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Corcoran RB, Do KT, Kim JE, Cleary JM, Parikh AR, Yeku OO, Xiong N, Weekes CD, Veneris J, Ahronian LG, Mauri G, Tian J, Norden BL, Michel AG, Van Seventer EE, Siravegna G, Camphausen K, Chi G, Fetter IJ, Brugge JS, Chen H, Takebe N, Penson RT, Juric D, Flaherty KT, Sullivan RJ, Clark JW, Heist RS, Matulonis UA, Liu JF, Shapiro GI. Phase I/II Study of Combined BCL-xL and MEK Inhibition with Navitoclax and Trametinib in KRAS or NRAS Mutant Advanced Solid Tumors. Clin Cancer Res 2024; 30:1739-1749. [PMID: 38456660 PMCID: PMC11061595 DOI: 10.1158/1078-0432.ccr-23-3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE MEK inhibitors (MEKi) lack monotherapy efficacy in most RAS-mutant cancers. BCL-xL is an anti-apoptotic protein identified by a synthetic lethal shRNA screen as a key suppressor of apoptotic response to MEKi. PATIENTS AND METHODS We conducted a dose escalation study (NCT02079740) of the BCL-xL inhibitor navitoclax and MEKi trametinib in patients with RAS-mutant tumors with expansion cohorts for: pancreatic, gynecologic (GYN), non-small cell lung cancer (NSCLC), and other cancers harboring KRAS/NRAS mutations. Paired pretreatment and day 15 tumor biopsies and serial cell-free (cf)DNA were analyzed. RESULTS A total of 91 patients initiated treatment, with 38 in dose escalation. Fifty-eight percent had ≥3 prior therapies. A total of 15 patients (17%) had colorectal cancer, 19 (11%) pancreatic, 15 (17%) NSCLC, and 32 (35%) GYN cancers. The recommended phase II dose (RP2D) was established as trametinib 2 mg daily days 1 to 14 and navitoclax 250 mg daily days 1 to 28 of each cycle. Most common adverse events included diarrhea, thrombocytopenia, increased AST/ALT, and acneiform rash. At RP2D, 8 of 49 (16%) evaluable patients achieved partial response (PR). Disease-specific differences in efficacy were noted. In patients with GYN at the RP2D, 7 of 21 (33%) achieved a PR and median duration of response 8.2 months. No PRs occurred in patients with colorectal cancer, NSCLC, or pancreatic cancer. MAPK pathway inhibition was observed in on-treatment tumor biopsies. Reductions in KRAS/NRAS mutation levels in cfDNA correlated with clinical benefit. CONCLUSIONS Navitoclax in combination with trametinib was tolerable. Durable clinical responses were observed in patients with RAS-mutant GYN cancers, warranting further evaluation in this population.
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Affiliation(s)
- Ryan B. Corcoran
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Khanh T. Do
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeong E. Kim
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - James M. Cleary
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aparna R. Parikh
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Oladapo O. Yeku
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Niya Xiong
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Colin D. Weekes
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Veneris
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Leanne G. Ahronian
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gianluca Mauri
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, and Department of Hematology Oncology, and Molecular Medicine, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Jun Tian
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bryanna L. Norden
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Alexa G. Michel
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Emily E. Van Seventer
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Giulia Siravegna
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kyle Camphausen
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Gary Chi
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Isobel J. Fetter
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joan S. Brugge
- Department of Cell Biology, Harvard Medical School, Boston, Massachusetts
| | - Helen Chen
- National Institute of Health, National Cancer Institute, Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, Bethesda, Maryland
| | - Naoko Takebe
- National Institute of Health, National Cancer Institute, Division of Cancer Treatment and Diagnosis, Cancer Therapy Evaluation Program, Bethesda, Maryland
| | - Richard T. Penson
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Dejan Juric
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Keith T. Flaherty
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ryan J. Sullivan
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey W. Clark
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebecca S. Heist
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ursula A. Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joyce F. Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Geoffrey I. Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Taylor MS, Wu C, Fridy PC, Zhang SJ, Senussi Y, Wolters JC, Cajuso T, Cheng WC, Heaps JD, Miller BD, Mori K, Cohen L, Jiang H, Molloy KR, Chait BT, Goggins MG, Bhan I, Franses JW, Yang X, Taplin ME, Wang X, Christiani DC, Johnson BE, Meyerson M, Uppaluri R, Egloff AM, Denault EN, Spring LM, Wang TL, Shih IM, Fairman JE, Jung E, Arora KS, Yilmaz OH, Cohen S, Sharova T, Chi G, Norden BL, Song Y, Nieman LT, Pappas L, Parikh AR, Strickland MR, Corcoran RB, Mustelin T, Eng G, Yilmaz ÖH, Matulonis UA, Chan AT, Skates SJ, Rueda BR, Drapkin R, Klempner SJ, Deshpande V, Ting DT, Rout MP, LaCava J, Walt DR, Burns KH. Ultrasensitive Detection of Circulating LINE-1 ORF1p as a Specific Multicancer Biomarker. Cancer Discov 2023; 13:2532-2547. [PMID: 37698949 PMCID: PMC10773488 DOI: 10.1158/2159-8290.cd-23-0313] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
