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Bogart J, Wang X, Masters G, Gao J, Komaki R, Gaspar LE, Heymach J, Bonner J, Kuzma C, Waqar S, Petty W, Stinchcombe TE, Bradley JD, Vokes E. High-Dose Once-Daily Thoracic Radiotherapy in Limited-Stage Small-Cell Lung Cancer: CALGB 30610 (Alliance)/RTOG 0538. J Clin Oncol 2023; 41:2394-2402. [PMID: 36623230 PMCID: PMC10150922 DOI: 10.1200/jco.22.01359] [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: 06/16/2022] [Revised: 08/16/2022] [Accepted: 11/22/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Although level 1 evidence supports 45-Gy twice-daily radiotherapy as standard for limited-stage small-cell lung cancer, most patients receive higher-dose once-daily regimens in clinical practice. Whether increasing radiotherapy dose improves outcomes remains to be prospectively demonstrated. METHODS This phase III trial, CALGB 30610/RTOG 0538 (ClinicalTrials.gov identifier: NCT00632853), was conducted in two stages. In the first stage, patients with limited-stage disease were randomly assigned to receive 45-Gy twice-daily, 70-Gy once-daily, or 61.2-Gy concomitant-boost radiotherapy, starting with either the first or second (of four total) chemotherapy cycles. In the second stage, allocation to the 61.2-Gy arm was discontinued following planned interim toxicity analysis, and the study continued with two remaining arms. The primary end point was overall survival (OS) in the intention-to-treat population. RESULTS Trial accrual opened on March 15, 2008, and closed on December 1, 2019. All patients randomly assigned to 45-Gy twice-daily (n = 313) or 70-Gy once-daily radiotherapy (n = 325) are included in this analysis. After a median follow-up of 4.7 years, OS was not improved on the once-daily arm (hazard ratio for death, 0.94; 95% CI, 0.76 to 1.17; P = .594). Median survival is 28.5 months for twice-daily treatment, and 30.1 months for once-daily treatment, with 5-year OS of 29% and 32%, respectively. Treatment was tolerable, and the frequency of severe adverse events, including esophageal and pulmonary toxicity, was similar on both arms. CONCLUSION Although 45-Gy twice-daily radiotherapy remains the standard of care, this study provides the most robust information available to help guide the choice of thoracic radiotherapy regimen for patients with limited-stage small-cell lung cancer.
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Affiliation(s)
- Jeffrey Bogart
- State University of New York Upstate Medical University, New York, NY
| | - Xiaofei Wang
- Alliance Statistics and Data Management Center, Duke University, Durham, NC
| | - Gregory Masters
- Delaware/Christiana Care NCORP, Helen Graham Cancer Center, Newark, DE
| | - Junheng Gao
- Alliance Statistics and Data Management Center, Duke University, Durham, NC
| | - Ritsuko Komaki
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Laurie E. Gaspar
- University of Colorado Denver Health Science Center, Denver, CO
- University of Colorado School of Medicine, Aurora, CO
| | - John Heymach
- MD Anderson Cancer Center, University of Texas, Houston, TX
| | | | - Charles Kuzma
- Southeast Clinical Oncology Research Consortium NCORP, FirstHealth of the Carolinas-Moore Regional Hospital, Pinehurst, NC
| | - Saiama Waqar
- Washington University—Siteman Cancer Center, St Louis, MO
| | - William Petty
- Wake Forest University Health Sciences, Winston-Salem, NC
| | | | | | - Everett Vokes
- University of Chicago Comprehensive Cancer Center, Chicago, IL
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LaCasce AS, Dockter T, Ruppert AS, Kostakoglu L, Schöder H, Hsi E, Bogart J, Cheson B, Wagner-Johnston N, Abramson J, Blum K, Leonard JP, Bartlett NL. Positron Emission Tomography-Adapted Therapy in Bulky Stage I/II Classic Hodgkin Lymphoma: CALGB 50801 (Alliance). J Clin Oncol 2023; 41:1023-1034. [PMID: 36269899 PMCID: PMC9928671 DOI: 10.1200/jco.22.00947] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with bulky stage I/II classic Hodgkin lymphoma (cHL) are typically treated with chemotherapy followed by radiation. Late effects associated with radiotherapy include increased risk of second cancer and cardiovascular disease. We tested a positron emission tomography (PET)-adapted approach in patients with bulky, early-stage cHL, omitting radiotherapy in patients with interim PET-negative (PET-) disease and intensifying treatment in patients with PET-positive (PET+) disease. METHODS Eligible patients with bulky disease (mass > 10 cm or 1/3 the maximum intrathoracic diameter on chest x-ray) received two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by interim fluorodeoxyglucose PET (PET2). Patients with PET2-, defined as 1-3 on the 5-point scale, received four additional cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine. Patients with PET2+ received four cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone followed by 30.6 Gy involved-field radiation. RESULTS Of 94 evaluable patients, 53% were female with median age 30 years (range, 18-58 years). Eight-five (90%) had stage II disease, including 48 (51%) with stage IIB/IIBE. Seventy-eight (78%) were PET2- and 21 (22%) were PET2+. The predominant toxicity was neutropenia, with 9% of patients developing febrile neutropenia and one developing sepsis. The primary end point of 3-year progression-free survival (PFS) was 93.1% in PET2- and 89.7% in PET2+ patients. Three-year overall survival was 98.6% and 94.4%, respectively. The estimated hazard ratio comparing PFS of patients with PET2+ and patients with PET2- was 1.03 (85% upper bound 2.38) and was significantly less than the null hypothesis of 4.1 (one-sided P = .04). CONCLUSION Our study of PET-adapted therapy in bulky stage I/II cHL met its primary goal and was associated with an excellent 3-year PFS rate of 92.3% in all patients, with the majority being spared radiotherapy and exposure to intensified chemotherapy.
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Affiliation(s)
| | - Travis Dockter
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Amy S. Ruppert
- Alliance Statistics and Data Management Center, The Ohio State University, Columbus, OH
| | | | - Heiko Schöder
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric Hsi
- Wake Forest University Health Sciences, Winston-Salem, NC
| | - Jeffrey Bogart
- State University of New York Upstate Medical University Syracuse-Health Science Center, Syracuse, NY
| | - Bruce Cheson
- Scientific Advisor, Lymphoma Research Foundation, New York, NY
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Bogart J, Wang X, Masters G, Gao J, Komaki R, Gaspar L, Heymach J, Bonner J, Kuzma C, Waqar S, Petty W, Stinchcombe T, Bradley J, Vokes E. 1546P Impact of stratification factors on outcomes in limited-stage small cell lung cancer: Analysis of CALGB 30610 (Alliance)/RTOG 0538. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1640] [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: 11/25/2022] Open
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Thibodeau R, Li HK, Tanny S, Gajra A, Bogart J. Heterogeneous Versus Homogeneous Radiation Dose Calculations of Twice-Daily Fractionation in Small Cell Lung Carcinoma. Cureus 2021; 13:e20226. [PMID: 35004043 PMCID: PMC8729317 DOI: 10.7759/cureus.20226] [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] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The standard radiotherapy regimen for small cell lung cancer (SCLC) was determined using dose calculations without corrections for tissue heterogeneity, while modern treatments are planned using algorithms accounting for tissue heterogeneity. We assessed differences in dose delivered using heterogeneous and homogeneous dose calculations in a cohort of patients treated for limited-stage small cell lung cancer (LS-SCLC). Methods This is a retrospective analysis of 35 patients (three-dimensional conformal radiation therapy (3D-CRT), n = 22; intensity-modulated radiation therapy (IMRT), n = 13) with LS-SCLC treated with chemoradiotherapy from 2011 to 2017. Treatment plans were developed in the Eclipse Treatment Planning System (TPS) version 13.6 using the Analytical Anisotropic Algorithm (AAA). Two plans were generated for each patient with one using the unit relative electron density and the other maintaining the same monitor units (MUs) with tissue density corrections. The prescription was 45 Gy in 30 fractions of 1.5 Gy delivered twice daily. Individuals who underwent replanning within the same treatment course were evaluated using a separate corrected and uncorrected plan sum. Variations greater than 5% in dose to the tumor or organs at risk were considered clinically relevant. A two-sided paired t-test was used to evaluate the statistical significance of the dosimetric differences. Results The percent dose difference between plans without tissue heterogeneity corrections to those with corrections resulted in an overall median difference of -3% (range: -15.1% to 9.6%; p < 0.01) for the dose covering 95% of the planning target volume (PTV D95) and was -5.6% (range: -17.3% to 5.4%; p < 0.01) for lung volume receiving ≥20 Gy (lung V20). For 3D-CRT, the median difference for the PTV D95 was -0.1% (range: -4.7% to 9.6%; p = 0.62) and the lung V20 was -4.2% (range: -9.4 to 5.4; p < 0.01). For IMRT, the median difference for the PTV D95 was -10.0% (range: -15.1% to -5.3%; p < 0.01) and the lung V20 was -8.9% (range: -17.3 to -3.5; p < 0.01). Conclusion Traditional planning without tissue heterogeneity corrections results in an overall decrease in the dose delivered to the target compared with those that incorporate tissue heterogeneity corrections. These differences are modest for 3D treatment plans but may result in clinically relevant differences for the IMRT cohort (>5% deviation).
