study drug resistance in patients with metastatic ALK-positive NSCLC. Methods The SPACEWALK study (Study of Plasma Next-Generation Sequencing for Remote Assessment, Characterization, Evaluation of Patients With ALK Drug Resistance) enrolled patients with ALK-positive NSCLC and progression on a next-generation ALK inhibitor who could participate remotely. Plasma was collected for next-generation sequencing (NGS) of cfDNA before initiating subsequent therapy, with results returned and subsequent therapy studied. Results Of the 62 patients enrolled, an ALK fusion was detected in 27 (44%) with a median allelic fraction of 2.6%. Among these 27 patients, a potential resistance mechanism was identified in 17 patients (63%): eight cases (30%) had secondary ALK kinase domain resistance mutations, three cases (11%) had bypass track resistance, and six cases (22%) had both ALK resistance mutations and bypass resistance. The most frequently detected mechanism of bypass resistance was MET amplification. Repeat plasma NGS was performed in 14 patients after subsequent treatment was initiated, with seven (50%) patients exhibiting greater than 50% reductions in ALK fusion allelic fraction. Conclusions Through the leveraging of remote participation, plasma NGS offers an optimal mechanism for characterizing resistance to emerging targeted therapies in rare cancer populations, though sensitivity depends on adequate tumor DNA samples. Repeat cfDNA analysis on therapy may offer an objective monitoring approach to remotely study treatment response.
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Affiliation(s)
- Marissa N. Lawrence
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rubii M. Tamen
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Pablo Martinez
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Tony Addario
- Addario Lung Cancer Medical Institute, San Carlos, California
| | - Pete Barbour
- Addario Lung Cancer Medical Institute, San Carlos, California
| | | | | | | | - Lee P. Lim
- Resolution Bioscience, Kirkland, Washington
| | - Fangxin Hong
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kesi Michael
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - George R. Simon
- Department of Thoracic/Head & Neck Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan W. Riess
- Division of Hematology/Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Mark M. Awad
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Corresponding author. Address for correspondence: Mark M. Awad, MD, PhD, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
| | - Geoffrey R. Oxnard
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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20
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Knoerl R, Mazzola E, Mitchell SA, Hong F, Salehi E, McCleary N, Ligibel JA, Reyes K, Berry DL. Measurement properties of brief neuropathy screening items in cancer patients receiving taxanes, platinums, or proteasome inhibitors. J Patient Rep Outcomes 2021; 5:101. [PMID: 34568984 PMCID: PMC8473487 DOI: 10.1186/s41687-021-00377-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely detection of chemotherapy-induced peripheral neuropathy (CIPN) is critical to effectively tailor chemotherapy dose levels and offer supportive care. The purpose of this secondary analysis was to determine the reliability and validity of the two Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) numbness and tingling severity and interference items to screen for CIPN in patients receiving taxanes, platinums, or proteasome inhibitors. METHODS Participants (N = 142) completed the two PRO-CTCAE items, a 0-10 numerical rating scale of worst CIPN pain intensity, and the Quality of Life Questionnaire-CIPN20 (QLQ-CIPN20) prior to three clinical visits (T1, T2, T3) during neurotoxic chemotherapy. Participants completed the two PRO-CTCAE items again following the T3 clinical visit (T4). In addition, study staff administered the modified Total Neuropathy Score-Clinical Version (TNSc©) at T3. We examined floor (i.e., no CIPN severity or interference) and ceiling effects, test-retest reliability, concurrent validity, longitudinal validity, construct validity of the response categories, and sensitivity and specificity of the two PRO-CTCAE items. RESULTS At T3, 29% of participants had PRO-CTCAE severity scores at the floor; 60.1% of participants reported interference item scores at the floor. Agreements between scores reported at T3 and T4 for PRO-CTCAE severity (ICC = 0.79) and interference (ICC = 0.73) were moderate to strong. The PRO-CTCAE severity and interference items correlated moderately-strongly with QLQ-CIPN20 sensory (Spearman's ρ-range = 0.53-0.72) and motor (Spearman's ρ-range = 0.50-0.58) subscale scores. The Cohen's d from T1 to T3 for the PRO-CTCAE items were small (severity: d = 0.32, interference: d = 0.40) and comparable to the effect sizes for change observed with the QLQ-CIPN20. The PRO-CTCAE severity (0-3) and interference (0-2) response categories distinguished respondents with significantly different levels of QLQ-CIPN20 sensory and motor subscale scores (p < 0.001 via Jonckheere-Terpstra tests). The sensitivity and specificity of the PRO-CTCAE severity item (cutoff > 0) to detect probable sensory peripheral neuropathy were 95.83% and 65.22%, while the sensitivity and specificity of the PRO-CTCAE™ interference item (cutoff > 0) were 51.39% and 73.91%. CONCLUSION Preliminary evidence supports the reliability and validity of the PRO-CTCAE numbness and tingling items for CIPN screening, although there may be floor effects and limitations in the capacity of the PRO-CTCAE items to identify the full range of CIPN sensory and motor features beyond numbness and tingling. Trial Registration ClinicalTrials.Gov, NCT03514680. Registered 21 April 2018. https://clinicaltrials.gov/ct2/show/NCT03514680.
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Affiliation(s)
- Robert Knoerl
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA. .,University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Emanuele Mazzola
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Fangxin Hong
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Elahe Salehi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nadine McCleary
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Kaitlen Reyes
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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21
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Cheng SM, Liu JL, Chen T, Bi YZ, Liu KY, Wang QY, Tang HX, Yang YH, Zhang XB, Hu RR, Liu SQ, Zhang K, Kong LB, Guo DL, Shu ZF, Hong F. [Establishment of human colon cancer transplantation tumor model in normal immune mice]. Zhonghua Zhong Liu Za Zhi 2021; 43:939-943. [PMID: 34530576 DOI: 10.3760/cma.j.cn112152-20190915-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Establishment of a new model of human primary colon cancer transplantation tumor in normal immune mice and to provide a reliable experimental animal model for studying the pathogenesis of colon cancer under normal immunity. Methods: Human colon cancer cells come from colon cancer patients who underwent surgery in the Affiliated Hospital of Jining Medical College in 2017. The mice in the cell control group were inoculated with phosphate buffered solution (PBS) containing colon cancer cells, the microcarrier control group was inoculated with PBS containing microcarrier 6, and the cell-microcarrier complex group was inoculated with the PBS containing colon cancer cell-microcarrier complex. The cells of each group were inoculated under the skin of the right axilla of mice by subcutaneous injection, and the time, size, tumor formation rate and pathological changes under microscope were recorded. The transplanted tumor tissue was immunohistochemically stained with the EnVisiion two-step method, and the tumor formation rate of the transplanted tumor was judged according to the proportion of positive cells in the visual field. The polymerase chain reaction (PCR) method was used to detect the expression of human-specific Alu sequence in mice tumor tissue. Results: After inoculation with tumor cells, the mice in the cell control group and the microcarrier control group did not die and did not form tumors; the mice in the cell-microcarrier complex group had palpable subcutaneous tumors in the right axillary subcutaneously on the 5th to 7th days after inoculation, and tumor formation rate is 67% (10/15), and the tumor volume can reach about 500 mm(3) 2 to 3 weeks after vaccination. The immunohistochemistry results showed that CK20, CDX-2 and carcinoembryonic antigen were all positively expressed. The PCR results showed that the expression of human-specific Alu sequence can be detected in the transplanted tumor tissue of tumor-bearing mice. Conclusion: Human primary colon cancer cells used microcarrier 6 as a carrier to form tumors in normal immunized mice, and successfully established a new model of human colon cancer transplantation tumor in normal immune mice.
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Affiliation(s)
- S M Cheng
- Jining Medical University Clinical Medical College, Jining 272000, China
| | - J L Liu
- The First Affiliated Hospital of Hebei North University, Cancer Institute, Zhangjiakou 075000, China
| | - T Chen
- Gastrointestinal Surgery, the Third Hospital of Jilin University, Changchun 130000, China
| | - Y Z Bi
- Department of Gastroenterology, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - K Y Liu
- Jining Medical University Clinical Medical College, Jining 272000, China
| | - Q Y Wang
- Department of Pathology, Affiliated Hospital of Jining Medical College, Jining 272000, China
| | - H X Tang
- Jining Medical University Clinical Medical College, Jining 272000, China
| | - Y H Yang
- Central Laboratory, Affiliated Hospital of Jining Medical College, Jining 272000, China
| | - X B Zhang
- Central Laboratory, Affiliated Hospital of Jining Medical College, Jining 272000, China
| | - R R Hu
- Department of Gastroenterology, Affiliated Hospital of Jining Medical College, Jining 272000, China
| | - S Q Liu
- Department of Gastroenterology, Affiliated Hospital of Jining Medical College, Jining 272000, China
| | - K Zhang
- Department of Gastrointestinal Surgery, the Second Hospital of Jilin University, Changchun 130000, China
| | - L B Kong
- Jining Medical University Clinical Medical College, Jining 272000, China
| | - D L Guo
- Jining Medical University Clinical Medical College, Jining 272000, China
| | - Z F Shu
- Shanghai Meifeng Biotechnology Co., Ltd, Shanghai 201203, China
| | - F Hong
- Central Laboratory, Affiliated Hospital of Jining Medical College, Jining 272000, China
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22
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Alessi JV, Ricciuti B, Jiménez-Aguilar E, Hong F, Wei Z, Nishino M, Plodkowski AJ, Sawan P, Luo J, Rizvi H, Carter BW, Heymach JV, Altan M, Hellmann M, Awad M. Outcomes to first-line pembrolizumab in patients with PD-L1-high (≥50%) non-small cell lung cancer and a poor performance status. J Immunother Cancer 2021; 8:jitc-2020-001007. [PMID: 32753547 PMCID: PMC7406027 DOI: 10.1136/jitc-2020-001007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with non-small cell lung cancer (NSCLC) and a poor Eastern Cooperative Oncology Group Performance Status (ECOG PS) have been excluded from phase III immunotherapy clinical trials. We sought to evaluate clinical outcomes to first-line pembrolizumab in patients with advanced NSCLC, a PD-L1 Tumor Proportion Score (TPS) of ≥50%, and an ECOG PS of 2. METHODS We performed a multicenter retrospective analysis of patients with metastatic NSCLC and a PD-L1 TPS of ≥50% (negative for genomic alterations in EGFR and ALK) who received treatment with first-line pembrolizumab. Clinical outcomes were compared in patients based on ECOG PS. RESULTS Among the 234 patients, 83.3% (n=195) had an ECOG PS of 0 or 1, and 16.7% (n=39) had an ECOG PS of 2. The baseline clinicopathological characteristics were balanced between the ECOG PS 0-1 vs 2 groups in terms of age, sex, tobacco use, histology, KRAS mutation status, presence of other potentially targetable driver mutations (BRAF, MET, HER2, RET), presence of brain metastases, and PD-L1 TPS distribution. Compared with patients with an ECOG PS of 0 or 1, patients with an ECOG PS of 2 had a significantly lower objective response rate (43.1% vs 25.6%; p=0.04), a numerically shorter median progression-free survival (6.6 months vs 4.0 months; HR 0.70 (95% CI 0.47 to 1.06); p=0.09), and a significantly shorter median overall survival (20.3 months vs 7.4 months; HR 0.42 (95% CI 0.26 to 0.68); p<0.001). On disease progression, patients with an ECOG PS of 2 were significantly less likely to receive second-line systemic therapy compared with patients with an ECOG PS of 0-1 (65% vs 22.2%, p=0.001). CONCLUSIONS A subset of patients with NSCLC and an ECOG PS of 2 can respond to first-line pembrolizumab. However, clinical outcomes in this population are often poor and use of second-line systemic therapy is infrequent.