Improved biomarkers are needed for early cancer detection, risk stratification, treatment selection, and monitoring treatment response. Although proteins can be useful blood-based biomarkers, many have limited sensitivity or specificity for these applications. Long INterspersed Element-1 (LINE-1) open reading frame 1 protein (ORF1p) is a transposable element protein overexpressed in carcinomas and high-risk precursors during carcinogenesis with negligible expression in normal tissues, suggesting ORF1p could be a highly specific cancer biomarker. To explore ORF1p as a blood-based biomarker, we engineered ultrasensitive digital immunoassays that detect mid-attomolar (10-17 mol/L) ORF1p concentrations in plasma across multiple cancers with high specificity. Plasma ORF1p shows promise for early detection of ovarian cancer, improves diagnostic performance in a multianalyte panel, provides early therapeutic response monitoring in gastroesophageal cancers, and is prognostic for overall survival in gastroesophageal and colorectal cancers. Together, these observations nominate ORF1p as a multicancer biomarker with potential utility for disease detection and monitoring. SIGNIFICANCE The LINE-1 ORF1p transposon protein is pervasively expressed in many cancers and is a highly specific biomarker of multiple common, lethal carcinomas and their high-risk precursors in tissue and blood. Ultrasensitive ORF1p assays from as little as 25 μL plasma are novel, rapid, cost-effective tools in cancer detection and monitoring. See related commentary by Doucet and Cristofari, p. 2502. This article is featured in Selected Articles from This Issue, p. 2489.
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Affiliation(s)
- Martin S. Taylor
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
| | - Connie Wu
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts
| | - Peter C. Fridy
- Laboratory of Cellular and Structural Biology, The Rockefeller University, New York, New York
| | - Stephanie J. Zhang
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts
| | - Yasmeen Senussi
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts
| | - Justina C. Wolters
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tatiana Cajuso
- Department of Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Wen-Chih Cheng
- Department of Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - John D. Heaps
- Department of Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Bryant D. Miller
- Department of Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Kei Mori
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- Healthcare Optics Research Laboratory, Canon U.S.A., Inc., Cambridge, Massachusetts
| | - Limor Cohen
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, Massachusetts
| | - Hua Jiang
- Laboratory of Cellular and Structural Biology, The Rockefeller University, New York, New York
| | - Kelly R. Molloy
- Laboratory of Mass Spectrometry and Gaseous Ion Chemistry, The Rockefeller University, New York, New York
| | - Brian T. Chait
- Laboratory of Mass Spectrometry and Gaseous Ion Chemistry, The Rockefeller University, New York, New York
| | | | - Irun Bhan
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph W. Franses
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xiaoyu Yang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Xinan Wang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - David C. Christiani
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Bruce E. Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Ravindra Uppaluri
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ann Marie Egloff
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elyssa N. Denault
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura M. Spring
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tian-Li Wang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ie-Ming Shih
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Euihye Jung
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kshitij S. Arora
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
| | - Osman H. Yilmaz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Sonia Cohen
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tatyana Sharova
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gary Chi
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryanna L. Norden
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yuhui Song
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Linda T. Nieman
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leontios Pappas
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aparna R. Parikh
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew R. Strickland
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan B. Corcoran