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Affiliation(s)
- Ryan Thibodeau
- Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, USA
| | - Hsin K Li
- Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, USA
| | - Sean Tanny
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, USA
| | - Ajeet Gajra
- Department of Medical Oncology, State University of New York Upstate Medical University, Syracuse, USA
| | - Jeffrey Bogart
- Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, USA
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Kozono DE, Stinchcombe TE, Salama JK, Bogart J, Petty WJ, Guarino MJ, Bazhenova L, Larner JM, Weiss J, DiPetrillo TA, Feigenberg SJ, Chen X, Sun Z, Nuthalapati S, Rosenwinkel L, Johnson EF, Bach BA, Luo Y, Vokes EE. Veliparib in combination with carboplatin/paclitaxel-based chemoradiotherapy in patients with stage III non-small cell lung cancer. Lung Cancer 2021; 159:56-65. [PMID: 34311345 DOI: 10.1016/j.lungcan.2021.06.028] [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: 01/29/2021] [Revised: 06/10/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Veliparib is a potent poly(ADP)-ribose polymerase (PARP) 1 and 2 inhibitor that impedes repair of DNA damage induced by cytotoxic and radiation therapies. This phase 1 study evaluated veliparib in combination with chemoradiotherapy in patients with unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Patients received veliparib orally twice daily (BID) in escalating doses (60-240 mg, Day -3 to 1 day after last dose of radiation) combined with weekly carboplatin (area under the curve [AUC] 2 mg/mL/min), paclitaxel (45 mg/m2), and daily radiation therapy (60 Gy in 30 fractions), followed by two cycles of veliparib (120-240 mg BID, Days -2 through 5 of each 21-day cycle), carboplatin (AUC 6 mg/mL/min, Day 1 of each cycle), and paclitaxel (200 mg/m2, Day 1 of each cycle) consolidation. Endpoints included veliparib maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), pharmacokinetics, safety, and efficacy. RESULTS Forty-eight patients were enrolled. The MTD/RP2D of veliparib was 240 mg BID with chemoradiotherapy followed by 120 mg BID with consolidation. The most common any-grade adverse events (AEs) in this cohort for the whole treatment period were nausea (83%), esophagitis (75%), neutropenia (75%), and thrombocytopenia (75%). Dose-proportional pharmacokinetics of veliparib were observed. Median progression-free survival (mPFS) was 19.6 months (95% CI: 9.7-32.6). Median overall survival was estimated to be 32.6 months (95% CI: 15.0-not reached). In patients treated with the RP2D, mPFS was 19.6 months (95% CI: 3.0-not reached). CONCLUSIONS When combined with standard concurrent chemoradiotherapy and consolidation chemotherapy in patients with stage III NSCLC, veliparib demonstrated an acceptable safety profile and antitumor activity with an mPFS of 19.6 months.
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Affiliation(s)
- David E Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
| | - Thomas E Stinchcombe
- Duke Cancer Institute, Durham, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA.
| | - Joseph K Salama
- Duke Cancer Institute, Durham, 2 Seeley Mudd, 10 Bryan Searle Drive, Durham, NC 27710, USA.
| | - Jeffrey Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
| | - W Jeffrey Petty
- Department of Hematology and Oncology, Wake Forest School of Medicine, Bowman Gray Center for Medical Education, 475 Vine Street, Winston-Salem, NC 27101, USA.
| | - Michael J Guarino
- Christiana Care Health System, Helen F Graham Cancer Center, 4701 Ogletown Stanton Road, Suite 3400, Newark, DE 19713, USA.
| | - Lyudmila Bazhenova
- Department of Medicine, Moores Cancer Center, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - James M Larner
- University of Virginia, Emily Couric Clinical Cancer Center, 1240 Lee Street, Charlottesville, VA 22903, USA.
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center at the University of North Carolina, Cancer Hospital, 101 Manning Drive, Chapel Hill, NC 27514, USA.
| | - Thomas A DiPetrillo
- Department of Radiation Oncology, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
| | - Steven J Feigenberg
- Greenebaum Comprehensive Cancer Center, University of Maryland, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Xin Chen
- Data and Statistical Sciences, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Zhaowen Sun
- Data and Statistical Sciences, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Silpa Nuthalapati
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Lindsey Rosenwinkel
- Global Pharmaceutical R&D, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Eric F Johnson
- Oncology Early Development, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Bruce A Bach
- Oncology Development, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Yan Luo
- Oncology Development, AbbVie Inc, 1 N. Waukegan Road, North Chicago, IL 60064, USA.
| | - Everett E Vokes
- Department of Medicine, University of Chicago, 5801 South Ellis Avenue, Chicago, IL 60637, USA.
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Assif J, Ennis W, Chaudhari R, Kim B, Rice S, Shapiro A, Damron T, Tanny S, Banashkevich A, Bogart J. PO-0257 Perioperative Radiation with/without High Dose Rate Brachytherapy for High-risk Soft Tissue Sarcoma. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06416-1] [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: 10/21/2022]
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Wang W, Kong F, Hu C, Jin J, Machtay M, Bogart J, Garces I, Narayan S, Robinson C, Kavadi V, Rothman J, Koprowski C, Gore E, Welsh J, Gaur R, Macrae R, Cannon G, Bradley J, Lu B. MA13.01 A Validation Study on DNA Repair Gene Variant for Lung Cancer Survival Prediction after Chemoradiation: A Secondary Analysis for RTOG-0617 Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.263] [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: 11/26/2022]
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Kozono D, Stinchcombe T, Salama J, Bogart J, Petty W, Guarino M, Bazhenova L, Larner J, Weiss J, Dipetrillo T, Feigenberg S, Chen X, Sun Z, Nuthalapati S, Rosenwinkel L, Johnson E, Bach B, Luo Y, Vokes E. P01.23 Veliparib (V) in Combination with Carboplatin/Paclitaxel (C/P)-Based Chemoradiotherapy (CRT) in Patients With Stage III NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.347] [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: 10/21/2022]
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Thor M, Deasy JO, Hu C, Gore E, Bar-Ad V, Robinson C, Wheatley M, Oh JH, Bogart J, Garces YI, Kavadi VS, Narayan S, Iyengar P, Witt JS, Welsh JW, Koprowski CD, Larner JM, Xiao Y, Bradley J. Modeling the Impact of Cardiopulmonary Irradiation on Overall Survival in NRG Oncology Trial RTOG 0617. Clin Cancer Res 2020; 26:4643-4650. [PMID: 32398326 DOI: 10.1158/1078-0432.ccr-19-2627] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/07/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To quantitatively predict the impact of cardiopulmonary dose on overall survival (OS) after radiotherapy for locally advanced non-small cell lung cancer. EXPERIMENTAL DESIGN We used the NRG Oncology/RTOG 0617 dataset. The model building procedure was preregistered on a public website. Patients were split between a training and a set-aside validation subset (N = 306/131). The 191 candidate variables covered disease, patient, treatment, and dose-volume characteristics from multiple cardiopulmonary substructures (atria, lung, pericardium, and ventricles), including the minimum dose to the hottest x% volume (Dx%[Gy]), mean dose of the hottest x% (MOHx%[Gy]), and minimum, mean (Mean[Gy]), and maximum dose. The model building was based on Cox regression and given 191 candidate variables; a Bonferroni-corrected P value threshold of 0.0003 was used to identify predictors. To reduce overreliance on the most highly correlated variables, stepwise multivariable analysis (MVA) was repeated on 1000 bootstrapped replicates. Multivariate sets selected in ≥10% of replicates were fit to the training subset and then averaged to generate a final model. In the validation subset, discrimination was assessed using Harrell c-index, and calibration was tested using risk group stratification. RESULTS Four MVA models were identified on bootstrap. The averaged model included atria D45%[Gy], lung Mean[Gy], pericardium MOH55%[Gy], and ventricles MOH5%[Gy]. This model had excellent performance predicting OS in the validation subset (c = 0.89). CONCLUSIONS The risk of death due to cardiopulmonary irradiation was accurately modeled, as demonstrated by predictions on the validation subset, and provides guidance on the delivery of safe thoracic radiotherapy.