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Affiliation(s)
- Joao V Alessi
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elizabeth Jiménez-Aguilar
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | - Fangxin Hong
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Zihan Wei
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mizuki Nishino
- Department of Radiology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter Sawan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jia Luo
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hira Rizvi
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brett W Carter
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Hellmann
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark Awad
- Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
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23
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Pozzar RA, Xiong N, Hong F, Wright AA, Goff BA, Underhill-Blazey ML, Tulsky JA, Hammer MJ, Berry DL. Perceived patient-centered communication, quality of life, and symptom burden in individuals with ovarian cancer. Gynecol Oncol 2021; 163:408-418. [PMID: 34454724 DOI: 10.1016/j.ygyno.2021.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe perceptions of patient-centered communication (PCC); assess whether physician specialty, patient characteristics, or health system characteristics are associated with PCC; and identify associations between PCC, health-related quality of life (HRQoL), and symptom burden among individuals with ovarian cancer. METHODS Cross-sectional, descriptive survey of English-speaking adults with ovarian cancer. PCC, HRQoL, and ovarian cancer symptom burden were assessed with the PCC-Ca-36, the FACT-G, and the FOSI-18, respectively. PCC-Ca-36 scores were summarized using descriptive statistics. Predictors of PCC-Ca-36, FACT-G, and FOSI-18 scores were identified using multiple linear regression. RESULTS Participants (n = 176) had a mean age of 59.4 years (SD = 12.1). The majority (65.9%) had advanced-stage disease, while 42.0% were receiving treatment. The mean PCC-Ca-36 total score was 4.09 (SD = 0.78) out of a possible 5, indicating participants often perceived that clinicians engaged in PCC. Among the PCC functions, participants reported that clinicians least often enabled patient self-management (M = 3.65, SD = 0.99), responded to emotions (M = 3.84, SD = 1.04), and managed uncertainty (M = 3.91, SD = 0.93). In multivariable analyses, neither physician specialty nor patient and health system characteristics were significantly associated with overall PCC. Greater overall PCC predicted better overall HRQoL; better social/family, emotional, and functional well-being; and lower overall and physical symptom burden (all p ≤ 0.05). CONCLUSION Greater PCC is significantly associated with better HRQoL and lower symptom burden among individuals with ovarian cancer. PRACTICE IMPLICATIONS Promotion of PCC is a promising strategy to improve patient-reported outcomes in the ovarian cancer care setting.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States.
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Alexi A Wright
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Barbara A Goff
- University of Washington, 1959 NE Pacific St., Seattle, WA 98115, United States
| | - Meghan L Underhill-Blazey
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States; University of Rochester, 255 Crittenden Blvd., Rochester, NY 14642, United States
| | - James A Tulsky
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Marilyn J Hammer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States
| | - Donna L Berry
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, United States; University of Washington, 1959 NE Pacific St., Seattle, WA 98115, United States
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24
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Mahadevan NR, Knelson EH, Wolff JO, Vajdi A, Saigí M, Campisi M, Hong D, Thai TC, Piel B, Han S, Reinhold BB, Duke-Cohan JS, Poitras MJ, Taus LJ, Lizotte PH, Portell A, Quadros V, Santucci AD, Murayama T, Cañadas I, Kitajima S, Akitsu A, Fridrikh M, Watanabe H, Reardon B, Gokhale PC, Paweletz CP, Awad MM, Van Allen EM, Lako A, Wang XT, Chen B, Hong F, Sholl LM, Tolstorukov MY, Pfaff K, Jänne PA, Gjini E, Edwards R, Rodig S, Reinherz EL, Oser MG, Barbie DA. Intrinsic Immunogenicity of Small Cell Lung Carcinoma Revealed by Its Cellular Plasticity. Cancer Discov 2021; 11:1952-1969. [PMID: 33707236 PMCID: PMC8338750 DOI: 10.1158/2159-8290.cd-20-0913] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [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: 06/26/2020] [Revised: 01/06/2021] [Accepted: 03/05/2021] [Indexed: 12/26/2022]
Abstract
Small cell lung carcinoma (SCLC) is highly mutated, yet durable response to immune checkpoint blockade (ICB) is rare. SCLC also exhibits cellular plasticity, which could influence its immunobiology. Here we discover that a distinct subset of SCLC uniquely upregulates MHC I, enriching for durable ICB benefit. In vitro modeling confirms epigenetic recovery of MHC I in SCLC following loss of neuroendocrine differentiation, which tracks with derepression of STING. Transient EZH2 inhibition expands these nonneuroendocrine cells, which display intrinsic innate immune signaling and basally restored antigen presentation. Consistent with these findings, murine nonneuroendocrine SCLC tumors are rejected in a syngeneic model, with clonal expansion of immunodominant effector CD8 T cells. Therapeutically, EZH2 inhibition followed by STING agonism enhances T-cell recognition and rejection of SCLC in mice. Together, these data identify MHC I as a novel biomarker of SCLC immune responsiveness and suggest novel immunotherapeutic approaches to co-opt SCLC's intrinsic immunogenicity. SIGNIFICANCE: SCLC is poorly immunogenic, displaying modest ICB responsiveness with rare durable activity. In profiling its plasticity, we uncover intrinsically immunogenic MHC Ihi subpopulations of nonneuroendocrine SCLC associated with durable ICB benefit. We also find that combined EZH2 inhibition and STING agonism uncovers this cell state, priming cells for immune rejection.This article is highlighted in the In This Issue feature, p. 1861.
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Affiliation(s)
- Navin R Mahadevan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Erik H Knelson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jacquelyn O Wolff
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amir Vajdi
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Maria Saigí
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Marco Campisi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Deli Hong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Tran C Thai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Brandon Piel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Saemi Han
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bruce B Reinhold
- Laboratory of Immunobiology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jonathan S Duke-Cohan
- Laboratory of Immunobiology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Michael J Poitras
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
- Experimental Therapeutics Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Luke J Taus
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patrick H Lizotte
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrew Portell
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Victor Quadros
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alison D Santucci
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Takahiko Murayama
- Blood Cell Development and Function Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Israel Cañadas
- Blood Cell Development and Function Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Shunsuke Kitajima
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Cell Biology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Aoi Akitsu
- Laboratory of Immunobiology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Maya Fridrikh
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hideo Watanabe
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brendan Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Prafulla C Gokhale
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
- Experimental Therapeutics Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Cloud P Paweletz
- Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mark M Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eliezer M Van Allen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ana Lako
- Translational Pathology, Bristol Myers Squibb, Trenton, New Jersey
| | - Xi-Tao Wang
- Translational Pathology, Bristol Myers Squibb, Trenton, New Jersey
| | - Benjamin Chen
- Translational Pathology, Bristol Myers Squibb, Trenton, New Jersey
| | - Fangxin Hong
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Y Tolstorukov
- Department of Informatics and Analytics, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kathleen Pfaff
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Pasi A Jänne
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Evisa Gjini
- Translational Pathology, Bristol Myers Squibb, Trenton, New Jersey
| | - Robin Edwards
- Translational Pathology, Bristol Myers Squibb, Trenton, New Jersey
| | - Scott Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
- Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ellis L Reinherz
- Laboratory of Immunobiology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Matthew G Oser
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - David A Barbie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
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Obeng-Gyasi S, Graham N, Kumar S, Lee JW, Cella D, Zhao F, Ip E, O'Connell N, Hong F, Peipert J, Gareen IF, Gray RJ, Wagner LI, Carlos R. Association between allostatic load, symptom burden and mortality in E1A11 trial for myeloma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12102] [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
12102 Background: Allostatic load (AL) conceptualizes the effects of chronic psychosocial adversity on physiologic dysregulation. To date, studies have shown an association between elevated AL and higher disease-specific and overall mortality among cancer patients; however, none have focused on multiple myeloma (MM) patients. We aim to understand the relationship between baseline AL, symptom burden, and mortality among patients enrolled in the E1A11 therapeutic trial in MM. Methods: ECOG-ACRIN E1A11 was a phase III RCT comparing induction with Bortezomib (Arm A) versus Carfilzomib (Arm B) in conjunction with Lenalidomide +Dexamethasone. AL included 7 biomarkers: BMI, alkaline phosphatase, creatinine, C-reactive protein, white blood cell count, albumin and creatinine clearance. AL7 was a composite summary score with a point was assigned for each biomarker value in the highest quartile, except for albumin and creatinine clearance, where a point was assigned for values in the lowest quartile. Endpoints included symptom burden at baseline and ̃1 month, non-completion of induction therapy, and overall survival (OS). Functional Assessment of Cancer Therapy Multiple Myeloma (FACT-MM) items assessed patient-reported symptom burden, including fatigue (item HI7), pain (GP4), and bother by side effects of treatment (GP5) on a 5-point Likert scale. Multivariable logistic regressions assessed the effect of AL7 (ranging 0-7) on high-pain, -fatigue, and -bother (QOL score > = 3 vs < 3), and non-completion of induction therapy. The effect of AL7 on OS was assessed using multivariable Cox regression. Regression covariates included study arm, age, sex, race, ECOG performance status, and the target symptom burden score at baseline. Results: The study cohort included 1087 patients. Mean baseline AL7 was 1.8 (±1.4). In adjusted analysis, a unit increase in AL7 was associated with a greater odds of high pain (OR 1.15, 95%CI [1.04-1.27]) and high fatigue (OR 1.19, 95%CI [1.07-1.32]) at baseline, which did not persist at ̃1 month (pain OR 0.96, 95%CI [0.84-1.10]; fatigue OR 1.03, 95%CI [0.91-1.16]). There was no association between AL7 and high side effect bother at baseline (OR 1.06, 95% CI [0.83-1.35]) or at ̃1 month (OR 1.06, 95%CI [0.90-1.24]). There was no association between AL7 and induction non-completion (OR 1.07, 95%CI [0.96-1.18]). Notably, each unit increase in AL7 was associated with higher mortality (HR 1.26, 95%CI [1.14-1.39]). Conclusions: Despite its association with fatigue and pain at baseline, AL7 was not associated with these symptoms at ̃1 month nor induction non-completion. However, elevated baseline AL7 was associated with poorer OS. AL composite score at baseline, which we interpret as a measure of physiological dysregulation associated with adverse social factors, may have implications on clinical outcomes within clinical trials despite presumed equal treatment access.