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tomas Mustelin
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, Washington
| | - George Eng
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- The David H. Koch Institute for Integrative Cancer Research at MIT, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Ömer H. Yilmaz
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- The David H. Koch Institute for Integrative Cancer Research at MIT, Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Ursula A. Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Steven J. Skates
- MGH Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bo R. Rueda
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Ronny Drapkin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Samuel J. Klempner
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vikram Deshpande
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
| | - David T. Ting
- Mass General Cancer Center and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael P. Rout
- Laboratory of Cellular and Structural Biology, The Rockefeller University, New York, New York
| | - John LaCava
- Laboratory of Cellular and Structural Biology, The Rockefeller University, New York, New York
- European Research Institute for the Biology of Ageing, University Medical Center Groningen, Groningen, the Netherlands
| | - David R. Walt
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts
| | - Kathleen H. Burns
- Department of Pathology, Mass General Brigham and Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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3
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Jarnagin JX, Saraf A, Baiev I, Chi G, van Seventer EE, Mojtahed A, Allen JN, Clark JW, Blaszkowsky L, Giantonio BJ, Weekes CD, Klempner SJ, Franses JW, Roeland EJ, Goyal L, Siravegna G, Horick N, Corcoran RB, Nipp RD, Parikh AR. Patient-Reported Outcomes, Tumor Markers, and Survival Outcomes in Advanced GI Cancer. JAMA Netw Open 2023; 6:e2343512. [PMID: 37976066 PMCID: PMC10656643 DOI: 10.1001/jamanetworkopen.2023.43512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/21/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Patient-reported outcomes (PROs), such as quality of life (QOL) and symptoms, are often associated with clinical outcomes in patients with cancer. In practice, oncologists use serum tumor markers (TMs) (ie, carcinoembryonic antigen [CEA] and carbohydrate antigen 19-9 [CA 19-9]) and imaging to monitor clinical outcomes in patients with gastrointestinal cancer. Objective To examine associations of 1-month changes in PROs and TMs with treatment response and survival among patients with gastrointestinal cancer. Design, Setting, and Participants This cohort study enrolled patients at Massachusetts General Hospital Cancer Center with at least 1 month follow-up from May 2019 to December 2020. Included patients were beginning first-line systemic therapy, aged 18 years or older, and had been diagnosed with metastatic pancreaticobiliary, colorectal, or gastroesophageal cancer. Data analyses took place from January 2021 to January 2022. Intervention PROs were collected, including QOL (Functional Assessment of Cancer Therapy General [FACT-G]), physical symptoms (Edmonton Symptom Assessment System [ESAS]), and psychological symptoms (Patient Health Questionnaire-4 [PHQ4] total, PHQ4-depression, and PHQ4-anxiety), as well as TMs (CEA and CA 19-9), at the time of chemotherapy initiation and 1 month later. Main Outcomes and Measures Associations of 1-month changes in PROs and TMs with treatment response (clinical benefit vs disease progression) at first scan, progression-free survival (PFS), and overall survival (OS), adjusted for baseline values using regression models. Results This study included 159 patients, with 134 patients (84.3%) evaluable for analysis. Patients had a median (range) age of 64.0 (28.0-84.0) years and 86 (64.2%) were male. One-month PRO changes (FACT-G: OR, 1.07; 95% CI, 1.03-1.11; P = .001; ESAS-total: OR, 0.97; 95% CI, 0.94-1.00; P = .02; ESAS-physical: OR, 0.96; 95% CI, 0.92-1.00; P = .03; PHQ4-depression: OR, 0.67; 95% CI, 0.49-0.92; P = .01) were significantly associated with treatment response, but PHQ4-total or TMs were not. Changes in FACT-G (HR, 0.97; 95% CI, 0.95-0.99; P = .003), ESAS-total (HR, 1.03; 95% CI, 1.01-1.05; P = .004), ESAS-physical (HR, 1.03; 95% CI, 1.00-1.05; P = .02), PHQ4-depression (HR, 1.22; 95% CI, 1.01-1.48; P = .04), and CEA (HR, 1.00; 95% CI, 1.001-1.004; P = .001) were associated with PFS, but changes in PHQ4-total or TMs were not. Changes in ESAS-total (HR, 1.03, 95% CI, 1.01-1.06; P = .006) and ESAS-physical (HR, 1.04, 95% CI, 1.01-1.06; P = .015) were associated with OS, but changes in TMs were not associated with OS. Conclusions and Relevance These findings suggest that 1-month changes in PROs can be associated with treatment response and survival in patients with advanced gastrointestinal cancer. Notably, 1-month changes in TMs were not consistently associated with these outcomes. These findings highlight the potential for monitoring early changes in PROs to associate with clinical outcomes while underscoring the need to address the QOL and symptom concerns of patients with advanced cancer.