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Affiliation(s)
- Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Elizabeth Gore
- Zablocki Veterans Administration Medical Center, Milwaukee, Wisconsin
| | - Voichita Bar-Ad
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Matthew Wheatley
- Mercy San Juan Medical Center Dignity Health, Carmichael, California
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeffrey Bogart
- State University of New York Upstate Medical University, Syracuse, New York
| | | | - Vivek S Kavadi
- Texas Oncology Cancer Center Sugar Land, Sugar Land, Texas
| | | | | | - Jacob S Witt
- University of Wisconsin-Madison (accruals under Washington University), Madison, Wisconsin
| | - James W Welsh
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - James M Larner
- University of Virginia Cancer Center, Charlottesville, Virginia
| | - Ying Xiao
- University of Pennsylvania, Philadelphia, Pennsylvania
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Quinn TJ, Daignault-Newton S, Bosch W, Mariados N, Sylvester J, Shah D, Gross E, Hudes R, Beyer D, Kurtzman S, Bogart J, Hsi RA, Kos M, Ellis R, Logsdon M, Zimberg S, Forsythe K, Zhang H, Soffen E, Francke P, Mantz C, DeWeese T, Gay HA, Michalski J, Hamstra DA. Who Benefits From a Prostate Rectal Spacer? Secondary Analysis of a Phase III Trial. Pract Radiat Oncol 2020; 10:186-194. [DOI: 10.1016/j.prro.2019.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/07/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
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Nsouli T, Alden R, Ennis W, Mix M, Bogart J. P1.17-24 Treatment of Ultracentral Lung Tumors with Hypofractionated Radiation Therapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1298] [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: 11/15/2022]
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Bogart J, Wang X, Masters G, Zhu H, Komaki R, Gaspar L, Dobelbower M, Kuzma C, Heymach J, Vokes E, Stinchcombe T. Interim toxicity analysis for patients with limited stage small cell lung cancer (LSCLC) treated on the experimental thoracic radiotherapy (TRT) arms of CALGB 30610 (Alliance) / RTOG 0538. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz264.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kozono DE, Stinchcombe T, Salama JK, Bogart J, Petty WJ, Guarino MJ, Bazhenova L, Larner JM, Weiss J, DiPetrillo TA, Feigenberg SJ, Hu B, Nuthalapati S, Luo Y, Vokes EE. Veliparib (Vel) in combination with chemoradiotherapy (CRT) of carboplatin/paclitaxel (C/P) plus radiation in patients (pts) with stage III non-small cell lung cancer (NSCLC) (M14-360/AFT-07). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8510 Background: CRT is standard treatment (Tx) for pts with unresectable stage III NSCLC. Vel, a potent oral PARP1/2 inhibitor, interferes with repair of chemotherapy- or radiation-induced DNA damage. In a phase 2 study, Vel showed favorable efficacy vs placebo when added to C/P in stage IV NSCLC. The reported phase 1 trial assessed the safety and efficacy of Vel + C/P-based CRT in Tx of stage III NSCLC (NCT02412371). Methods: Eligible pts (≥18 yr, unresectable stage III NSCLC, no prior NSCLC therapy) received Vel + CRT of weekly C area under the curve (AUC) 2 + P 45 mg/m2 weekly + 60 Gy (2 Gy/day) RT over 6–9 weeks (wk). Vel was dose escalated from 60 mg twice daily (BID) to 240 mg BID followed by Vel 120 mg BID added to consolidation therapy (CON) once every 3 wk of C AUC 6 + P 200 mg/m2 for 2 cycles (cohort 1–5). Cohort 6 received Vel 240 mg BID + CRT followed by Vel 240 mg BID + CON. Samples for pharmacokinetic (PK) analysis were collected on wk 4 day –3. The primary endpoint was to establish the recommended phase 2 dose (RP2D) of Vel + CRT/Vel + CON. Results: As of Sep 2018, 48 pts enrolled into cohorts 1–6 at Vel 60 mg/120 mg (n = 7), 80 mg/120 mg (n = 9), 120 mg/120 mg (n = 7), 200 mg/120 mg (n = 8), 240 mg/120 mg (n = 12), and 240 mg/240 mg (n = 5) added to CRT/CON; median age 65 yr (range, 48–81). Vel PK was dose proportional; 39 (81.3%) pts completed therapy. Grade ≥3 Tx-emergent adverse events (AEs) were reported in 37 (77.1%) pts; anemia and febrile neutropenia (10.4% each) were the most common. Serious AEs were observed in 19 (39.6%) pts. Dose-limiting toxicities occurred at 200 mg/120 mg (n = 1; influenza and pneumonia), 240 mg/120 mg (n = 1; insomnia), and 240 mg/240 mg (n = 2; febrile neutropenia, neutropenia, thrombocytopenia, esophagitis, suprapubic pain, sepsis); Vel 240 mg BID + CRT/Vel 120 mg + CON was chosen as the maximum tolerated dose/RP2D. Of 41 pts evaluable for tumor assessment, 26 (63.4%) had a confirmed response. Interim median progression-free survival was 24.1 mo (range, 8.9 – not reached); updated results will be reported. Conclusions: Vel 240 + CRT/Vel 120 mg BID + CON was well tolerated with promising antitumor activity in stage III NSCLC and was determined as RP2D. Clinical trial information: NCT02412371.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jared Weiss
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | - Yan Luo
- AbbVie Inc., North Chicago, IL
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Deck J, Eastwick G, Sima J, Raymond A, Bogart J, Aridgides P. Efficacy and tolerability of stereotactic body radiotherapy for lung metastases in three patients with pediatric malignancies. Onco Targets Ther 2019; 12:3723-3727. [PMID: 31190873 PMCID: PMC6526915 DOI: 10.2147/ott.s194812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/15/2018] [Accepted: 03/27/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose: To report a case series of 3 pediatric patients treated with Stereotactic Body Radiation Therapy (SBRT) for lung metastases. Patients and methods: Three patients (ages 9, 11, and 21) received SBRT for rhabdoid tumor, Ewing sarcoma, and Wilms tumor histologies, respectively. SBRT doses were 37.5–50 Gy in 3–5 fractions treating twelve lesions. Results: Three patients (ages 9, 11, and 21) received photon SBRT for pulmonary metastases. The patients were as follows: 1) 21-year-old male with favorable histology Wilms tumor and 1 lesion treated, 2) 11-year-old female with Ewing sarcoma and 1 lesion treated for relapse after previous whole lung radiation (15 Gy), and 3) 9-year-old female with rhabdoid tumor of the left thigh with 10 lesions treated over a two-year period. Median dose delivered was 40 Gy (range, 37.5–50 Gy), delivered in a median of 4 fractions (range, 4–5) of a median of 10 Gy per fraction (range, 9.4–10 Gy). Within a minimum follow-up of 1.9 years (range 1.9–4 years), local control for all 13 treated metastases is 100% without any observed acute toxicities. One possible late toxicity (grade 2 rib fracture) developed 1.3 years following SBRT for treatment of a peripheral lesion (rhabdoid tumor) in an area of disease progression and was managed conservatively. Two patients are surviving 2.9 years (Wilms tumor) and 1.9 years (Ewing sarcoma) after SBRT, and one (rhabdoid tumor) expired 2 years after her final course (4 years after initial SBRT). Two patients (rhabdoid tumor and Ewing sarcoma) suffered disease progression outside of the treated lesions and one patient (Wilms tumor) is without evidence of disease and has not required whole lung irradiation or further systemic therapy. Conclusion: SBRT appears effective and well tolerated for pediatric lung metastases, however further studies are warranted.
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Affiliation(s)
- Jared Deck
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gary Eastwick
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jody Sima
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Amanda Raymond
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jeffrey Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
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Thibodeau R, Tanny S, Eastwick G, Hahn SS, Bogart J, Aridgides P. Potential Impact of Real-Time Ultrasound Guidance with Adoption of Combined Interstitial/Intracavitary Cervical Brachytherapy. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.206] [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: 11/26/2022]
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16
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Aridgides P, Nsouli T, Chaudhari R, Kincaid R, Rosenbaum PF, Tanny S, Mix M, Bogart J. Clinical outcomes following advanced respiratory motion management (respiratory gating or dynamic tumor tracking) with stereotactic body radiation therapy for stage I non-small-cell lung cancer. Lung Cancer (Auckl) 2018; 9:103-110. [PMID: 30464667 PMCID: PMC6223331 DOI: 10.2147/lctt.s175168] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To report the outcomes of stereotactic body radiation therapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) according to respiratory motion management method. Methods Patients with stage I NSCLC who received SBRT from 2007 to 2015 were reviewed. Computed tomography (CT) simulation with four-dimensional CT was performed for respiratory motion assessment. Tumor motion >1 cm in the craniocaudal direction was selectively treated with advanced respiratory management: either respiratory gating to a pre-specified portion of the respiratory cycle or dynamic tracking of an implanted fiducial marker. Comparisons were made with internal target volume approach, which treated all phases of respiratory motion. Results Of 297 patients treated with SBRT at our institution, 51 underwent advanced respiratory management (48 with respiratory gating and three with tumor tracking) and 246 underwent all-phase treatment. Groups were similarly balanced with regard to mean age (P=0.242), tumor size (P=0.315), and histology (P=0.715). Tumor location in the lower lung lobes, as compared to middle or upper lobes, was more common in those treated with advanced respiratory management (78.4%) compared to all-phase treatment (25.6%, P<.0001). There were 17 local recurrences in the treated lesions. Kaplan-Meier analyses showed that there were no differences with regard to mean time to local failure (91.5 vs 98.8 months, P=0.56), mean time to any failure (73.2 vs 78.7 months, P=0.73), or median overall survival (43.3 vs 45.5 months, P=0.56) between patients who underwent advanced respiratory motion management and all-phase treatment. Conclusion SBRT with advanced respiratory management (the majority with respiratory gating) showed similar efficacy to all-phase treatment approach for stage I NSCLC.