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Affiliation(s)
| | | | | | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - John Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilana F. Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Pozzar RA, Xiong N, Hong F, Wright AA, Goff BA, Tulsky JA, Underhill-Blazey M, Hammer MJ, Berry DL. Associations between patient-centered communication and quality of life in patients with ovarian cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12120] [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
12120 Background: Patient-centered communication (PCC) occurs when clinicians respond to patients’ needs, preferences, concerns, and emotions. The National Cancer Institute (NCI) Framework for PCC in Cancer Care highlights the potential of PCC to improve health-related quality of life (HRQoL), but to date few studies have empirically examined associations between PCC and HRQoL in patients with ovarian cancer. We assessed associations between perceived PCC and HRQoL in patients with ovarian cancer. Methods: Cross-sectional, descriptive survey of English-speaking adults with ovarian cancer recruited both online and from one NCI-designated cancer center. We assessed perceived PCC with the Patient-Centered Communication in Cancer Care (PCC-Ca)-36 and HRQoL with the Functional Assessment of Cancer Therapy: General (FACT-G). We used simple linear regression to identify univariate associations between participant characteristics, PCC-Ca-36 total, FACT-G total, and FACT-G subscale (physical, social and family, emotional, and functional well-being) scores. We identified significant predictors of FACT-G total and subscale scores by entering variables associated with each outcome at p ≤ 0.25 into a multiple linear regression model and using backward elimination. Results: One hundred seventy-six participants completed the survey. In multivariable analyses, older age, working (vs. not working), no current treatment (vs. any current treatment), and greater perceived PCC were associated with better overall HRQoL. Working and no current treatment were associated with better physical well-being. Older age, not being cared for by a gynecologic oncologist (vs. being cared for by a gynecologic oncologist), and greater perceived PCC were associated with better social and family well-being. Older age, being recruited online (vs. in clinic), and greater perceived PCC were associated with better emotional well-being. Older age, working, rural residence (vs. not), no current treatment, and greater perceived PCC were associated with better functional well-being (all p ≤ 0.05). Conclusions: Greater perceived PCC was significantly associated with better overall HRQoL and better social, emotional, and functional well-being in this cross-sectional study of patients with ovarian cancer. The NCI Framework for PCC in Cancer Care posits that PCC promotes HRQoL by strengthening the therapeutic alliance, enhancing social support, and improving patient knowledge. Although PCC is theorized to promote patient self-management, PCC was not significantly associated with physical well-being in this sample. Future research should (a) identify mediators of the associations between PCC and HRQoL; (b) examine inter-individual variability in characteristics that may compromise HRQoL; (c) and examine associations between PCC and HRQoL over time.
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Affiliation(s)
| | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
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Nowakowski GS, Hong F, Scott DW, Macon WR, King RL, Habermann TM, Wagner-Johnston N, Casulo C, Wade JL, Nagargoje GG, Reynolds CM, Cohen JB, Khan N, Amengual JE, Richards KL, Little RF, Leonard JP, Friedberg JW, Kostakoglu L, Kahl BS, Witzig TE. Addition of Lenalidomide to R-CHOP Improves Outcomes in Newly Diagnosed Diffuse Large B-Cell Lymphoma in a Randomized Phase II US Intergroup Study ECOG-ACRIN E1412. J Clin Oncol 2021; 39:1329-1338. [PMID: 33555941 PMCID: PMC8078264 DOI: 10.1200/jco.20.01375] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/08/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Lenalidomide combined with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) (R2CHOP) in untreated diffuse large B-cell lymphoma (DLBCL) has shown promising activity, particularly in the activated B-cell-like (ABC) subtype. Eastern Cooperative Oncology Group (ECOG)-ACRIN trial E1412 was a randomized phase II study comparing R2CHOP versus R-CHOP in untreated DLBCL. PATIENTS AND METHODS Patients with newly diagnosed DLBCL, stage II bulky-IV disease, International Prognostic Index (IPI) ≥ 2, and ECOG performance status ≤ 2 were eligible and randomly assigned 1:1 to R2CHOP versus R-CHOP for six cycles. Tumors were analyzed using the NanoString Lymph2Cx for cell of origin. The primary end point was progression-free survival (PFS) in all patients with the co-primary end point of PFS in ABC-DLBCL. Secondary end points included overall response rate (ORR), complete response (CR) rate, and overall survival (OS). RESULTS Three hundred forty-nine patients were enrolled; 280 patients (145 R2CHOP and 135 R-CHOP) were evaluable: 94 were ABC-DLBCL, 122 germinal center B-cell-like-DLBCL, 18 unclassifiable, and 46 unknowns. Baseline characteristics were well-balanced between arms, and the median age was 66 (range, 24-92); 70% of patients had stage IV disease; 34%, 43%, and 24% had IPI 2, 3, and 4 or 5, respectively. Myelosuppression was more common in the R2CHOP arm. The ORR and CR rate were 92% and 68% in R-CHOP and 97% (P = .06) and 73% (P = .43) in the R2CHOP arm, respectively. The median follow-up was 3.0 years; R2CHOP was associated with a 34% reduction in risk of progression or death versus R-CHOP (hazard ratio [HR], 0.66 95% CI, 0.43 to 1.01) and 3-year PFS of 73% versus 61%, one-sided P = .03, and an improvement in OS (83% and 75% at 3 years; HR, 0.67; one-sided P = .05). The PFS HR for R2CHOP was 0.67 for ABC-DLBCL, one-sided P = .1. CONCLUSION In this signal-seeking study, the addition of lenalidomide to R-CHOP (R2CHOP) improved outcomes in newly diagnosed DLBCL including patients with ABC-DLBCL.
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Affiliation(s)
| | - Fangxin Hong
- Department of Data Sciences, Dana Farber Cancer Institute, Boston, MA
| | - David W. Scott
- British Columbia Cancer Center for Lymphoid Cancer, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | - Nadia Khan
- Fox Case Cancer Center, Philadelphia, PA
| | | | | | | | | | | | | | - Brad S. Kahl
- Department of Medicine, Washington University School of Medicine, St Louis, MO
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Cao Y, Hong F, Conlon DM, Sidur L, Smith KM, Fang Y, Cuff CA, Kaymakcalan Z, Ruzek MC. Potential predictive biomarkers of adalimumab response in patients with hidradenitis suppurativa. Br J Dermatol 2021; 185:804-814. [PMID: 33811319 DOI: 10.1111/bjd.20097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adalimumab provides significant efficacy for patients with hidradenitis suppurativa (HS), which was demonstrated by at least 50% of patients achieving a clinical response by week 12 that was maintained through to week 168 in the PIONEER trials. OBJECTIVES To identify whether there are biomarkers that could predict adalimumab response, as well as markers that differentially respond to adalimumab in patients with HS. METHODS Baseline and week-12 plasma samples from the PIONEER studies were used to assess the levels of circulating proteins by multiplex and enzyme-linked immunosorbent assays. RESULTS Analyses revealed significantly higher high-sensitivity C-reactive protein (hs-CRP) and chemokine (C-C motif) ligand (CCL) 16 (HCC-4) levels in nonresponders at baseline and identified a multivariate response signature of calprotectin, fractalkine and HCC-4, reaching an 86% predictive accuracy rate for adalimumab response. Additionally, post-treatment reduction of plasma C-X-C motif chemokine ligand (CXCL)9, CXCL8 (interleukin-8) and CCL19 (macrophage inflammatory protein 3β) were greater in adalimumab super-responders than in nonresponders (P = 0·026, P = 0·044 and P = 0·026, respectively). These cytokines are involved in the recruitment of innate and adaptive inflammatory cells, and/or stimulation of certain inflammatory responses, suggesting that these pathways could be disease drivers in adalimumab nonresponders. CONCLUSIONS These initial results suggest HCC-4, calprotectin and fractalkine could be potential predictive biomarkers of adalimumab response in HS and identified possible tumour necrosis factor-independent disease pathways.