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Affiliation(s)
- Joy X. Jarnagin
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Anurag Saraf
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Islam Baiev
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Gary Chi
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Emily E. van Seventer
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jill N. Allen
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Jeffrey W. Clark
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Lawrence Blaszkowsky
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Bruce J. Giantonio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Colin D. Weekes
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Samuel J. Klempner
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Joseph W. Franses
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Eric J. Roeland
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Lipika Goyal
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Giulia Siravegna
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Nora Horick
- Department of Statistics, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Ryan B. Corcoran
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
| | - Ryan D. Nipp
- OU Health Stephenson Cancer Center, Section of Hematology and Oncology, Department of Internal Medicine, The University of Oklahoma (OU) College of Medicine, Oklahoma City
| | - Aparna R. Parikh
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston
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4
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Taylor MS, Connie W, Fridy PC, Zhang SJ, Senussi Y, Wolters JC, Cheng WC, Heaps J, Miller BD, Mori K, Cohen L, Jiang H, Molloy KR, Norden BL, Chait BT, Goggins M, Bhan I, Franses JW, Yang X, Taplin ME, Wang X, Christiani DC, Johnson BE, Meyerson M, Uppaluri R, Egloff AM, Denault EN, Spring LM, Wang TL, Shih IM, Jung E, Arora KS, Zukerberg LR, Yilmaz OH, Chi G, Matulonis UA, Song Y, Nieman L, Parikh AR, Strickland M, Corcoran RB, Mustelin T, Eng G, Yilmaz ÃMH, Skates SJ, Rueda BR, Drapkin R, Klempner SJ, Deshpande V, Ting DT, Rout MP, LaCava J, Walt DR, Burns KH. Ultrasensitive detection of circulating LINE-1 ORF1p as a specific multi-cancer biomarker. bioRxiv 2023:2023.01.25.525462. [PMID: 36747644 PMCID: PMC9900799 DOI: 10.1101/2023.01.25.525462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Improved biomarkers are needed for early cancer detection, risk stratification, treatment selection, and monitoring treatment response. While proteins can be useful blood-based biomarkers, many have limited sensitivity or specificity for these applications. Long INterspersed Element-1 (LINE-1, L1) open reading frame 1 protein (ORF1p) is a transposable element protein overexpressed in carcinomas and high-risk precursors during carcinogenesis with negligible detectable expression in corresponding normal tissues, suggesting ORF1p could be a highly specific cancer biomarker. To explore the potential of ORF1p as a blood-based biomarker, we engineered ultrasensitive digital immunoassays that detect mid-attomolar (10-17 M) ORF1p concentrations in patient plasma samples across multiple cancers with high specificity. Plasma ORF1p shows promise for early detection of ovarian cancer, improves diagnostic performance in a multi-analyte panel, and provides early therapeutic response monitoring in gastric and esophageal cancers. Together, these observations nominate ORF1p as a multi-cancer biomarker with potential utility for disease detection and monitoring.
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5
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Tian J, Chen JH, Chao SX, Pelka K, Giannakis M, Hess J, Burke K, Jorgji V, Sindurakar P, Braverman J, Mehta A, Oka T, Huang M, Lieb D, Spurrell M, Allen JN, Abrams TA, Clark JW, Enzinger AC, Enzinger PC, Klempner SJ, McCleary NJ, Meyerhardt JA, Ryan DP, Yurgelun MB, Kanter K, Van Seventer EE, Baiev I, Chi G, Jarnagin J, Bradford WB, Wong E, Michel AG, Fetter IJ, Siravegna G, Gemma AJ, Sharpe A, Demehri S, Leary R, Campbell CD, Yilmaz O, Getz GA, Parikh AR, Hacohen N, Corcoran RB. Combined PD-1, BRAF and MEK inhibition in BRAF V600E colorectal cancer: a phase 2 trial. Nat Med 2023; 29:458-466. [PMID: 36702949 PMCID: PMC9941044 DOI: 10.1038/s41591-022-02181-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2023]
Abstract
While BRAF inhibitor combinations with EGFR and/or MEK inhibitors have improved clinical efficacy in BRAFV600E colorectal cancer (CRC), response rates remain low and lack durability. Preclinical data suggest that BRAF/MAPK pathway inhibition may augment the tumor immune response. We performed a proof-of-concept single-arm phase 2 clinical trial of combined PD-1, BRAF and MEK inhibition with sparatlizumab (PDR001), dabrafenib and trametinib in 37 patients with BRAFV600E CRC. The primary end point was overall response rate, and the secondary end points were progression-free survival, disease control rate, duration of response and overall survival. The study met its primary end point with a confirmed response rate (24.3% in all patients; 25% in microsatellite stable patients) and durability that were favorable relative to historical controls of BRAF-targeted combinations alone. Single-cell RNA sequencing of 23 paired pretreatment and day 15 on-treatment tumor biopsies revealed greater induction of tumor cell-intrinsic immune programs and more complete MAPK inhibition in patients with better clinical outcome. Immune program induction in matched patient-derived organoids correlated with the degree of MAPK inhibition. These data suggest a potential tumor cell-intrinsic mechanism of cooperativity between MAPK inhibition and immune response, warranting further clinical evaluation of optimized targeted and immune combinations in CRC. ClinicalTrials.gov registration: NCT03668431.