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Affiliation(s)
- Paul Aridgides
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Tamara Nsouli
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Rishabh Chaudhari
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Russell Kincaid
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Paula F Rosenbaum
- Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sean Tanny
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Michael Mix
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
| | - Jeffrey Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA,
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Bogart J. PC02.04 BID Radiation - PRO. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.098] [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: 10/28/2022]
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Stinchcombe T, Fan W, Schild S, Vokes E, Bogart J, Le QT, Thomas C, Edelman M, Horn L, Komaki R, Cohen H, Ganti A, Pang H, Wang X. A pooled analysis of individual patient data (IPD) of concurrent chemoradiotherapy for limited-stage small cell lung cancer (LS-SCLC) in elderly compared to younger patients (pts) who participated in US National Cancer Institute cooperative group studies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy298.004] [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: 11/13/2022] Open
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Deck J, Eastwick G, Raymond A, Sima J, Bogart J, Aridgides P. (P54) Stereotactic Body Radiotherapy for Lung Metastases in Pediatric Malignancies: a Case Series of Three Patients. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.02.142] [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: 12/01/2022]
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20
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Ou SHI, Ali SM, Bogart J, Graziano SL, Mix MD, Ross JS, Miller VA, Schrock AB. Characterization of 1,233 NSCLCs with non-del19/L858R EGFR mutations (EGFRm) using comprehensive genomic profiling (CGP). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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21
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Oaks Z, Bogart J, Nsouli T, Aridgides P. PS03.03 Salvage Therapy for Relapse after Stereotactic Body Radiation for Stage I Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.068] [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: 11/25/2022]
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22
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Kozono DE, Salama JK, Stinchcombe T, Bogart J, Petty WJ, Guarino MJ, Bazhenova L, Larner JM, Weiss J, DiPetrillo TA, Feigenberg SJ, Xu T, Hu B, Nuthalapati S, Rosenwinkel L, Bensman L, Johnson EF, McKee MD, Vokes EE. Tolerability of veliparib (V) in combination with carboplatin (C)/paclitaxel (P): Based chemoradiotherapy (CRT) in subjects with stage III non-small cell lung cancer (NSCLC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8546 Background: CRT is a standard for patients with Stage III NSCLC. V is a potent, orally bioavailable PARP1/2 inhibitor that can delay DNA repair following chemotherapy or radiation induced damage. A Phase 2 study indicated favorable efficacy of V vs placebo when added to C/P in advanced NSCLC (Ramalingam et al. Clin Cancer Res. 2016). Based on these results, a Phase 1/2 trial was initiated to study the safety and efficacy of V/C/P-based CRT in the treatment of Stage III NSCLC. Methods: Subjects without prior NSCLC therapy suitable for definitive CRT received V plus C AUC 2 + P 45 mg/m2 weekly + 60 Gy over 6-9 weeks. V was escalated from 60 mg BID to a maximum planned dose based on prior studies of 240 mg BID via 3+3 design with allowed over-enrollment followed by consolidation therapy of V 120 mg BID + C AUC 6 + P 200 mg/m2 for up to two 21-day cycles. Results: Thirty-one subjects (median age 64; 10 male) have been enrolled to date into dosing cohorts at 60 mg (7), 80 mg (9), 120 mg (7) and 200 mg (8). PK of V was dose proportional. CRT or V required dose reduction for 0 or 1 subject, respectively. Four (13%) subjects discontinued study during CRT. No DLTs have been observed and an MTD has not yet been identified. The most common any grade AEs were fatigue (16), esophagitis (15), nausea (13), neutropenia (12), thrombocytopenia (12), constipation (10) and decreased appetite (10). 21 SAEs were observed including 8 with reasonable attribution to V but outside the DLT window including G3/4 febrile neutropenia (2), G3 dehydration (1), G3 vomiting (1), G3 radiation esophagitis (1), G3 esophageal stricture (1), G3 intractable N/V (1) and G5 sepsis during consolidation (1). Of 21 subjects evaluable for tumor assessment, best response was CR (1), PR (11), SD (6), and PD (3). Conclusions: V/C/P-based CRT followed by V/C/P consolidation therapy is a tractable regimen for the treatment of Stage III NSCLC. A randomized placebo-controlled Phase 2 extension of this study is planned. Clinical trial information: NCT02412371.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jared Weiss
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Hamstra DA, Shah D, Kurtzman S, Sylvester J, Zimberg SH, Hudes RS, Karsh LI, Logsdon MD, Beyer D, Kos M, Hsi RA, Forsythe K, Soffen EM, Francke PM, Zhang H, DeWeese TL, Ellis RJ, Bogart J, Mantz C, Mariados N. Evaluation of sexual function on a randomized trial of a prostate rectal spacer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.69] [Citation(s) in RCA: 2] [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
69 Background: The SpaceOAR phase 3 trial showed that a hydrogel spacer between the prostate and rectum decreased rectal dose and toxicity while improving bowel quality of life (QOL) after image guided prostate IMRT to 79.2 Gy. Here we evaluated dose to penile bulb as well as sexual function on this trial Methods: Sexual QOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) by mean summary scores and the proportion of patients with a minimally important decline (MID) (11 points). Stratification was based on severe erectile dysfunction (ED)(EPIC < = 60) vs not. The single question on “Erections sufficient for intercourse over the preceding 4 weeks” was also evaluated. Results: Median Follow-up was 37 months with 63% of men evaluable at 3 years. With spacer the dose to the penile bulb was reduced for mean (21 vs 11 Gy), Dmax (46 vs 36 Gy), and V10-V30 (all p < 0.05). Baseline sexual function was 53 (±24) with 54% having severe ED with no difference between arms (p > 0.1). At 3 years average EPIC score was 39.7 (± 23) and 82% had severe ED with no differences between arms (p > 0.1). At enrollment 42% had EPIC > 60 with average summary of 77 (±8.3) which at 3 years was 53 (±24.8). In this sub-group at 3 years a higher EPIC was observed on the Spacer arm (57.7 (±24.1) vs. 44.6 (± 24.4)) which met the threshold for an MID without statistical significance (p = 0.07). Based on MID and twice that there was a trend favoring Spacer with 53% vs 75% for 11-point decline (p = 0.064) and 41% vs 60% for 22 point decline (p = 0.11). A small number of these men were potent at baseline and evaluable both at baseline and 3 years (n = 49). Of these 37.5% in the Control arm had erections sufficient for intercourse at 3 years as compared to 66.7% (p = 0.07) in the Spacer arm. Power analysis revealed 35% power to detect a change of 11 points between arms and 27% power to detect a difference of 22 points. Conclusions: The use of a hydrogel spacer decreased dose to the penile bulb with a suggestion of a clinically significant improvement in patient reported sexual function and potency. These did not achieve statistical significance potentially due to the high prevalence of ED at baseline and, therefore, the small evaluable sample size. Analysis of penile bulb dose and QOL is ongoing. Clinical trial information: NCT01538628.