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Affiliation(s)
- Y Cao
- Immunology Discovery, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - F Hong
- Discovery and Early Pipeline Statistics, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - D M Conlon
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - L Sidur
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - K M Smith
- Immunology Systems Computational Biology, AbbVie Cambridge Research Center, Cambridge, MA, USA
| | - Y Fang
- DMPK-BA, AbbVie Redwood City, CA, USA
| | - C A Cuff
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - Z Kaymakcalan
- Immunology Discovery, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - M C Ruzek
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
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Hong F, Salmon S, Ong XY, Liew K, Koh Y, Young A, Ang B, Foo ML, Lee LC, Ling ML, Marimuthu K, Pada S, Poh BF, Thoon KC, Fisher D. Routine antiseptic baths and MRSA decolonization: diverse approaches across Singapore's acute-care hospitals. J Hosp Infect 2021; 112:87-91. [PMID: 33812940 DOI: 10.1016/j.jhin.2021.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
To determine the variation in practices on meticillin-resistant Staphylococcus aureus (MRSA) surveillance and management of MRSA-colonized patients amongst 17 acute healthcare facilities in Singapore, the Ministry of Health convened a sharing session with Infection Prevention and Control Leads. All hospitals practised close to universal MRSA entry swabbing in keeping with national policy. There were, however, major variations in the response to both positive and negative surveillance swabs across facilities including the role of routine antiseptic bathing and MRSA decolonization. Most undertaking decolonization considered its role to be in 'bioburden reduction' rather than longer-term clearance.
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Affiliation(s)
- F Hong
- Ministry of Health, Singapore
| | - S Salmon
- University of New South Wales, School of Population Health, UNSW Medicine, Australia; Indo-Pacific Centre for Health Security, Department of Foreign Affairs and Trade, Australia
| | - X Y Ong
- Ministry of Health, Singapore
| | - K Liew
- Ministry of Health, Singapore
| | - Y Koh
- Ministry of Health, Singapore
| | - A Young
- Ministry of Health, Singapore
| | - B Ang
- Infectious Diseases, Tan Tock Seng Hospital, Singapore; Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | - M L Foo
- Infection Control, Khoo Teck Puat Hospital, Singapore
| | - L C Lee
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - M L Ling
- Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - K Marimuthu
- Infectious Diseases, National Centre of Infectious Diseases, Singapore
| | - S Pada
- Infectious Diseases, Ng Teng Fong General Hospital, Singapore
| | - B F Poh
- Infection Prevention and Control, Tan Tock Seng Hospital, Singapore
| | - K C Thoon
- Infectious Diseases, KK Women's and Children's Hospital, Singapore
| | - D Fisher
- Division of Infectious Diseases, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Nishino M, Hong F, Ricciuti B, Hatabu H, Awad MM. Tumor Response Dynamics During First-Line Pembrolizumab Therapy in Patients With Advanced Non-Small-Cell Lung Cancer. JCO Precis Oncol 2021; 5:PO.20.00478. [PMID: 34250409 DOI: 10.1200/po.20.00478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 12/26/2022] Open
Abstract
The objectives of the study were to characterize the tumor burden dynamics on serial computed tomography scans in patients with advanced non-small-cell lung cancer treated with first-line pembrolizumab and to identify imaging markers for prolonged overall survival (OS). MATERIALS AND METHODS Eighty-eight patients treated with first-line pembrolizumab monotherapy were evaluated on serial computed tomography scans to characterize their quantitative tumor burden during therapy. Tumor burden dynamics were studied for the association with OS. RESULTS The overall response rate was 42% (37/88), with the median tumor burden changes at the best overall response of -18.3% (range, -100.0% to +103.6%). Response rates were higher in men than in women (P = .05) and in patients with higher programmed cell death ligand-1 expression levels (P = .02). Tumor burden stayed below the baseline burden throughout therapy in 55 patients (63%). In an 8-week landmark analysis, patients with tumor burden below the baseline burden during the first 8 weeks of therapy had longer OS compared with patients who had ≥ 0% increase (median OS, 30.7 v 16.2 months; hazard ratio [HR] = 0.44; P = .01). In the extended Cox models, patients whose tumor burden stayed below the baseline burden throughout therapy had significantly reduced hazards of death (HR = 0.41, P = .003, univariate; HR = 0.35, P = .02, multivariate). Only one patient (1.1%) experienced pseudoprogression with initial tumor increase and subsequent tumor regression. CONCLUSION In patients with advanced non-small-cell lung cancer treated with first-line single-agent pembrolizumab, tumor burden reduction below the baseline burden during therapy was an independent marker for prolonged OS, which may serve as a practical guide for treatment decisions.
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Affiliation(s)
- Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital, Boston, MA.,Department of Imaging, Dana-Farber Cancer Institute, Boston, MA
| | - Fangxin Hong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | - Biagio Ricciuti
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Boston, MA.,Department of Imaging, Dana-Farber Cancer Institute, Boston, MA
| | - Mark M Awad
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
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Pozzar RA, Hong F, Xiong N, Stopfer JE, Nayak MM, Underhill-Blazey M. Knowledge and psychosocial impact of genetic counseling and multigene panel testing among individuals with ovarian cancer. Fam Cancer 2021; 21:35-47. [PMID: 33751319 DOI: 10.1007/s10689-021-00240-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/19/2020] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
In a sample of individuals with ovarian cancer, we aimed to (a) identify factors associated with the psychosocial impact of genetic counseling and multigene panel testing, (b) identify factors associated with cancer genetics knowledge, and (c) summarize patient-reported recommendations to improve the genetic counseling and multigene panel testing process. Eligible participants in this secondary analysis of quantitative and qualitative survey data were English-speaking adults with ovarian cancer. Psychosocial impact was assessed using the Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire. Knowledge of cancer genetics was assessed using the KnowGene scale. Significant predictors of MICRA and KnowGene scores were identified using multiple regression. Open-ended survey item responses were analyzed using conventional content analysis. Eighty-seven participants met eligibility criteria. A positive genetic test result was associated with greater adverse psychosocial impact (B = 1.13, p = 0.002). Older age (B = - 0.07, p = 0.044) and being a member of a minority racial or ethnic group (B = - 3.075, p = 0.033) were associated with lower knowledge, while a personal history of at least one other type of cancer (B = 1.975, p = 0.015) was associated with higher knowledge. In open-ended item responses, participants wanted clinicians to assist with family communication, improve result disclosure, and enhance patient and family understanding of results. A subset of individuals with ovarian cancer who receive a positive genetic test result may be at risk for adverse psychosocial outcomes. Tailored cancer genetics education is necessary to promote the equitable uptake of targeted ovarian cancer treatment and risk-reducing therapies. Interventions to enhance patient-clinician communication in this setting are a research priority.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.
| | - Fangxin Hong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Niya Xiong
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Jill E Stopfer
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Manan M Nayak
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA
| | - Meghan Underhill-Blazey
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA, 02215, USA.,University of Rochester, 601 Elmwood Ave., Rochester, NY, 14642, USA
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Knoerl R, Mazzola E, Hong F, Salehi E, McCleary N, Ligibel J, Reyes K, Berry DL. Exploring the impact of a decision support algorithm to improve clinicians' chemotherapy-induced peripheral neuropathy assessment and management practices: a two-phase, longitudinal study. BMC Cancer 2021; 21:236. [PMID: 33676431 PMCID: PMC7937225 DOI: 10.1186/s12885-021-07965-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) negatively affects physical function and chemotherapy dosing, yet, clinicians infrequently document CIPN assessment and/or adhere to evidence-based CIPN management in practice. The primary aims of this two-phase, pre-posttest study were to explore the impact of a CIPN clinician decision support algorithm on clinicians' frequency of CIPN assessment documentation and adherence to evidence-based management. METHODS One hundred sixty-two patients receiving neurotoxic chemotherapy (e.g., taxanes, platinums, or bortezomib) answered patient-reported outcome measures on CIPN severity and interference prior to three clinic visits at breast, gastrointestinal, or multiple myeloma outpatient clinics (n = 81 usual care phase [UCP], n = 81 algorithm phase [AP]). During the AP, study staff delivered a copy of the CIPN assessment and management algorithm to clinicians (N = 53) prior to each clinic visit. Changes in clinicians' CIPN assessment documentation (i.e., index of numbness, tingling, and/or CIPN pain documentation) and adherence to evidence-based management at the third clinic visit were compared between the AP and UCP using Pearson's chi-squared test. RESULTS Clinicians' frequency of adherence to evidence-based CIPN management was higher in the AP (29/52 [56%]) than the UCP (20/46 [43%]), but the change was not statistically significant (p = 0.31). There were no improvements in clinicians' CIPN assessment frequency during the AP (assessment index = 0.5440) in comparison to during the UCP (assessment index = 0.6468). CONCLUSIONS Implementation of a clinician-decision support algorithm did not significantly improve clinicians' CIPN assessment documentation or adherence to evidence-based management. Further research is needed to develop theory-based implementation interventions to bolster the frequency of CIPN assessment and use of evidence-based management strategies in practice. TRIAL REGISTRATION ClinicalTrials.Gov, NCT03514680 . Registered 21 April 2018.