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Affiliation(s)
- Jun Tian
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Jonathan H Chen
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Sherry X Chao
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Karin Pelka
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Gladstone-UCSF Institute of Genomic Immunology, Gladstone Institutes Department of Microbiology and Immunology, UCSF, San Francisco, CA, USA
| | - Marios Giannakis
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Julian Hess
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Kelly Burke
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Vjola Jorgji
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Princy Sindurakar
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Jonathan Braverman
- The Koch Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Arnav Mehta
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Tomonori Oka
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Mei Huang
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - David Lieb
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Maxwell Spurrell
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Jill N Allen
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Thomas A Abrams
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Andrea C Enzinger
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Peter C Enzinger
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Samuel J Klempner
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Nadine J McCleary
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | | | - David P Ryan
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Matthew B Yurgelun
- Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Katie Kanter
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Emily E Van Seventer
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Islam Baiev
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Gary Chi
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Joy Jarnagin
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - William B Bradford
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Edmond Wong
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Alexa G Michel
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Isobel J Fetter
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Giulia Siravegna
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Angelo J Gemma
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Arlene Sharpe
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Shadmehr Demehri
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Rebecca Leary
- Novartis Institute for Biomedical Research, Cambridge, MA, USA
| | | | - Omer Yilmaz
- The Koch Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Gad A Getz
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Aparna R Parikh
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | - Nir Hacohen
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA.
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
| | - Ryan B Corcoran
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA.
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Jarnagin JX, Saraf A, Chi G, Baiev I, Mojtahed A, Allen JN, Ryan DP, Clark JW, Blaszkowsky LS, Giantonio BJ, Weekes CD, Klempner SJ, Franses JW, Roeland E, Goyal L, Horick NK, Corcoran RB, Parikh AR. Changes in Functional Assessment of Cancer Therapy: General (FACT-G) to predict treatment response and survival outcomes in patients with metastatic gastrointestinal (GI) cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6570] [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
6570 Background: The FACT-G contains 27 questions within 4 subscale domains [Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, Functional Well-Being] related to health-related quality of life (QOL) in the past 7 days, with higher scoring indicating better QOL. In this prospective cohort study, we assessed longitudinal FACT-G data with treatment response and survival outcomes among patients with metastatic GI cancer. Methods: From 5/2019-11/2021, we enrolled patients at Massachusetts General Hospital with metastatic GI cancer to study before their treatment start. We collected the FACT-G survey at baseline (start of treatment) and 1-month later. We then used regression models to assess associations of 1-month changes in FACT-G with treatment response and survival outcomes (progression-free survival [PFS] and overall survival [OS]). For treatment response, clinical benefit was defined as decreased or stable tumor burden versus progressive disease at the time of first scan. All models were adjusted for baseline values of each respective variable. Results: We enrolled 203 of 262 patients approached (77.5% enrollment); 160 had 1-month follow-up data (median age = 63.0 years [range: 28.0-84.0 years], 66.3% male, 45.6% pancreaticobiliary cancer). For treatment response, 66.3% experienced a clinical benefit and 33.8% had progressive disease at the time of first scan (mean time to first scan = 2.7 months). Increases in FACT-G Total were predictors for treatment response (OR = 1.05, p = 0.0028), and improved PFS (HR = 0.98, p = 0.026) and OS (HR = 0.98, p = 0.038). Increases in FACT-G Emotional were associated with clinical benefit at the time of first scan (OR = 1.18, p = 0.0024), improved PFS (HR = 0.94, p = 0.023), and improved OS (HR = 0.93, p = 0.012). Improvement in FACT-G Physical were predictors for clinical benefit at time of first scan (OR = 1.08, p = 0.038) and better PFS (HR = 0.96, p = 0.038), while increases in FACT-G Functional were associated with improved PFS (HR = 0.96, p = 0.034) and OS (HR = 0.96, p = 0.019). Finally, changes in FACT-G Social were only associated with treatment response (OR = 1.16, p = 0.011). Conclusions: We found that 1-month increases in FACT-G can predict for treatment response and improved survival outcomes in patients with metastatic GI cancers. Notably, the FACT-G Total and FACT-G Emotional subscore predicted for all three outcomes of interest, while the FACT-G Social only predicted for clinical benefit at first scan. These data support previous findings indicating the possible use of early changes in patient-reported outcomes as a biomarker for early treatment response while emphasizing the growing need to integrate more patient-centric interventions into clinical care for cancer patients. Clinical trial information: NCT04776837.