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Affiliation(s)
| | - Dhiren Shah
- Western New York Urology Associates, Cheektowaga, NY
| | - Steven Kurtzman
- Urological Surgeons of Northern California, Inc., Campbell, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Theodore L. DeWeese
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Rodney J. Ellis
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | | | | | - Neil Mariados
- Associated Medical Professionals of New York, PLLC, Syracuse, NY
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Hamstra DA, Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, Beyer D, Kurtzman S, Bogart J, Hsi RA, Kos M, Ellis R, Logsdon M, Zimberg S, Forsythe K, Zhang H, Soffen E, Francke P, Mantz C, Rossi P, DeWeese T, Daignault-Newton S, Fischer-Valuck BW, Chundury A, Gay H, Bosch W, Michalski J. Continued Benefit to Rectal Separation for Prostate Radiation Therapy: Final Results of a Phase III Trial. Int J Radiat Oncol Biol Phys 2016; 97:976-985. [PMID: 28209443 DOI: 10.1016/j.ijrobp.2016.12.024] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE SpaceOAR, a Food and Drug Administration-approved hydrogel intended to create a rectal-prostate space, was evaluated in a single-blind phase III trial of image guided intensity modulated radiation therapy. A total of 222 men were randomized 2:1 to the spacer or control group and received 79.2 Gy in 1.8-Gy fractions to the prostate with or without the seminal vesicles. The present study reports the final results with a median follow-up period of 3 years. METHODS AND MATERIALS Cumulative (Common Terminology Criteria for Adverse Events, version 4.0) toxicity was evaluated using the log-rank test. Quality of life (QOL) was examined using the Expanded Prostate Cancer Index Composite (EPIC), and the mean changes from baseline in the EPIC domains were tested using repeated measures models. The proportions of men with minimally important differences (MIDs) in each domain were tested using repeated measures logistic models with prespecified thresholds. RESULTS The 3-year incidence of grade ≥1 (9.2% vs 2.0%; P=.028) and grade ≥2 (5.7% vs 0%; P=.012) rectal toxicity favored the spacer arm. Grade ≥1 urinary incontinence was also lower in the spacer arm (15% vs 4%; P=.046), with no difference in grade ≥2 urinary toxicity (7% vs 7%; P=0.7). From 6 months onward, bowel QOL consistently favored the spacer group (P=.002), with the difference at 3 years (5.8 points; P<.05) meeting the threshold for a MID. The control group had a 3.9-point greater decline in urinary QOL compared with the spacer group at 3 years (P<.05), but the difference did not meet the MID threshold. At 3 years, more men in the control group than in the spacer group had experienced a MID decline in bowel QOL (41% vs 14%; P=.002) and urinary QOL (30% vs 17%; P=.04). Furthermore, the control group were also more likely to have experienced large declines (twice the MID) in bowel QOL (21% vs 5%; P=.02) and urinary QOL (23% vs 8%; P=.02). CONCLUSIONS The benefit of a hydrogel spacer in reducing the rectal dose, toxicity, and QOL declines after image guided intensity modulated radiation therapy for prostate cancer was maintained or increased with a longer follow-up period, providing stronger evidence for the benefit of hydrogel spacer use in prostate radiation therapy.
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Affiliation(s)
| | - Neil Mariados
- Associated Medical Professionals of NY, PLLC, Syracuse, New York
| | - John Sylvester
- 21st Century Oncology, Inc, Lakewood Ranch, East Bradenton, Florida
| | - Dhiren Shah
- Western New York Urology Associates, LLC, Doing Business as Cancer Care of WNY, Cheektowaga, New York
| | | | - Richard Hudes
- Chesapeake Urology Associates, Doing Business as Chesapeake Urology Research Associates (The Prostate Center), Owings Mills, Maryland
| | - David Beyer
- Arizona Oncology Services Foundation, Phoenix, Arizona
| | - Steven Kurtzman
- Urological Surgeons of Northern California Inc, Campbell, California
| | - Jeffrey Bogart
- The Research Foundation of State University of New York/State University of New York Upstate Medical University, Syracuse, New York
| | - R Alex Hsi
- Peninsula Cancer Center, Poulsbo, Washington
| | | | - Rodney Ellis
- University Hospitals Case Medical Center, Cleveland, Ohio
| | - Mark Logsdon
- Sutter Health Sacramento Sierra Region, Doing Business as Sutter Institute for Medical Research, Sacramento, California
| | - Shawn Zimberg
- Advanced Radiation Centers of New York, Lake Success, New York
| | | | - Hong Zhang
- University of Rochester, Rochester, New York
| | | | - Patrick Francke
- Carolina Regional Cancer Center, LLC, 21st Century Oncology, Inc, Myrtle Beach, South Carolina
| | | | | | | | | | | | | | - Hiram Gay
- Washington University School of Medicine, St Louis, Missouri
| | - Walter Bosch
- Washington University School of Medicine, St Louis, Missouri
| | - Jeff Michalski
- Washington University School of Medicine, St Louis, Missouri
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Rodrigues G, Choy H, Bradley J, Rosenzweig KE, Bogart J, Curran WJ, Gore E, Langer C, Louie AV, Lutz S, Machtay M, Puri V, Werner-Wasik M, Videtic GMM. Adjuvant radiation therapy in locally advanced non-small cell lung cancer: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline. Pract Radiat Oncol 2016; 5:149-155. [PMID: 25957185 DOI: 10.1016/j.prro.2015.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/18/2015] [Accepted: 02/25/2015] [Indexed: 01/16/2023]
Abstract
PURPOSE To provide guidance to physicians and patients with regard to the use of adjuvant external beam radiation therapy (RT) in locally advanced non-small cell lung cancer (LA NSCLC) based on available medical evidence complemented by consensus-based expert opinion. METHODS AND MATERIALS A panel authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors and Guidelines Subcommittee conducted 2 systematic reviews on the following topics: (1) indications for postoperative adjuvant RT and (2) indications for preoperative neoadjuvant RT. Practice guideline recommendations were approved using an a priori-defined consensus-building methodology supported by ASTRO and approved tools for the grading of evidence quality and the strength of guideline recommendations. RESULTS For patients who have undergone surgical resection, high-level evidence suggests that use of postoperative RT does not influence survival, but optimizes local control for patients with N2 involvement, and its use in the setting of positive margins or gross primary/nodal residual disease is recommended. No high-level evidence exists for the routine use of preoperative induction chemoradiation therapy; however, modern surgical series and a post-hoc Intergroup 0139 clinical trial analysis suggest that a survival benefit may exist if patients are properly selected and surgical techniques/postoperative care is optimized. CONCLUSIONS A consensus and evidence-based clinical practice guideline for the adjuvant radiotherapeutic management of LA NSCLC has been created addressing 2 important questions.
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Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Kenneth E Rosenzweig
- Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Bogart
- Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Corey Langer
- Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stephen Lutz
- Department of Radiation Oncology, Blanchard Valley Health System, Findlay, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio
| | - Varun Puri
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Rodrigues G, Choy H, Bradley J, Rosenzweig KE, Bogart J, Curran WJ, Gore E, Langer C, Louie AV, Lutz S, Machtay M, Puri V, Werner-Wasik M, Videtic GMM. Definitive radiation therapy in locally advanced non-small cell lung cancer: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline. Pract Radiat Oncol 2016; 5:141-148. [PMID: 25957184 DOI: 10.1016/j.prro.2015.02.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/18/2015] [Accepted: 02/25/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE To provide guidance to physicians and patients with regard to the use of definitive external beam radiation therapy (RT) in locally advanced non-small cell lung cancer (LA NSCLC) based on available medical evidence complemented by consensus-based expert opinion. METHODS AND MATERIALS A panel authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors and Guidelines Subcommittee conducted 3 systematic reviews on the following topics: (1) ideal radical RT dose fractionation for RT alone; (2) ideal radical RT dose fractionation for chemoradiation; and (3) ideal timing of radical radiation therapy with systemic chemotherapy. Practice guideline recommendations were approved using an a priori-defined consensus-building methodology supported by ASTRO and approved tools for the grading of evidence quality and the strength of guideline recommendations. RESULTS For patients managed by RT alone, a minimum dose of 60 Gy of RT is recommended. Dose escalation beyond 60 Gy in the context of combined modality concurrent chemoradiation has not been found to be associated with any clinical benefits. In the context of combined modality therapy, chemotherapy and radiation should ideally be given concurrently to maximize survival, local control, and disease response rate. CONCLUSIONS A consensus and evidence-based clinical practice guideline for the definitive radiotherapeutic management of LA NSCLC has been created that addresses 3 important questions.