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Affiliation(s)
| | - Emanuele Mazzola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elahe Salehi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nadine McCleary
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Kaitlen Reyes
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
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Filson CP, Hong F, Xiong N, Pozzar R, Halpenny B, Berry DL. Reply to What is a good medical choice? Cancer 2021; 127:1935-1936. [PMID: 33544391 DOI: 10.1002/cncr.33442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia.,Department of Urology, Atlanta VA Medical Center, Decatur, Georgia
| | - Fangxin Hong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Barbara Halpenny
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.,Department of Urology, University of Washington, Seattle, Washington
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Kalinsky K, Hong F, McCourt CK, Sachdev JC, Mitchell EP, Zwiebel JA, Doyle LA, McShane LM, Li S, Gray RJ, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Conley BA, O’Dwyer PJ, Harris LN, Arteaga CL, Chen AP, Flaherty KT. Effect of Capivasertib in Patients With an AKT1 E17K-Mutated Tumor: NCI-MATCH Subprotocol EAY131-Y Nonrandomized Trial. JAMA Oncol 2021; 7:271-278. [PMID: 33377972 PMCID: PMC7774047 DOI: 10.1001/jamaoncol.2020.6741] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 06/10/2020] [Accepted: 09/30/2020] [Indexed: 01/15/2023]
Abstract
Importance In the National Cancer Institute Molecular Analysis for Therapy Choice (NCI-MATCH) trial, agents targeting genetic tumor abnormalities are administered to patients. In the NCI-MATCH subprotocol EAY131-Y trial, patients with an AKT1 E17K-mutated metastatic tumor received the pan-AKT inhibitor capivasertib. Objective To assess the objective response rate (ORR) of capivasertib in patients with an AKT1 E17K-mutated tumor. Design, Setting, and Participants Between July 13, 2016, and August 10, 2017, patients in the NCI-MATCH trial were enrolled and assigned to the subprotocol EAY131-Y nonrandomized trial. Patients included adults with an AKT1 E17K-mutated metastatic tumor that had progressed with standard treatment, and these patients were assigned to receive capivasertib. Tumor assessments were repeated every 2 cycles. Data analysis of this evaluable population was performed from November 8, 2019, to March 12, 2020. Interventions The study treatment was capivasertib, 480 mg, orally twice daily for 4 days on and 3 days off weekly in 28-day cycles until disease progression or unacceptable toxic effect. If patients continued hormone therapy for metastatic breast cancer, the capivasertib dose was 400 mg. Main Outcomes and Measures The primary end point was the ORR (ie, complete response [CR] and partial response) according to the Response Evaluation Criteria in Solid Tumors criteria, version 1.1. Secondary end points included progression-free survival (PFS), 6-month PFS, overall survival, and safety. Results In total, 35 evaluable and analyzable patients were included, of whom 30 were women (86%), and the median (range) age was 61 (32-73) years. The most prevalent cancers were breast (18 [51%]), including 15 patients with hormone receptor (HR)-positive/ERBB2-negative and 3 with triple-negative disease, and gynecologic (11 [31%]) cancers. The ORR rate was 28.6% (95% CI, 15%-46%). One patient with endometrioid endometrial adenocarcinoma achieved a CR and remained on therapy at 35.6 months. Patients with confirmed partial response had the following tumor types: 7 had HR-positive/ERBB2-negative breast cancer, 1 had uterine leiomyosarcoma, and 1 had oncocytic parotid gland carcinoma and continued receiving treatment at 28.8 months. Sixteen patients (46%) had stable disease as the best response, 2 (6%) had progressive disease, and 7 (20%) were not evaluable. With a median follow-up of 28.4 months, the overall 6-month PFS rate was 50% (95% CI, 35%-71%). Capivasertib was discontinued because of adverse events in 11 of 35 patients (31%). Grade 3 treatment-related adverse events included hyperglycemia (8 [23%]) and rash (4 [11%]). One grade 4 hyperglycemic adverse event was reported. Conclusions and Relevance This nonrandomized trial found that, in patients with an AKT1 E17K-mutated tumor treated with capivasertib, a clinically significant ORR was achieved, including 1 CR. Clinically meaningful activity with single-agent capivasertib was demonstrated in refractory malignant neoplasms, including rare cancers. Trial Registration ClinicalTrials.gov Identifier: NCT00700882.
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Affiliation(s)
- Kevin Kalinsky
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Now with Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Fangxin Hong
- Department of Biostatistics, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn K. McCourt
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jasgit C. Sachdev
- Department of Medicine, TGen/HonorHealth Research Institute, Scottsdale, Arizona
| | - Edith P. Mitchell
- Department of Medicine, Thomas Jefferson University Health, Philadelphia, Pennsylvania
| | - James A. Zwiebel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - L. Austin Doyle
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Lisa M. McShane
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Shuli Li
- Department of Biostatistics, Dana-Farber Cancer Institute–ECOG (Eastern Cooperative Oncology Group)–ACRIN (American College of Radiology Imaging Network) Biostatistics Center, Boston, Massachusetts
| | - Robert J. Gray
- Department of Biostatistics, Dana-Farber Cancer Institute–ECOG (Eastern Cooperative Oncology Group)–ACRIN (American College of Radiology Imaging Network) Biostatistics Center, Boston, Massachusetts
| | - Larry V. Rubinstein
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - David Patton
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Paul M. Williams
- Division of Cancer Therapeutics and Diagnosis, Molecular Characterization and Assay Development Laboratory, Leidos, Frederick, Maryland
| | - Stanley R. Hamilton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Barbara A. Conley
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Peter J. O’Dwyer
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Lyndsay N. Harris
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Carlos L. Arteaga
- Department of Medicine, University of Texas Southwestern Simmons Cancer Center, Dallas
| | - Alice P. Chen
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
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Abstract
The pathogenesis of hepatic encephalopathy (HE) has been generally linked to blood ammonia, gamma-aminobutyric acid and serotonin. However, the exact mechanism remains unclear. In the present study, we aimed to explore the role of hippocampal dopamine (DA) and its receptors in the pathogenesis of HE through the use of behavioral testing, western blotting, and immunofluorescence staining in normal rats, HE model rats and rats treated with the DA precursor-levodopa (L-DOPA). HE model rats manifested fibrotic livers and showed serious behavioral disorders. They also had significantly lower hippocampal DA content and increased expression of both D1 and D2 receptors relative to normal rats. After treatment with L-DOPA, the HE model rats showed normal behavior and expression of D1 returned to normal levels. Furthermore, pretreatment with the D1 antagonist SCH23390 blocked the therapeutic effect of L-DOPA on behavior in HE model rats. Taken together, these results clarify that the decrease in hippocampal DA plays a role in the pathogenesis of HE and that this effect is mediated by D1. These findings provide new evidence for the pathogenesis of HE.
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Affiliation(s)
- B Chen
- School of Preclinical Medicine, Wannan Medical College, Wuhu, China.
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Berry DL, Hong F, Blonquist TM, Halpenny B, Xiong N, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M. Decision regret, adverse outcomes, and treatment choice in men with localized prostate cancer: Results from a multi-site randomized trial. Urol Oncol 2020; 39:493.e9-493.e15. [PMID: 33353864 DOI: 10.1016/j.urolonc.2020.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Men diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted the secondary outcome of post-treatment decision regret. METHODS Participants were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care prior to a final treatment decision. Symptoms were measured just before randomization and 6 months later; decision regret was measured at 6 months along with records review to ascertain treatment choices. Regression modeling explored associations between baseline variables including race and D`Amico risk, study group, and 6-month variables regret, choice, and symptoms. RESULTS At 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201 of 257 (78%) completely answered the regret scale. Regret was not significantly different between participants randomized to the P3P intervention compared to the control group (P = 0.360). In univariate analyses, we found that Black men, men with hormonal symptoms, and men with bowel symptoms reported significantly higher decision regret (all P < 0.01). Significant interactions were detected between race and study group (intervention vs. usual care) in the multivariable model; use of the Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (P = 0.037). Interactions between regret, symptoms and treatment revealed that (1) men choosing definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others; and (2) men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others. CONCLUSION The Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. TRIAL REGISTRATION NCT01844999.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Nursing, Seattle, WA.
| | | | | | | | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | | | - Seth Wolpin
- University of Washington School of Nursing, Seattle, WA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Medical Center, Worchester, MA
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Filson CP, Hong F, Xiong N, Pozzar R, Halpenny B, Berry DL. Decision support for men with prostate cancer: Concordance between treatment choice and tumor risk. Cancer 2020; 127:203-208. [PMID: 33119142 DOI: 10.1002/cncr.33241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Decision support tools improve decisional conflict and elicit patient preferences related to prostate cancer treatment. It was hypothesized that men using the Personal Patient Profile-Prostate (P3P) would be more likely to pursue guideline-concordant treatment. METHODS Men from a trial assessing the P3P decision support intervention were identified. The primary exposure was allocation to P3P (vs usual care), and the outcome was appropriate treatment per guidelines (eg, low risk = active surveillance). It was assessed whether providers recommended against any treatment options (ie, restricted). A multivariable model was fit for men with low-risk cancer that estimated the odds of the outcome of interest. RESULTS This study identified 295 men in the cohort: 113 (38%) had low-risk disease, 119 (40%) had favorable intermediate-risk disease, and 63 (21%) had unfavorable intermediate-risk disease. Among low-risk patients, more men pursued active surveillance after using P3P whether they were given unrestricted (62% vs 54% with usual care; P = .54) or restricted options (71% vs 59% with usual care; P = .34). After adjustments, only Black race (odds ratio [OR], 0.31; 95% CI, 0.11-0.89) and restricted options (OR, 0.23; 95% CI, 0.08-0.65) had an inverse association with the receipt of surveillance for patients with low-risk prostate cancer. An impact associated with P3P versus usual care (OR, 0.89; 95% CI, 0.36-2.20) was not observed. CONCLUSIONS Among men in a trial assessing a decision support tool, Black race and restricted treatment options were associated with less use of active surveillance for low-risk prostate cancer. Although the P3P instrument ameliorates decisional conflict, its use was not associated with more appropriate alignment of treatment with disease risk.
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Affiliation(s)
- Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute, Emory Healthcare, Atlanta, Georgia.,Department of Urology, Atlanta VA Medical Center, Decatur, Georgia
| | - Fangxin Hong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Barbara Halpenny
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Donna L Berry
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington.,Department of Urology, University of Washington, Seattle, Washington
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Pozzar R, Hammer MJ, Underhill-Blazey M, Wright AA, Tulsky JA, Hong F, Gundersen DA, Berry DL. Threats of Bots and Other Bad Actors to Data Quality Following Research Participant Recruitment Through Social Media: Cross-Sectional Questionnaire. J Med Internet Res 2020; 22:e23021. [PMID: 33026360 PMCID: PMC7578815 DOI: 10.2196/23021] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/26/2023] Open
Abstract
Background Recruitment of health research participants through social media is becoming more common. In the United States, 80% of adults use at least one social media platform. Social media platforms may allow researchers to reach potential participants efficiently. However, online research methods may be associated with unique threats to sample validity and data integrity. Limited research has described issues of data quality and authenticity associated with the recruitment of health research participants through social media, and sources of low-quality and fraudulent data in this context are poorly understood. Objective The goal of the research was to describe and explain threats to sample validity and data integrity following recruitment of health research participants through social media and summarize recommended strategies to mitigate these threats. Our experience designing and implementing a research study using social media recruitment and online data collection serves as a case study. Methods Using published strategies to preserve data integrity, we recruited participants to complete an online survey through the social media platforms Twitter and Facebook. Participants were to receive $15 upon survey completion. Prior to manually issuing remuneration, we reviewed completed surveys for indicators of fraudulent or low-quality data. Indicators attributable to respondent error were labeled suspicious, while those suggesting misrepresentation were labeled fraudulent. We planned to remove cases with 1 fraudulent indicator or at least 3 suspicious indicators. Results Within 7 hours of survey activation, we received 271 completed surveys. We classified 94.5% (256/271) of cases as fraudulent and 5.5% (15/271) as suspicious. In total, 86.7% (235/271) provided inconsistent responses to verifiable items and 16.2% (44/271) exhibited evidence of bot automation. Of the fraudulent cases, 53.9% (138/256) provided a duplicate or unusual response to one or more open-ended items and 52.0% (133/256) exhibited evidence of inattention. Conclusions Research findings from several disciplines suggest studies in which research participants are recruited through social media are susceptible to data quality issues. Opportunistic individuals who use virtual private servers to fraudulently complete research surveys for profit may contribute to low-quality data. Strategies to preserve data integrity following research participant recruitment through social media are limited. Development and testing of novel strategies to prevent and detect fraud is a research priority.