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Affiliation(s)
| | | | - Gary Chi
- Massachusetts General Hospital, Boston, MA
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Kalayci A, Gibson CM, Chi G, Yee M, Korjian S, Datta S, Nafee T, Gurin M, Haroian N, Hull RD, Hernandez AF, Cohen AT, Harrington RA, Goldhaber SZ. P251Asymptomatic deep vein thrombosis in acutely ill medical patients: insights from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p251] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Kalayci
- Harvard Medical School, Cardiology, Boston, United States of America
| | - C M Gibson
- Harvard Medical School, Cardiology, Boston, United States of America
| | - G Chi
- Harvard Medical School, Cardiology, Boston, United States of America
| | - M Yee
- Harvard Medical School, Cardiology, Boston, United States of America
| | - S Korjian
- Harvard Medical School, Cardiology, Boston, United States of America
| | - S Datta
- Harvard Medical School, Cardiology, Boston, United States of America
| | - T Nafee
- Harvard Medical School, Cardiology, Boston, United States of America
| | - M Gurin
- Harvard Medical School, Cardiology, Boston, United States of America
| | - N Haroian
- Harvard Medical School, Cardiology, Boston, United States of America
| | - R D Hull
- University of Calgary, Cardiology, Calgary, Canada
| | - A F Hernandez
- Duke University Medical Center, Cardiology, Durham, United States of America
| | - A T Cohen
- St Thomas' Hospital, Haematology, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Cardiology, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Cardiology, Boston, United States of America
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Nafee T, Gibson CM, Yee MK, Travis R, Kerneis M, Chi G, Alkhalfan F, Daaboul Y, Korjian S, Bandman O, Hernandez AF, Hull RD, Cohen AT, Harrington RA, Goldhaber SZ. P6072Characterization of major and clinically relevant non-major bleeding in the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6072] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Nafee
- Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M K Yee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Travis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - G Chi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - F Alkhalfan
- Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - Y Daaboul
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - S Korjian
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - O Bandman
- Portola Pharmaceuticals Inc., South San Francisco, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Department of Medicine, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Chi G, Gibson CM, Hernandez AF, Hull RD, Kalayci A, Kerneis M, Alkhalfan F, Nafee T, Cohen AT, Harrington RA, Goldhaber SZ. P1623Association of low hemoglobin with venous thromboembolism in acutely ill hospitalized medical patients: findings from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1623] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- G Chi
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A Kalayci
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - T Nafee
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Yee MK, Kerneis M, Nafee T, Travis R, Chi G, Mehran R, Wildegoose P, Bode C, Halperin J, Verheugt FW, Lip GYH, Cohen M, Peterson ED, Fox KAA, Gibson CM. 1460Effect of the INR stability characteristics on bleeding events among atrial fibrillation patients undergoing percutaneous coronary intervention: insights from the PIONEER AF-PCI trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1460] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M K Yee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Kerneis
- Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - T Nafee
- Harvard Medical School, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Travis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - G Chi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Mehran
- Mount Sinai Medical Center, Cardiovascular Institute, New York, United States of America
| | - P Wildegoose
- Janssen Pharmaceuticals, Titusville, United States of America
| | - C Bode
- University of Freiburg, Heart Center, Department of Cardiology and Angiology, Freiburg, Germany
| | - J Halperin
- Mount Sinai Medical Center, Cardiovascular Institute, New York, United States of America
| | - F W Verheugt
- Hospital Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - G Y H Lip
- Birmingham City Hospital, Birmingham, United Kingdom
| | - M Cohen
- Newark Beth Israel Medical Center, Newark, United States of America
| | - E D Peterson
- Duke Clinical Research Institute, Durham, United States of America
| | - K A A Fox
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
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Yee MK, Gibson CM, Nafee T, Kerneis M, Travis R, Alkhalfan F, Chi G, Datta S, Jafarizade M, Ghaffarpasand E, Hull RD, Hernandez AF, Cohen AT, Harrington RA, Goldhaber SZ. 109Betrixaban compared to enoxaparin among obese acute medically ill subjects: an APEX trial subgroup analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M K Yee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - T Nafee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Travis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - G Chi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - S Datta
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Jafarizade
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - E Ghaffarpasand