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Affiliation(s)
- George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey Bradley
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Kenneth E Rosenzweig
- Department of Radiation Oncology, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey Bogart
- Department of Radiation Oncology, State University of New York Upstate Medical University, Syracuse, New York
| | - Walter J Curran
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Corey Langer
- Department of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stephen Lutz
- Department of Radiation Oncology, Blanchard Valley Health System, Findlay, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio
| | - Varun Puri
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
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Mariados N, Sylvester J, Shah D, Karsh L, Hudes R, Beyer D, Kurtzman S, Bogart J, Hsi RA, Kos M, Ellis R, Logsdon M, Zimberg S, Forsythe K, Zhang H, Soffen E, Francke P, Mantz C, Rossi P, DeWeese T, Hamstra DA, Bosch W, Gay H, Michalski J. Hydrogel Spacer Prospective Multicenter Randomized Controlled Pivotal Trial: Dosimetric and Clinical Effects of Perirectal Spacer Application in Men Undergoing Prostate Image Guided Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 92:971-977. [DOI: 10.1016/j.ijrobp.2015.04.030] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/13/2015] [Accepted: 04/17/2015] [Indexed: 12/13/2022]
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Pieczonka C, Mariados N, Sylvester J, Aliotta P, Skomra C, Karsh L, Smith B, Hudes R, Beyer D, Kurtzman S, Tiara A, Bogart J, Hsi A, Gholodian CG, Ponsky L, Ellis R, Logsdon M, Rosenthal S, Forsythe K, Zhang H, Soffen E, Shore N, Mantz C, Nieh P, Han M. MP78-11 PERIRECTAL HYDROGEL SPACER APPLICATION IN MEN RECEIVING PROSTATE RADIOTHERAPY: A PROSPECTIVE MULTICENTER RANDOMIZED CONTROLLED TRIAL. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ready NE, Pang HH, Gu L, Otterson GA, Thomas SP, Miller AA, Baggstrom M, Masters GA, Graziano SL, Crawford J, Bogart J, Vokes EE. Chemotherapy With or Without Maintenance Sunitinib for Untreated Extensive-Stage Small-Cell Lung Cancer: A Randomized, Double-Blind, Placebo-Controlled Phase II Study-CALGB 30504 (Alliance). J Clin Oncol 2015; 33:1660-5. [PMID: 25732163 DOI: 10.1200/jco.2014.57.3105] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the efficacy of maintenance sunitinib after chemotherapy for small-cell lung cancer (SCLC). PATIENTS AND METHODS The Cancer and Leukemia Group B 30504 trial was a randomized, placebo-controlled, phase II study that enrolled patients before chemotherapy (cisplatin 80 mg/m(2) or carboplatin area under the curve of 5 on day 1 plus etoposide 100 mg/m(2) per day on days 1 to 3 every 21 days for four to six cycles). Patients without progression were randomly assigned 1:1 to placebo or sunitinib 37.5 mg per day until progression. Cross-over after progression was allowed. The primary end point was progression-free survival (PFS) from random assignment for maintenance placebo versus sunitinib using a one-sided log-rank test with α = .15; 80 randomly assigned patients provided 89% power to detect a hazard ratio (HR) of 1.67. RESULTS One hundred forty-four patients were enrolled; 138 patients received chemotherapy. Ninety-five patients were randomly assigned; 10 patients did not receive maintenance therapy (five on each arm). Eighty-five patients received maintenance therapy (placebo, n = 41; sunitinib, n = 44). Grade 3 adverse events with more than 5% incidence were fatigue (19%), decreased neutrophils (14%), decreased leukocytes (7%), and decreased platelets (7%) for sunitinib and fatigue (10%) for placebo; grade 4 adverse events were GI hemorrhage (n = 1) and pancreatitis, hypocalcemia, and elevated lipase (n = 1; all in same patient) for sunitinib and thrombocytopenia (n = 1) and hypernatremia (n = 1) for placebo. Median PFS on maintenance was 2.1 months for placebo and 3.7 months for sunitinib (HR, 1.62; 70% CI, 1.27 to 2.08; 95% CI, 1.02 to 2.60; one-sided P = .02). Median overall survival from random assignment was 6.9 months for placebo and 9.0 months for sunitinib (HR, 1.28; 95% CI, 0.79 to 2.10; one-sided P = .16). Three sunitinib and no placebo patients achieved complete response during maintenance. Ten (77%) of 13 patients evaluable after cross-over had stable disease on sunitinib (6 to 27 weeks). CONCLUSION Maintenance sunitinib was safe and improved PFS in extensive-stage SCLC.
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Affiliation(s)
- Neal E Ready
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY.
| | - Herbert H Pang
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Lin Gu
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Otterson
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Sachdev P Thomas
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Antonius A Miller
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Maria Baggstrom
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Gregory A Masters
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Stephen L Graziano
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Crawford
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Jeffrey Bogart
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
| | - Everett E Vokes
- Neal E. Ready and Jeffrey Crawford, Duke University Medical Center; Herbert H. Pang and Lin Gu, Alliance Statistics and Data Center, Duke University Medical Center, Durham; Antonius A. Miller, Wake Forest University Medical Center, Winston Salem, NC; Gregory A. Otterson, Ohio State University Medical Center, Columbus, OH; Sachdev P. Thomas, Illinois Oncology Research Association Community Clinical Oncology Program, Illinois Cancer Care, Peoria; Everett E. Vokes, University of Chicago, Chicago, IL; Maria Baggstrom, Washington University School of Medicine, St Louis, MO; Gregory A. Masters, Christiana Healthcare Services, Christiana Hospital, Newark, DE; Stephen L. Graziano and Jeffrey Bogart, State University of New York Upstate Medical University, Syracuse, NY
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Bradley JD, Paulus R, Komaki R, Masters G, Blumenschein G, Schild S, Bogart J, Hu C, Forster K, Magliocco A, Kavadi V, Garces YI, Narayan S, Iyengar P, Robinson C, Wynn RB, Koprowski C, Meng J, Beitler J, Gaur R, Curran W, Choy H. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol 2015; 16:187-99. [PMID: 25601342 DOI: 10.1016/s1470-2045(14)71207-0] [Citation(s) in RCA: 1377] [Impact Index Per Article: 153.0] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to compare overall survival after standard-dose versus high-dose conformal radiotherapy with concurrent chemotherapy and the addition of cetuximab to concurrent chemoradiation for patients with inoperable stage III non-small-cell lung cancer. METHODS In this open-label randomised, two-by-two factorial phase 3 study in 185 institutions in the USA and Canada, we enrolled patients (aged ≥ 18 years) with unresectable stage III non-small-cell lung cancer, a Zubrod performance status of 0-1, adequate pulmonary function, and no evidence of supraclavicular or contralateral hilar adenopathy. We randomly assigned (1:1:1:1) patients to receive either 60 Gy (standard dose), 74 Gy (high dose), 60 Gy plus cetuximab, or 74 Gy plus cetuximab. All patients also received concurrent chemotherapy with 45 mg/m(2) paclitaxel and carboplatin once a week (AUC 2); 2 weeks after chemoradiation, two cycles of consolidation chemotherapy separated by 3 weeks were given consisting of paclitaxel (200 mg/m(2)) and carboplatin (AUC 6). Randomisation was done with permuted block randomisation methods, stratified by radiotherapy technique, Zubrod performance status, use of PET during staging, and histology; treatment group assignments were not masked. Radiation dose was prescribed to the planning target volume and was given in 2 Gy daily fractions with either intensity-modulated radiation therapy or three-dimensional conformal radiation therapy. The use of four-dimensional CT and image-guided radiation therapy were encouraged but not necessary. For patients assigned to receive cetuximab, 400 mg/m(2) cetuximab was given on day 1 followed by weekly doses of 250 mg/m(2), and was continued through consolidation therapy. The primary endpoint was overall survival. All analyses were done by modified intention-to-treat. The study is registered with ClinicalTrials.gov, number NCT00533949. FINDINGS Between Nov 27, 2007, and Nov 22, 2011, 166 patients were randomly assigned to receive standard-dose chemoradiotherapy, 121 to high-dose chemoradiotherapy, 147 to standard-dose chemoradiotherapy and cetuximab, and 110 to high-dose chemoradiotherapy and cetuximab. Median follow-up for the radiotherapy comparison was 22.9 months (IQR 27.5-33.3). Median overall survival was 28.7 months (95% CI 24.1-36.9) for patients who received standard-dose radiotherapy and 20.3 months (17.7-25.0) for those who received high-dose radiotherapy (hazard ratio [HR] 1.38, 95% CI 1.09-1.76; p=0.004). Median follow-up for the cetuximab comparison was 21.3 months (IQR 23.5-29.8). Median overall survival in patients who received cetuximab was 25.0 months (95% CI 20.2-30.5) compared with 24.0 months (19.8-28.6) in those who did not (HR 1.07, 95% CI 0.84-1.35; p=0.29). Both the radiation-dose and cetuximab results crossed protocol-specified futility boundaries. We recorded no statistical differences in grade 3 or worse toxic effects between radiotherapy groups. By contrast, the use of cetuximab was associated with a higher rate of grade 3 or worse toxic effects (205 [86%] of 237 vs 160 [70%] of 228 patients; p<0.0001). There were more treatment-related deaths in the high-dose chemoradiotherapy and cetuximab groups (radiotherapy comparison: eight vs three patients; cetuximab comparison: ten vs five patients). There were no differences in severe pulmonary events between treatment groups. Severe oesophagitis was more common in patients who received high-dose chemoradiotherapy than in those who received standard-dose treatment (43 [21%] of 207 patients vs 16 [7%] of 217 patients; p<0.0001). INTERPRETATION 74 Gy radiation given in 2 Gy fractions with concurrent chemotherapy was not better than 60 Gy plus concurrent chemotherapy for patients with stage III non-small-cell lung cancer, and might be potentially harmful. Addition of cetuximab to concurrent chemoradiation and consolidation treatment provided no benefit in overall survival for these patients. FUNDING National Cancer Institute and Bristol-Myers Squibb.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/secondary