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Affiliation(s)
- Rachel Pozzar
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Marilyn J Hammer
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Meghan Underhill-Blazey
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States.,School of Nursing, University of Rochester, Rochester, NY, United States
| | - Alexi A Wright
- McGraw/Patterson Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Fangxin Hong
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Daniel A Gundersen
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Donna L Berry
- Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, United States.,Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
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Diefenbach CS, Hong F, Ambinder RF, Cohen JB, Robertson MJ, David KA, Advani RH, Fenske TS, Barta SK, Palmisiano ND, Svoboda J, Morgan DS, Karmali R, Sharon E, Streicher H, Kahl BS, Ansell SM. Ipilimumab, nivolumab, and brentuximab vedotin combination therapies in patients with relapsed or refractory Hodgkin lymphoma: phase 1 results of an open-label, multicentre, phase 1/2 trial. Lancet Haematol 2020; 7:e660-e670. [PMID: 32853585 DOI: 10.1016/s2352-3026(20)30221-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recognising that the immune suppressive microenvironment promotes tumour growth in Hodgkin lymphoma, we hypothesised that activating immunity might augment the activity of targeted chemotherapy. We evaluated the safety and activity of combinations of brentuximab vedotin with nivolumab or ipilimumab, or both in patients with relapsed or refractory Hodgkin lymphoma. METHODS In this multicentre, open-label, phase 1/2 trial, patients with relapsed or refractory Hodgkin lymphoma aged 18 years or older who had relapsed after at least one line of therapy, with an Eastern Cooperative Oncology Group performance status of 2 or lower, and adequate organ and marrow function, with no pulmonary dysfunction were eligible for inclusion. Phase 1 primary objectives were to determine the maximum tolerated dose and dose limiting toxicities of brentuximab vedotin combined with ipilimumab (ipilimumab group), nivolumab (nivolumab group), or both (triplet therapy group) using a 3 + 3 dose escalation design with expansion cohorts. During the dose escalation phase, patients were enrolled sequentially into one of six cohorts: in the ipilimumab group fixed brentuximab vedotin 1·8 mg/kg with ipilimumab 1 mg/kg (cohort A) or 3 mg/kg (cohort B); in the nivolumab group fixed nivolumab 3 mg/kg with brentuximab vedotin 1·2 mg/kg (cohort D) or 1·8 mg/kg (cohort E); and in the triplet therapy group fixed nivolumab 3 mg/kg and ipilimumab 1 mg/kg with brentuximab vedotin 1·2 mg/kg (cohort G) or 1·8 mg/kg (cohort H). Additional patients were enrolled in the expansion phase at the same doses of cohorts B, E, and H. All drugs were given intravenously; brentuximab vedotin and nivolumab were given every 3 weeks, ipilimumab was given every 6 weeks in the ipilimumab group and every 12 weeks in the triplet therapy group. All eligible and treated patients were included in the analysis. This phase 1/2 study is registered with ClinicalTrials.gov, NCT01896999. The phase 2, randomised portion of the trial is still enrolling. FINDINGS Between March 7, 2014, and Dec 28, 2017, 64 patients were enrolled; two patients in the ipilimumab group and one patient in the nivolumab group were excluded due to ineligibility after enrolment and 61 were evaluable. A total of six dose limiting toxicities were reported in four patients, and the doses used in cohorts B, E, and H were established as maximum tolerated doses and patients were subsequently enrolled onto expansion cohorts (C, F, and I) with these schedules. There were ten (43%) grade 3-4 treatment related adverse events in the ipilimumab group, three (16%) in the nivolumab group, and 11 (50%) in the triplet therapy group including: eight (13%) of 64 patients reporting rash, and colitis, gastritis, pancreatitis and arthritis, and diabetic ketoacidosis each occurring in one (2%) patient. There were two (3%) treatment related deaths, one in the nivolumab group and one in the triplet therapy group. The overall response rate was 76% (95% CI 53-92) in the ipilimumab group, 89% (65-99) in the nivolumab group, and 82% (60-95) in the triplet therapy group, and the complete response rate was 57% (95% CI 34-78%) in the ipilimumab group, 61% (36-83%) in the nivolumab group, and 73% (50-89%) in the triplet therapy group. With a median follow-up of 2·6 years (IQR 1·8-2·9) in the ipilimumab group, 2·4 years (2·2-2·6) in the nivolumab group, and 1·7 years (1·6-1·9) in the triplet therapy group, median progression-free survival is 1·2 years (95% CI 1·7-not reached) in the ipilimumab group, but was not reached in the other two treatment groups. Median overall survival has not been reached in any of the groups. INTERPRETATION There are clear differences in activity and toxicity of the three combination regimens. The tolerability and preliminary activity for the two most active regimens, brentuximab vedotin with nivolumab and the triplet therapy, are being compared in a randomised phase 2 trial (NCT01896999). FUNDING Eastern Cooperative Oncology Group-American College of Radiology Imaging Network and the National Cancer Institute of the National Institutes of Health.
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Affiliation(s)
| | - Fangxin Hong
- Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Biostatistics Center, Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Kevin A David
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey, New Jersey, NJ, USA
| | | | - Timothy S Fenske
- Division of Hematology and Oncology, Froedtert and the Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Stefan K Barta
- Divison of Hematology and Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil D Palmisiano
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jakub Svoboda
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Morgan
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reem Karmali
- Robert H Lurie Comprehensive Cancer Center, Northwestern University, Evanston, IL, USA
| | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethseda, MD, USA
| | - Howard Streicher
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethseda, MD, USA
| | - Brad S Kahl
- School of Medicine, Washington University, St Louis, MO, USA
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Underhill-Blazey M, Blonquist T, Chittenden A, Pozzar R, Nayak M, Lansang K, Hong F, Garber J, Stopfer JE. Informing models of cancer genetics care in the era of multigene panel testing with patient-led recommendations. J Genet Couns 2020; 30:268-282. [PMID: 32851753 DOI: 10.1002/jgc4.1317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022]
Abstract
The study describes patient-reported experiences and recommendations to improve the genetic counseling and multigene panel testing (MGPT) process. A descriptive mixed-method study with concurrently collected and integrated qualitative and quantitative data was conducted. Eligible participants were English-speaking adults with a breast or gynecologic cancer diagnosis who had received genetic counseling and testing with a MGPT from one Comprehensive Cancer Center. Satisfaction with the genetic counseling, genetic knowledge using a recently validated scale (KnowGene), the multidimensional impact of cancer risk assessment (MICRA), family communication, and the association with demographic factors were evaluated. To supplement the large quantitative data set, qualitative focus group responses and open-ended text items were collected. Univariate and multivariable associations between each outcome of interest and personal characteristics were assessed. Qualitative data were content-analyzed. 603 participants completed the survey (48% response rate) and 10 individuals participated in the focus groups. Participants were mostly Caucasian, educated with a college degree or more, and female with median age 58 (24-91), and 78% of participants had a breast cancer diagnosis. Of all individuals undergoing genetic testing using a MGPT, 13% had a pathogenic variant identified, and 30% had a variant of uncertain significance (VUS). Overall, participants reported satisfaction with the genetic counseling and testing process (mean 36.9 [SD 4.7]). On average, participants had 7 incorrect answers out of 19 on the genetic knowledge scale (mean 12.3 [SD 3.4]). MICRA scores showed overall low levels of distress and uncertainty, as well as positive experiences, with wide variability (median 17 [0-84]). Age, marital status, education level, type of cancer diagnosis, and genetic testing results were significantly associated with outcomes. Most participants communicated genetic testing results to mainly female first-degree relatives. A wide range of individual preferences affecting overall satisfaction, or suggestions for improvement were shared. As new models of streamlined cancer genetic services are being clinically implemented, approaches should continue to assess and tailor the process based on patients' informational and emotional needs.