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University, Department of Medicine, Palo Alto, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Nafee T, Gibson CM, Travis R, Kerneis M, Yee MK, Alkhalfan F, Chi G, Kalayci A, Mir M, Alihashemi M, Hull RD, Hernandez AF, Cohen AT, Harrington RA, Goldhaber SZ. 2160Performance of a machine learning model vs. IMPROVE score for VTE prediction in acute medically ill patients: insights from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2160] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Nafee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R Travis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M K Yee
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - G Chi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - A Kalayci
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Mir
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - M Alihashemi
- Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, Boston, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University, Department of Medicine, Stanford, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Chi G, Gibson CM, Hernandez AF, Hull RD, Cohen AT, Harrington RA, Alkhalfan F, Kalayci A, Kerneis M, Nafee T, Goldhaber SZ. 4321Betrixaban versus enoxaparin for venous thromboembolism prophylaxis in critically ill patients: findings from the APEX trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4321] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G Chi
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - C M Gibson
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A F Hernandez
- Duke Clinical Research Institute, Durham, United States of America
| | - R D Hull
- University of Calgary, Calgary, Canada
| | - A T Cohen
- Guy's Hospital, London, United Kingdom
| | - R A Harrington
- Stanford University Medical Center, Stanford, United States of America
| | - F Alkhalfan
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - A Kalayci
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - M Kerneis
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - T Nafee
- Beth Israel Deaconess Medical Center, Cardiology, Boston, United States of America
| | - S Z Goldhaber
- Brigham and Women's Hospital, Boston, United States of America
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Chi G, Yee M, Amin A, Goldhaber S, Hernandez A, Hull R. Extended-Duration Betrixaban Reduces the Risk of Rehospitalization Associated With Venous Thromboembolism Among Acutely Ill Hospitalized Medical Patients: Findings From the Apex Trial (Acute Medically Ill Venous Thromboembolism Prevention With Extended Duration Betrixaban Trial). J Vasc Surg Venous Lymphat Disord 2018. [DOI: 10.1016/j.jvsv.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chi G, Goldhaber SZ, Kittelson JM, Turpie AGG, Hernandez AF, Hull RD, Gold A, Curnutte JT, Cohen AT, Harrington RA, Gibson CM. Effect of extended-duration thromboprophylaxis on venous thromboembolism and major bleeding among acutely ill hospitalized medical patients: a bivariate analysis. J Thromb Haemost 2017; 15:1913-1922. [PMID: 28762617 DOI: 10.1111/jth.13783] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 11/30/2022]
Abstract
Essentials Anticoagulants prevent venous thromboembolism but may be associated with greater bleeding risks. Bivariate analysis assumes a non-linear relationship between efficacy and safety outcomes. Extended full-dose betrixaban is favorable over standard enoxaparin in bivariate endpoint. Clinicians must weigh efficacy and safety outcomes in decision-making on thromboprophylaxis. SUMMARY Background Among acutely ill hospitalized medical patients, extended-duration thromboprophylaxis reduces the risk of venous thromboembolism (VTE), but some pharmacologic strategies have been associated with greater risks of major bleeding, thereby offsetting the net clinical benefit (NCB). Methods To assess the risk-benefit profile of anticoagulation regimens, a previously described bivariate method that does not assume a linear risk-benefit tradeoff and can accommodate different margins for efficacy and safety was performed to simultaneously assess efficacy (symptomatic VTE) and safety (major bleeding) on the basis of data from four randomized controlled trials of extended-duration (30-46 days) versus standard-duration (6-14 days) thromboprophylaxis among 28 227 patients (EXCLAIM, ADOPT, MAGELLAN and APEX trials). Results Extended thromboprophylaxis with full-dose betrixaban (80 mg once daily) was superior in efficacy and non-inferior in safety to standard-duration enoxaparin, and showed a significantly favorable NCB, with a risk difference of - 0.51% (- 0.89% to - 0.10%) in the bivariate outcome. Extended enoxaparin was superior in efficacy and inferior in safety (bivariate outcome: 0.03% [- 0.37% to 0.43%]), whereas apixaban and rivaroxaban were non-inferior in efficacy and inferior in safety (- 0.20% [- 0.49% to 0.17%] and 0.23% [- 0.16% to 0.69%], respectively). Reduced-dose betrixaban did not show a significant difference in either efficacy or safety (0.41% [- 0.85% to 1.94%]). Conclusions In a bivariate analysis that assumes non-linear risk-benefit tradeoffs, extended prophylaxis with full-dose betrixaban was superior to standard-duration enoxaparin, whereas other regimens failed to simultaneously achieve both superiority and non-inferiority with respect to symptomatic VTE and major bleeding in the management of acutely ill hospitalized medical patients.