- Adenocarcinoma/therapy
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carboplatin/administration & dosage
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/secondary
- Carcinoma, Large Cell/therapy
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/secondary
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/therapy
- Cetuximab
- Chemoradiotherapy
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Metastasis
- Neoplasm Staging
- Paclitaxel/administration & dosage
- Prognosis
- Radiotherapy Dosage
- Radiotherapy, Conformal
- Radiotherapy, Image-Guided
- Survival Rate
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Affiliation(s)
| | - Rebecca Paulus
- Radiation Therapy Oncology Group-Statistical Center, Philadelphia, PA, USA
| | - Ritsuko Komaki
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Masters
- Christiana Care/Helen Graham Medical Center, Newark, DE, USA
| | | | | | | | - Chen Hu
- Radiation Therapy Oncology Group-Statistical Center, Philadelphia, PA, USA
| | | | | | - Vivek Kavadi
- USON- Texas Oncology-Sugarland, Sugarland, TX, USA
| | | | - Samir Narayan
- Michigan Cancer Research Consortium CCOP, Ypsilanti, MI, USA
| | | | | | | | | | - Joanne Meng
- The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | | | | | | | - Hak Choy
- University of Texas Southwestern, Dallas, TX, USA
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Lilenbaum R, Samuels M, Wang X, Kong FM, Jänne PA, Masters G, Katragadda S, Hodgson L, Bogart J, Bradley J, Vokes E. A phase II study of induction chemotherapy followed by thoracic radiotherapy and erlotinib in poor-risk stage III non-small-cell lung cancer: results of CALGB 30605 (Alliance)/RTOG 0972 (NRG). J Thorac Oncol 2015; 10:143-7. [PMID: 25384173 PMCID: PMC4320012 DOI: 10.1097/jto.0000000000000347] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with stage III non-small-cell lung cancer and poor performance status and/or weight loss do not seem to benefit from standard therapy. Based on the preclinical interaction between epidermal growth factor receptor inhibitors and radiation, we designed a trial of induction chemotherapy followed by thoracic radiotherapy and concurrent erlotinib. METHODS Patients with poor-risk unresectable stage III non-small-cell lung cancer received two cycles of carboplatin at an AUC of 5 and nab-paclitaxel at 100 mg/m on days 1 and 8 every 21 days, followed by erlotinib administered concurrently with thoracic radiotherapy. Maintenance was not permitted. Molecular analysis was performed in available specimens. Seventy-two eligible patients were required to test whether the 1-year survival rate was less than 50% or greater than or equal to 65% with approximately 90% power at a significance level of 0.10. RESULTS From March 2008 to October 2011, 78 patients were enrolled, three of whom were ineligible. The median age was 68 (range, 39-88) and 32% were aged greater than or equal to 75 years. Patients were evenly distributed between stages IIIA and IIIB and the majority had performance status 2. The overall response rate was 67% and the disease control rate was 93%. Treatment was well tolerated. The median PFS and OS were 11 and 17 months, respectively. The overall 12-month OS was 57%, which narrowly missed the prespecified target for significance. CONCLUSIONS Patients with poor-risk stage III non-small-cell lung cancer had better than expected outcomes with a regimen of induction carboplatin/nab-paclitaxel followed by thoracic radiotherapy and erlotinib. However, as per the statistical design, the 12-month OS was not sufficiently high to warrant further studies.
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Affiliation(s)
| | | | - Xiaofei Wang
- Alliance Statistics and Data Center, Duke University, Durham, NC; supported by CA33601
| | - Feng Ming Kong
- University of Michigan, Ann Arbor, MI; supported by (to be added)
| | - Pasi A. Jänne
- Dana-Farber Cancer Institute, Boston, MA; supported by CA32291
| | - Gregory Masters
- Christiana Care Health System, Wilmington, DE; supported by CA45418
| | | | - Lydia Hodgson
- Alliance Statistics and Data Center, Duke University, Durham, NC; supported by CA33601
| | - Jeffrey Bogart
- SUNY Upstate University, Syracuse, NY; supported by CA21060
| | - Jeffrey Bradley
- Washington University School of Medicine, St. Louis, MO; supported by CA77440
| | - Everett Vokes
- University of Chicago, Chicago, IL; supported by CA41287
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Hahn SS, Bogart J, Chung CT, Hsu J, Kellman R, Lacombe MA, Kim JAH, Graziano SL, Martin D, Gajra A. A phase II study of radiation therapy (RT), paclitaxel poliglumex (PPX), and cetuximab (C) in locally advanced head and neck cancer (LA-HNC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6059] [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
6059 Background: RT + cisplatin in LA-HNC showed a survival benefit over RT alone, but with significant toxicity. Addition of C to RT demonstrated survival benefit without increased RT-related toxicity. PPX consists of paclitaxel linked to a biodegradable, water-soluble polymer of glutamic acid. PPX has a radiation enhancement factor of ≈8 in a radiocurability murine model. This study addresses the combined use of intensity modulated RT (IMRT), PPX, and C in patients with LA-HNC. Methods: Eligible patients had untreated stage III/ IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, larynx, or unknown primary, ECOG PS 0-1, and adequate bone marrow function. Patients received C 400 mg/m2 day 1 and 250 mg/m2 weekly for 7 weeks. PPX was administered at 40 mg/m² weekly for 7 weeks. IMRT began on day 8 consisting of 69.96 Gy delivered in 2.12 Gy daily. Results: 38 patients with LA-HNC are included in this report and evaluable for response. 24 (63%) had CR and 14 (37%) had PR. HPV status is 21+, 11- and 8 unknown. Pre-therapy, 36 patients had nodal disease, 9 underwent neck dissection post-treatment and 1/ 9 patients had microscopic involvement by cancer. Locoregional tumor control occurred in 36/38 (95%) patients with two patients developing locoregional recurrence after completion of therapy. Two patients have died from metastatic disease and two patients are alive with distant metastases. Two additional deaths were unrelated to therapy (sudden cardiac death and COPD exacerbation with respiratory failure). The majority of adverse events (AEs) were grade 1/2 and consistent with known toxicities of individual agents. The most common grade 3 AEs were mucositis (n=28), radiation dermatitis (n=15), dehydration (n=8) and cetuximab rash (n=9). The median overall survival and progression free survival have not been reached. Updated numbers will be presented. Overall survival rate is 34/38 (89%) by intent-to-treat analysis, with a median follow up of 13 months. Conclusions: The combination of IMRT, PPX, and C is tolerable and shows promising clinical activity in patients with LA-HNC. An expansion cohort of HPV negative patients on this protocol is in progress. Clinical trial information: NCT00660218.
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Affiliation(s)
| | | | | | - Jack Hsu
- SUNY Upstate Medical University, Syracuse, NY
| | | | | | - Jung-AH Kim
- SUNY Upstate Medical University, Syracuse, NY
| | | | - Dena Martin
- SUNY Upstate Medical University, Syracuse, NY
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Bradley JD, Paulus R, Komaki R, Masters GA, Forster K, Schild SE, Bogart J, Garces YI, Narayan S, Kavadi V, Nedzi LA, Michalski JM, Johnson D, MacRae RM, Curran WJ, Choy H. A randomized phase III comparison of standard-dose (60 Gy) versus high-dose (74 Gy) conformal chemoradiotherapy with or without cetuximab for stage III non-small cell lung cancer: Results on radiation dose in RTOG 0617. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7501] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [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
7501 Background: The first objective of RTOG 0617 was to compare the overall survival(OS) of patients(pts) treated with standard-dose(SD)(60Gy) versus high-dose(HD)(74Gy) radiotherapy with concurrent chemotherapy(CT). Methods: This Phase III Intergroup trial randomized 464 pts with Stage III NSCLC to the SD(60Gy) vs. HD(74Gy) arms prior to closure of the HD arm. Concurrent CT included weekly paclitaxel(45 mg/m2) and carboplatin(AUC=2). Pts randomized to cetuximab received a 400 mg/m2 loading dose on Day 1 followed by weekly doses of 250 mg/m2. All pts were to receive consolidation CT. We are reporting the final results on radiation dose. Results: 464 pts were accrued prior to closure of the HD arm in 6/11, of which 419 were eligible for analysis. Median follow up was 17.2 months. There were 2 and 10 grade 5 treatment-related adverse events(AEs) on the SD and HD arms, respectively. Grade 3+AEs were 74.2% and 78.2% on SD and HD arms, respectively (p=0.34). The median survival times and 18-month OS rates for the SD and HD arms were 28.7 vs 19.5 months, and 66.9% vs 53.9% respectively (p=0.0007). The primary cause of death was lung cancer (72.2% vs 73.5%)(p=0.84). Local failure rates at 18 months were 25.1% vs 34.3% for SD and HD patients, respectively(p=0.03). Local-regional and distant failures at 18 months were 35.3% vs 44%(p=0.04) and 42.4% vs 47.8%(p=0.16) for SD and HD arms, respectively. Factors predictive of less favorable OS on multivariate analysis were higher radiation dose, higher esophagitis/dysphagia grade, greater gross tumor volume, and heart volume >5 Gy. Conclusions: In this setting of chemoradiation for locally-advanced Stage III NSCLC, 60 Gy is superior to 74 Gy in terms of OS and local-regional control. The effect of the anti-EGFR antibody (cetuximab) awaits further follow up. This project was supported by RTOG grant U10 CA21661, CCOP grant U10 CA37422, and ATC U24 CA 81647 from the National Cancer Institute (NCI) and Eli Lilly and Company. Clinical trial information: NCT00533949.