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Affiliation(s)
- Meghan Underhill-Blazey
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA.,School of Nursing, University of Rochester, Rochester, NY, USA
| | - Traci Blonquist
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anu Chittenden
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Manan Nayak
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kristina Lansang
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fangxin Hong
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Judy Garber
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jill E Stopfer
- Cancer Genetics and Prevention Program, Dana-Farber Cancer Institute, Boston, MA, USA
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Evens AM, Hong F, Habermann TM, Advani RH, Gascoyne RD, Witzig TE, Quon A, Ranheim EA, Ansell SM, Cheema PS, Dy PA, O'Brien TE, Winter JN, Cescon TP, Chang JE, Kahl BS. A Three-Arm Randomized Phase II Study of Bendamustine/Rituximab with Bortezomib Induction or Lenalidomide Continuation in Untreated Follicular Lymphoma: ECOG-ACRIN E2408. Clin Cancer Res 2020; 26:4468-4477. [PMID: 32532790 DOI: 10.1158/1078-0432.ccr-20-1345] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE We sought to improve upon frontline bendamustine/rituximab (BR) induction therapy followed by rituximab maintenance in untreated high-risk follicular lymphoma (FL). PATIENTS AND METHODS Patients were randomized to BR induction followed by 2-year rituximab maintenance (BR-R), BR with bortezomib and rituximab maintenance (BVR-R), or BR followed by lenalidomide (1 year) with rituximab maintenance (BR-LR). Dual primary objectives were complete remission (CR) rate and 1-year disease-free survival (DFS); 289 patients enrolled (NCT01216683). RESULTS For induction, 92%, 87%, and 86% of patients randomized to BR-R, BVR-R, or BR-LR received six cycles, respectively. CR rate with BR versus BVR induction was 62% versus 75%, respectively (P = 0.04). One-year DFS rates with BR-R versus BR-LR were 85% versus 67%, respectively (P = 0.0009). This was due to an imbalance in CR rates post-BR induction and discontinuation due to adverse events (AEs). The most common grade 3-4 AEs for BVR versus BR were neutropenia and sensory neuropathy (12% vs <1%); 83% of the latter occurred with intravenous bortezomib. The most common grade 3-4 AEs related to LR versus rituximab maintenance were neutropenia 66% versus 21%, respectively (P < 0.0001), and febrile neutropenia 10% versus 2%, respectively (P = 0.05). The overall treatment-related mortality was 1.4%. With 5-year median follow-up, 3-year PFS rates for BR-R, BVR-R, and BR-LR were 77%, 82%, and 76%, respectively (P = 0.36) with OS rates of 87%, 90%, and 84%, respectively (P = 0.79). For prognostication, CR rate and POD-24 were associated with survival. CONCLUSIONS Altogether, neither bortezomib added to BR induction nor lenalidomide added to rituximab maintenance immediately post-BR induction is recommended in untreated FL.
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Affiliation(s)
- Andrew M Evens
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey.
| | - Fangxin Hong
- Dana Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, Massachusetts
| | | | | | | | | | - Andrew Quon
- University of California at Los Angeles, California
| | | | | | | | - Philip A Dy
- Decatur Memorial Hospital, Effingham, Illinois
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Chae YK, Hong F, Vaklavas C, Cheng HH, Hammerman P, Mitchell EP, Zwiebel JA, Ivy SP, Gray RJ, Li S, McShane LM, Rubinstein LV, Patton D, Williams PM, Hamilton SR, Mansfield A, Conley BA, Arteaga CL, Harris LN, O'Dwyer PJ, Chen AP, Flaherty KT. Phase II Study of AZD4547 in Patients With Tumors Harboring Aberrations in the FGFR Pathway: Results From the NCI-MATCH Trial (EAY131) Subprotocol W. J Clin Oncol 2020; 38:2407-2417. [PMID: 32463741 DOI: 10.1200/jco.19.02630] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE NCI-MATCH is a nationwide, histology-agnostic, signal-finding, molecular profile-driven trial for patients with refractory cancers, lymphomas, or myelomas. Patients with tumors harboring actionable aberration(s) in fibroblast growth factor receptor (FGFR) 1-3 were treated with AZD4547, an oral FGFR1-3 inhibitor. METHODS Patients' tumors were screened by next-generation sequencing for predefined FGFR amplification, activating mutations, or fusions. Patients were treated with AZD4547, 80 mg orally twice daily until progression of disease or drug intolerance. A response rate of 16% was considered promising. RESULTS Between July 2016 and June 2017, 70 patients were assigned and 48 received protocol therapy and are eligible for analysis. Patients' tumors harbored FGFR1 or FGFR2 amplification (n = 20), FGFR2 or FGFR3 single-nucleotide variants (n = 19), or FGFR1 or FGFR3 fusions (n = 9). The most common primary tumors were breast (33.3%), urothelial (12.5%), and cervical cancer (10.4%).Grade 3 adverse events were consistent with those described in previous clinical trials. Confirmed partial responses were seen in 8% (90% CI, 3% to 18%) and were observed only in patients whose tumors harbored FGFR1-3 point mutations or fusions. Stable disease was observed in 37.5% (90% CI, 25.8% to 50.4%). The median progression-free survival (PFS) was 3.4 months, and the 6-month PFS rate was 15% (90% CI, 8% to 31%). For patients with tumors harboring FGFR fusions, the response rate was 22% (90% CI, 4.1% to 55%), and 6-month PFS rate was 56% (90% CI, 31% to 100%). CONCLUSION Preliminary signals of activity appeared to be limited to cancers harboring FGFR activating mutations and fusions, although AZD4547 did not meet the primary end point. Different FGFR somatic alterations may confer different levels of signaling potency and/or oncogene dependence.
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Affiliation(s)
| | - Fangxin Hong
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Christos Vaklavas
- University of Alabama at Birmingham, Birmingham, AL.,Huntsman Cancer Institute of the University of Utah, Salt Lake City, UT
| | | | | | | | - James A Zwiebel
- Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - S Percy Ivy
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Robert J Gray
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Shuli Li
- Dana Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Lisa M McShane
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - Larry V Rubinstein
- Biometric Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - David Patton
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, Bethesda, MD
| | | | | | | | - Barbara A Conley
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Lyndsay N Harris
- Cancer Diagnosis Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | | | - Alice P Chen
- Investigational Drug Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
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Zhao F, Peipert J, Lee JW, Hong F, Ip E, Gareen IF, O'Connell N, Carlos R, Mayer IA, Miller K, Partridge AH, Shanafelt TD, Stewart AK, Tarhini AA, Thomas ML, Weiss M, Sparano JA, Cella D, Gray RJ, Wagner LI. Predictive value of bother by side effects of treatment prior to protocol therapy for early treatment discontinuation in clinical trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19132 Background: The Functional Assessment of Cancer Therapy–General has an item about patient tolerability of treatment: “I am bothered by side effects of treatment” (GP5). We examined the predictive value of this single item for early treatment discontinuation in clinical trials. Methods: GP5 level prior to protocol therapy (rated using a 5-point Likert scale) and treatment start/end dates and off treatment reason data at each treatment phase were drawn from five phase III clinical trials conducted by ECOG-ACRIN. In the present analysis, GP5 was dichotomized as 0 = “Not at all”/“A little bit” and 1 = “Somewhat”/“Quite a bit”/“Very Much”. Early treatment discontinuation was defined either as receiving less than protocol specified cycles of treatment when maximum cycles specified in the protocol (E1A06 induction, E1912 induction, E1609 induction, E1105 induction, E5103 adjuvant), analyzed using logistic regression via odds ratio [OR]), or treatment cessation for reasons other than progressive disease or death when treatment continued until progression or intolerability (E1A06 maintenance, E1912 maintenance, E1609 maintenance, E1105 maintenance), analyzed using Cox proportional hazard model via hazard ratio [HR]. Results: GP5 prior to treatment was significantly associated with early discontinuation of E1A06 maintenance, E1609 maintenance, E1912 maintenance, and E1912 induction. No significant association was found for other therapies examined in the study. Conclusions: High GP5 level prior to treatment is associated with higher likelihood of early treatment discontinuation in patients who have received previous treatment. The limited predictive value of GP5 for treatment naïve patients is more limited, serial on-treatment assessment should be considered in this setting. Clinical trial information: NCT00602641 . [Table: see text]
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Affiliation(s)
| | - John Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ilana F Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Kathy Miller
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | - Ahmad A. Tarhini
- H. Lee Moffitt Comprehensive Cancer Center and Research Institute, Tampa, FL
| | | | | | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | | | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
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44
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Alessi JVM, Ricciuti B, Jimenez Aguilar E, Hong F, Wei Z, Nishino M, Plodkowski AJ, Sawan P, Luo J, Rizvi H, Carter BW, Heymach J, Altan M, Hellmann MD, Awad MM. Outcomes to first-line pembrolizumab in patients with PD-L1-high (≥50%) non-small-cell lung cancer and a poor performance status. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9568] [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
9568 Background: Patients with non-small cell lung cancer (NSCLC) and a poor Eastern Cooperative Oncology Group performance status (ECOG PS) have been excluded from immunotherapy clinical trials. We sought to evaluate clinical outcomes to first-line pembrolizumab in patients with advanced NSCLC, a PD-L1 tumor proportion score (TPS) of ≥50%, and an ECOG PS of 2. Methods: We performed a multicenter retrospective analysis of patients with metastatic NSCLC and a PD-L1 tumor proportion score (TPS) of ≥50% (negative for genomic alterations in EGFR and ALK) who received treatment with first-line commercial pembrolizumab. Clinical outcomes were compared in patients based on ECOG PS. Results: Among 234 patients, 83.3% (N = 195) had an ECOG PS of 0 or 1, and 16.7% (N = 39) had an ECOG PS of 2. The baseline clinicopathological characteristics were balanced between the ECOG PS 0-1 vs 2 groups in terms of age, sex, tobacco use, histology, KRAS mutation status, presence of other potentially targetable driver mutations ( BRAF, MET, HER2, RET), history of central nervous system (CNS) disease, and PD-L1 TPS distribution. Compared to patients with an ECOG PS of 0-1, patients with an ECOG PS of 2 had a significantly lower objective response rate (ORR 43.1% vs 25.6%; P = 0.04), a numerically shorter median progression free survival (mPFS 6.6 months vs 4.0 months; P = 0.09), and a significantly shorter median overall survival (mOS 20.3 months vs 7.4 months; P < 0.001). Upon disease progression, patients with an ECOG PS of 2 were significantly less likely to receive second-line systemic therapy compared to patients with an ECOG PS of 0-1 (55.5% vs 14.3%, P < 0.001). Conclusions: Although a subset of patients with an ECOG PS of 2 can respond first-line pembrolizumab, clinical outcomes in this population are poor, and use of second-line systemic therapy is infrequent.