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Affiliation(s)
- G Chi
- Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S Z Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - J M Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A G G Turpie
- Department of Medicine, Hamilton Health Sciences, General Division, Hamilton, Ontario, Canada
| | - A F Hernandez
- Duke University and Duke Clinical Research Institute, Durham, NC, USA
| | - R D Hull
- Division of Cardiology, R. A. H. Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Gold
- Portola Pharmaceuticals Inc., South San Francisco, CA, USA
| | - J T Curnutte
- Portola Pharmaceuticals Inc., South San Francisco, CA, USA
| | - A T Cohen
- Department of Haematological Medicine, Guy's and St Thomas' Hospitals, King's College, London, UK
| | - R A Harrington
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - C M Gibson
- Cardiovascular Division, Departments of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Chi G, Nafee T, Korjian S, Daaboul Y, Harrington R, Goldhaber S, Hull R, Gold A, Cohen A, Gibson C. P5599Effect of extended-duration thromboprophylaxis on venous thromboembolism and major bleeding among acutely ill hospitalized medical patients: a bivariate analysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5599] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gibson C, Arbetter D, Jain P, Halaby R, Chi G, Nafee T, Korjian S, Daaboul Y, Harrington R, Goldhaber S, Hull R, Gold A, Cohen A. P1551D-dimer concentration is associated with increased risk for VTE and greater absolute benefit of extended prophylaxis with betrixaban in acutely Ill medical patients: insights from the APEX trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1551] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gibson C, Arbetter D, Jain P, Halaby R, Chi G, Nafee T, Korjian S, Daaboul Y, Goldhaber S, Hull R, Gold A, Hernandez A, Cohen A, Harrington R. P1732Extended duration betrixaban in acutely ill medical patients is associated with reduction in fatal or irreversible ischemic or bleeding events compared with standard dose enoxaparin: an APEX substudy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1732] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chi G, Korjian S, Daaboul Y, Nafee T, Mehran R, Bode C, Halperin J, Verheugt F, Wildgoose P, Eickels M, Lip G, Cohen M, Peterson E, Fox K, Gibson C. P6112Effect of procedure and lesion characteristics on bleeding and ischemic outcomes among atrial fibrillation patients undergoing percutaneous coronary intervention: results from the PIONEER AF-PCI trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6112] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chi G, Nafee T, Korjian S, Daaboul Y, Harrington R, Goldhaber S, Hull R, Gold A, Cohen A, Gibson C. P4316N-terminal pro-B-type natriuretic peptide (NT-proBNP) is associated with stroke among hospitalized medical patients: an APEX trial substudy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4316] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yee M, Chi G, Nafee T, Korjian S, Daaboul Y, Harrington R, Goldhaber S, Hull R, Gold A, Cohen A, Gibson C. P5600History of venous thromboembolism is associated with higher risk for recurrent venous thromboembolism: insights from the APEX trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5600] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yee M, Chi G, Jain P, Mehran R, Bode C, Halperin J, Verheugt F, Wildgoose P, Korjian S, Daaboul Y, Lip G, Cohen M, Peterson E, Fox K, Gibson C. P4565Rivaroxaban treatment strategies reduce not only the first bleeding event, but all (including multiple) bleeding events: A PIONEER Substudy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4565] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dong X, Peek-Asa C, Yang J, Wang S, Chen X, Chi G, Marizen R. The association of road safety knowledge, risk behaviour and road traffic injury among school-aged children in Guangzhou, China. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chi G, Wang S. An epidemiological study on road traffic injury in China. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chi G, Chen H, Wang S. An epidemiological investigation and analysis on its influence factors of campus violence on secondary schools in China. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chi G, Wang S, Liu R. [An epidemiological analysis on the relationship between road injury and traffic environment in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2000; 21:330-2. [PMID: 11860807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To explore the influence of traffic environment on road injury so as to provide basis for prevention and control. METHODS Principal component regression analysis was used to explain the relationship between road injury and the numbers of vehicle, capacity of road transport and mileage of rigid highway. RESULTS Results showed a positive correlation between level of personal safety (LPS) and the numbers of vehicle, volume of road haulage, volume of passenger transport, mileage of rigid highway (correlation coefficients were 0.8714, 0.9691, 0.9611, 0.9510, P = 0.0005). The numbers of vehicle, volume of road haulage, volume of passenger transport and mileage of rigid highway were increasing when LPS decreased. Principal component regression analysis overcame multi collinearty of independent variables and obtained a regression equation y =-3.7197 + 1.49E-03X(1) + 5.2E-06X(3) + 6.19E-02X(4). CONCLUSION The primary determinants of LPS were numbers of vehicle, volume of road haulage, volume of passenger and mileage of rigid highway. Road injury thus could be reduced through improving the traffic environment, strengthening the traffic administration as well as promoting traffic safety.
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Affiliation(s)
- G Chi
- Medical College of Jinan University, Guangzhou 510632, China
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Hu Y, Wang S, Chi G. [Epidemiologic features and the stepwise regression analysis of fatal motor vehicle accidents in Guangzhou]. Zhonghua Liu Xing Bing Xue Za Zhi 1994; 15:114-6. [PMID: 7923333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This paper describes the epidemiologic features of 1,532 fatal motor vehicle crashes, and analyses of some crash-related factors by means of stepwise regression analysis as well. The crashes between motor vehicle and bicycle accounted for 39.49 percent. The 36.84 percent of drivers responsible for accidents were at the age of 20-24. The analysis of accident victim characteristics indicated that all age groups were at risk. Most victims were the people younger than 25 years old as well as aged 50 and over. About one-third of the victims were peasants. The analysis of stepwise regression suggested that the crashes were positively related to the quantity of automobile and the ratio between male and female.
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Affiliation(s)
- Y Hu
- Department of Epidemiology, Medical College of Jinan University, Guangzhou
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