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Affiliation(s)
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Zihan Wei
- Dana-Farber Cancer Institute, Boston, MA
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | | | - Peter Sawan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jia Luo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hira Rizvi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Brett W. Carter
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Heymach
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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45
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Peipert J, Zhao F, Lee JW, Hong F, Ip E, Gareen IF, O'Connell N, Carlos R, Stewart AK, Weiss M, Sparano JA, Cella D, Gray RJ, Wagner LI. Increase in side effect bother was associated with early treatment discontinuation in a clinical trial among multiple myeloma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19136] [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
e19136 Background: Patient reported side effect bother is needed to understand tolerability of cancer drugs. We examined whether increase in side effect bother from baseline to cycle 7 as measured by a single item (GP5) from the FACT-G, “I am bothered by side effects of treatment”, was associated with early treatment discontinuation (ETD) in a multiple myeloma (MM) trial. Methods: Data were drawn from the induction phase of ECOG ACRIN E1A06, a two arm, phase 3 trial conducted in patients with untreated MM. The induction phase occurred over twelve, 28-day cycles. GP5 was assessed at registration and cycle 7. ETD was defined as completion of less than 12 cycles of treatment. We tested whether increase in side effect bother on the GP5 from baseline to cycle 7 was associated with months to ETD in two ways. At each timepoint, GP5 was rated with these response options: “Not at all”, “A little bit”, “Somewhat”, “Quite a bit”, “Very Much”. First, we stratified Kaplan Meier curves by patients with versus without substantially increased side effect burden from registration to cycle 7 on the GP5, defined as an increase of > 2 response categories; Cox regression was used to calculate a hazard ratio. Second, we fit a joint model of the GP5 change trajectory on months to ETD that substituted the estimated slope of a longitudinal logistic regression model into the hazard function of a Cox model. In this model, GP5 was dichotomized as 0 = “Not at all/”A little bit”; 1 = “Somewhat”/ “Quite a bit”/ “Very Much”. Results: 159 patients were followed during induction for a median of 11 months (range: 0.2-16.0). 10 patients (6%) reported a substantial increase on GP5 from registration to cycle 7. After 16 months, these patients had a significantly higher hazard of ETD as estimated by Kaplan Meier methods: 40% experienced ETD vs. 24% of patients without substantial GP5 increase [hazard ratio (HR): 3.08 (95% CI: 1.18-8.02)]. In the joint model, the effect of GP5 on hazard of ETD was larger [HR: 9.56 (95% CI: 2.41-37.82)]. Conclusions: This study found initial evidence that increase in side effect bother as measured by the GP5 predicts ETD and may therefore reflect treatment intolerability in cancer drug trials. The effects found in this study will be tested for replication in additional ECOG-ACRIN trials with diverse designs, treatments, and cancer types. Clinical trial information: NCT00602641 .
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Affiliation(s)
- John Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ilana F Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | | | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | | | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
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46
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Yu ZN, Huang XW, Hong F, Zhang T, Yang JB. [Baraitser-Winter syndrome caused by ACTB gene variation]. Zhonghua Er Ke Za Zhi 2020; 58:333-335. [PMID: 32234145 DOI: 10.3760/cma.j.cn112140-20190825-00535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Z N Yu
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - X W Huang
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - F Hong
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - T Zhang
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - J B Yang
- Department of Genetics and Metabolism, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
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Zhang Z, Liu YY, Liu Y, Li Q, Liang TT, Hong F, Feng L, Sun Y. [The effect of peroxiredoxin 2 on transforming growth factor-β1-induced fibroblast proliferation and collagen synthesis]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2020; 38:7-12. [PMID: 32062888 DOI: 10.3760/cma.j.issn.1001-9391.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of peroxiredoxin 2 (Prx2) overexpression on fibroblast proliferation and collagen synthesis induced by transforming growth factor-β1 (TGF-β1) . Methods: Fibroblasts were randomly divided into control group (DMEM medium) , TGF-β1 group (5 μg/L TGF-β1) , negative control group (treated with 5 μg/L TGF-β1 and transfected with empty lentiviral vector) , and Prx2 group (treated with 5 μg/L TGF-β1 and transfected with Prx2 overexpression lentiviral vector) . MTT assay was used to measure cell proliferation, immunofluorescence assay was used to measure the expression of 8-OHdG, and Western blot was used to measure the expression of p-JNK, p-P38, collagen type I, collagen type III, and Prx2. SPSS 18.0 was used for statistical analysis. The continuous data were expressed as mean±standard deviation; an analysis of variance was used for comparison between groups, and the least significant difference t-test was used for further comparison between two groups. Results: Lentiviral transfection was performed successfully, and the Prx2 group had a significant increase in the protein expression of Prx2 (P<0.05) . Compared with the control group, the TGF-β1 group had a significant increase in the proliferation ability (P<0.05) , and compared with the TGF-β1 group, the Prx2 group had a significant reduction in the proliferation ability (P<0.05) . Compared with the control group, the TGF-β1 group had significant increases in the expression of 8-OHdG, p-JNK, p-P38, collagen type I, and collagen type III (P<0.05) ; compared with the TGF-β1 group, the negative control group had no significant changes in the expression of 8-OHdG, p-JNK, p-P38, collagen type I, and collagen type III (P>0.05) , while the Prx2 group had significant reductions in the above parameters (P<0.05) . Conclusion: Prx2 overexpression inhibits fibroblast proliferation and collagen synthesis induced by TGF-β1 through inhibiting reactive oxygen species and activating the JNK and P38 pathways.
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Affiliation(s)
- Z Zhang
- Department of Pathology, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China; Department of Respiratory Medicine, Tangshan Works Hospital Affiliated to North China University of Science and Technology, Tangshan 063000, China
| | - Y Y Liu
- Department of Respiratory Medicine, Tangshan Works Hospital Affiliated to North China University of Science and Technology, Tangshan 063000, China
| | - Y Liu
- Department of Pathology, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China
| | - Q Li
- Department of Pathology, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China
| | - T T Liang
- Department of Pathology, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China
| | - F Hong
- Department of Pathology, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China
| | - L Feng
- Department of Pathology, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China
| | - Y Sun
- Department of Pathology, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China; Hebei Chronic Disease Key Laboratory Disease, School of Basic Medical Science, North China University of Science and Technology, Tangshan 063210, China
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Trinh QD, Hong F, Halpenny B, Epstein M, Berry DL. Racial/ethnicity differences in endorsing influential factors for prostate cancer treatment choice: An analysis of data from the personal patient profile-prostate (P3P) I and II trials. Urol Oncol 2020; 38:78.e7-78.e13. [DOI: 10.1016/j.urolonc.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/12/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022]
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Berry DL, Hong F, Halpenny B, Epstein M, Trinh QD. Racial/ethnicity differences when endorsing influential factors for prostate cancer treatment choice: An analysis of data from the personal patient profile-prostate (P3P) I and II trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.351] [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
351 Background: Race and ethnicity impact the type of treatment received for localized prostate cancer in American men. We hypothesized that there may be differences in men’s influential values and preferences related to treatment decisions. Methods: We analyzed samples from two multicenter, randomized trials of the Patient Profile-Prostate (P3P) decision aid, first comparing the trial groups on demographic and decisional variables using Chi-square tests. Stratified (P3P I vs II) logistic regression was then used to assess the univariate association between race/ethnicity and endorsement of moderate-or-strong influence of 14 lifestyle factors, current or future symptoms, or important others on the decision. A multivariable stratified logistic regression with backward variable selection was used to further estimate the association between influential factors and race/ethnicity. Results: Data from 494 and 392 participants in P3PI and P3PII, respectively, were analyzed for 40 Hispanic, 168 non-Hispanic black, 637 non-Hispanic white, 19 others and 6 missing. Age (p=.0001), education (p<.0001), marital status (p<.0001), income (p<.0001), Internet use for information (p<.0001) and decisional control preference were significantly different across racial/ethnic groups. In adjusted analyses, racial/ethnic differences existed for influence of age (Non Hispanic Black (NHB) vs. Non Hispanic White (NHW) OR: 0.56 95%CI 0.38-0.85p=.002), religion/spirituality (NHB vs. NHW OR: 3.2095%CI1.95-5.26, p<.0001), future bladder function (NHB vs. NHW OR: 0.5795%CI0.35-0.90, p=.04), future ability to engage in recreation (NHB vs. NHW OR: 0.5495%CI 0.34-0.86, p=0.02), and a story of a famous person with prostate cancer (NHB vs. NHW OR: 2,11 95%CI1.30-3.43, p=.007). Conclusions: Our results suggest racial/ethnic differences for influences underlying treatment choice. Better understanding these influences may help us present salient information about treatment options to patients and address disparities.
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Affiliation(s)
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Barbara Halpenny
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
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Azizoddin DR, Enzinger AC, Wright AA, Yusufov M, Hong F, Tulsky JA, Campbell EG, Pirl WF, Nayak M, Braun I. Oncologists’ perspectives on medical marijuana for the elderly. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.31_suppl.78] [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
78 Background: Cancer patients are increasingly using medical marijuana (MM) to manage symptoms and treatment side effects. Although cancer disproportionately affects the elderly, little is known about oncologists’ attitudes toward MM in this population. We surveyed US oncologists’ beliefs about the benefits of MM for older adults, and examined their associations with oncologists’ perceptions of MM efficacy and safety. Methods: 232 out of 400 randomly selected U.S. oncologists (63% response rate) completed a cross-sectional survey about their beliefs and recommendations regarding MM for cancer patients. Using Chi-square tests, we examined associations between oncologists’ demographics, their perceptions of geriatric MM use, as well as beliefs about comparative effectiveness of MM for cancer related symptoms, and comparative risks of MM to prescription opioids. Results: Among 232 oncologists included in this cohort, 109 (47.0%) reported that MM had at least some benefit for elderly cancer patients, 66 (28.4%) responded it was rarely or never beneficial, and 57 (24.6%) reported not knowing. There were no significant associations between oncologists’ beliefs about MM’s benefit for older adults and their sociodemographic characteristics. Those who believed MM was beneficial for the elderly were significantly more likely to report that MM was at least as effective as standard treatments for the following indications: coping (58.3% vs. 26.6%), appetite (83.3% vs 58.5%), depression (46.3% vs 25.0%), and nausea (66.7% vs 33.9%), respectively ( p < 0.001). In contrast, oncologists’ beliefs about MM for the elderly were not significantly associated with perceptions of the comparative risks of MM ( p > 0.05). Conclusions: In this nationally-representative sample of US oncologists, about half thought MM was beneficial for older adults with cancer. Oncologists’ support of MM for older adults was associated with perceptions of MM’s efficacy but was not associated with perceptions of MM’s risks. More research is needed regarding the safety and efficacy of MM to guide oncologists’ recommendations about its use in older adults.
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Affiliation(s)
| | | | | | | | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
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