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Affiliation(s)
- Jeffrey D Bradley
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Rebecca Paulus
- Radiation Therapy Oncology Group, Statistical Center, Philadelphia, PA
| | - Ritsuko Komaki
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | - Jeff M. Michalski
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | - Hak Choy
- The University of Texas Southwestern Medical Center, Dallas, TX
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Ready N, Pang H, Gu L, Otterson GA, Thomas SP, Miller AA, Baggstrom MQ, Masters GA, Graziano SL, Crawford J, Bogart J, Vokes EE. Chemotherapy with or without maintenance sunitinib for untreated extensive-stage small cell lung cancer: A randomized, placebo controlled phase II study CALGB 30504 (ALLIANCE). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7506 Background: Sunitinib (S) inhibits small cell lung cancer (SCLC) targets VEGFR1-3, PDGFR, and KIT. We tested whether giving S after chemotherapy (C) for extensive stage SCLC improves progression free survival (PFS). Methods: CALGB 30504 was a randomized, double-blind, placebo (P) controlled phase II study for untreated SCLC, performance status 0-2, adequate organ function, and no S risk factors: bleeding, hypertension, or brain metastases. Enrollment was prior to C: cisplatin 80 mg/m2 or carboplatin AUC5 day 1 plus etoposide 100 mg/m2days 1-3 every 21 days 4-6 cycles. Patients without progression after C were stratified cisplatin vs carboplatin, and 4-5 vs 6 cycles C, and randomized 1:1 to P or S 37.5 mg daily until progression assessed every 6 weeks. Prophylactic cranial irradiation was offered to responders (CR or PR) to start about 4-6 weeks after C. S was held during radiation. Crossover from P to S was allowed at progression. Primary endpoint was PFS (from time of randomization) for maintenance (M) P vs S using a 1-sided log rank test with a=0.15; 80 randomized and treated patients provide »89% power to detect a hazard ratio (HR) of 1.67. Results: Between 5/09 and 12/11, 144 enrolled and 138 received C. Ninety five were randomized to P vs S; 10 did not receive M due to progression, refusal, and AE (5 each arm). Eighty five received M, 41 P and 44 S. Demographics were balanced. M toxicities grade > 3 and incidence > 5% included (%): grade 3 (S: fatigue 19, neutrophils 10, leukocytes 7, platelets 7) (P: fatigue 5); grade 4 (S: 1case GI hemorrhage, 1case lipase) P zero; grade 5 zero both arms. Efficacy (90% CI): PFS on maintenance after C was P 2.3 mo (CI: 1.7-2.6) and S 3.8 mo (2.7-4.4) (HR=1.54, CI 1.03-2.32, p=0.04). Overall survival (OS) was P 6.7 mo (5.5-9.5) and S 8.8 mo (8.0-9.8) (HR=1.10, CI 0.71-1.70, p=0.36). At progression on P, 17 received S and among 14 evaluable 10 (71%) had stable disease receiving 2-9 cycles S. Conclusions: The primary objective was met showing improved PFS for maintenance S. There was a non-significant trend toward improved OS despite crossover design. S was well tolerated. Further study of sunitinib after chemotherapy for SCLC is justified. Clinical trial information: NCT00453154.
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Affiliation(s)
- Neal Ready
- Duke University Medical Center, Durham, NC
| | | | - Lin Gu
- Cancer and Leukemia Group B Statistical Center, Durham, NC
| | - Gregory Alan Otterson
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | | | | | | | | | - Everett E. Vokes
- The University of Chicago Medicine and Biological Sciences, Chicago, IL
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Hahn SS, Bogart J, Chung CT, Hsu J, Kellman R, Kim JAH, Graziano S, Martin D, Gajra A. A phase I/II study of radiation therapy, paclitaxel poliglumex, and cetuximab in locally advanced head and neck cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e16047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16047 Background: In patients with locally advanced head and neck cancer (LA-HNC), radiotherapy (RT) + cisplatin showed survival benefit over RT alone, but with significant toxicity. The addition of cetuximab to RT demonstrated survival benefit without increased RT-related toxicity. Paclitaxel poliglumex (PPX) is a novel conjugate consisting of paclitaxel linked to a biodegradable, water-soluble polymer of glutamic acid. PPX has a radiation enhancement factor of ≈8 and improved curability in a murine carcinoma model. In a phase I study of PPX + RT in esophageal cancer, no dose-limiting toxicities (DLTs) occurred at PPX doses up to 70 mg/m2/week and an encouraging rate of pathological CRs was observed. This phase I/II study addresses the combined use of intensity modulated RT (IMRT), PPX, and cetuximab in patients with LA-HNC. Methods: Eligible patients had untreated stage III or IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx; ECOG PS 0-1; and adequate bone marrow function. In the phase I portion, patients received cetuximab 400 mg/m2 day 1 and 250 mg/m2 days 8, 15, 22, 29, 36, 43, and 50. PPX was administered at 40 mg/m2 days 8, 15, 22, 29, 36, 43, and 50 for Cohort 1 (n = 3) then escalated or decreased for Cohorts 2-5 (3 patients each) until the maximum tolerated dose (MTD) was established. IMRT began on day 8 and consisted of 69.96 Gy delivered in 2.12 Gy daily fractions. In the phase II portion, patients received PPX at the MTD + cetuximab and IMRT at the phase I dose and schedule. Results: In total, 14 patients were treated (9 phase I, 5 phase II). The PPX MTD was determined to be 40 mg/m2. The majority of adverse events (AEs) were grade 1/2 and consistent with known toxicities of individual agents. The most common grade 3 AEs were mucositis (n = 8), radiation dermatitis (n = 4), and cetuximab rash (n = 3). Of 13 patients evaluable for response, 9 had CR and 4 had PR. After a median 17-month follow up, the local control rate was 11/11 and the median survival was 20 months. Two patients with stage IVC disease were excluded for local control and survival analysis. Conclusions: The combination of IMRT, PPX, and cetuximab is tolerable and shows promising clinical activity in patients with LA-HNC.
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Affiliation(s)
| | | | | | - Jack Hsu
- SUNY Upstate Medical University, Syracuse, NY
| | | | - Jung-AH Kim
- SUNY Upstate Medical University, Syracuse, NY
| | | | - Dena Martin
- SUNY Upstate Medical University, Syracuse, NY
| | - Ajeet Gajra
- Upstate Medical University and VAMC, Syracuse, NY
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Richter SM, Aridgides PD, Shapiro O, Aronowitz JN, Bogart J. Tolerability of and biochemical control of permanent Pd-103 brachytherapy followed by external beam radiotherapy for localized prostate adenocarcinoma. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
245 Background: The optimal sequencing of brachytherapy and external radiotherapy (EBRT) for patients receiving combined therapy for localized prostate cancer has not been established, and in this series we report our experience of patients treated with brachytherapy followed by EBRT. Methods: Retrospective review of patients treated with combined Pd-103 brachytherapy and EBRT with minimum of 2 years of follow-up. Variables assessed included T stage, Gleason score, pre-treatment PSA, use of androgen suppression (ADT), EBRT dose and brachytherapy dose. Biochemical failure was defined as a PSA rise of ≥ 2 ng/mL above nadir. Results: 87 patients received Pd-103 brachytherapy (median 80 Gy) followed by EBRT (median 45 Gy). Median age was 65 years (49–80). By risk groupings (Zelefsky) 26.4% of patients were low risk, 47.1% were intermediate risk, and 26.4% were high risk. Most low risk patients had either perineural invasion or ≥ 50% involved biopsy cores. Neoadjuvant and concurrent ADT was given in 21% of patients. With a median follow-up of 56 months (range 24 to 113), there were 4 failures (all in the intermediate or high risk group), with an overall 5-year biochemical failure free survival (BFFS) of 91.8%. 2 patients had documented distant failures, while none of the presumed local failures had a positive biopsy. There was no statistical difference in BFFS based on risk group, T stage, Gleason score, initial PSA, or ADT use. The median PSA nadir was 0.1 and occurred at a median of 30 months from brachytherapy. A nadir of ≤ 0.5 was seen in 87% of patients and was associated with improved 5-year BFFS (100% vs 22%, p<.0001). The median time to PSA nadir for patients < 60 years was 34.5 months compared to 26.5 months in patients ≥ 60 (p=.036). Overall, treatment was well-tolerated with no cases of late Grade ≥ 2 rectal or urinary toxicity reported. Conclusions: Excellent long-term disease control and low morbidity was observed for patients with localized prostate adenocarcinoma treated with interstitial brachytherapy followed by EBRT. Future prospective research assessing the relative therapeutic ratio of alternate sequencing approaches would appear warranted.
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Govindan R, Bogart J, Stinchcombe T, Wang X, Hodgson L, Kratzke R, Garst J, Brotherton T, Vokes EE. Randomized phase II study of pemetrexed, carboplatin, and thoracic radiation with or without cetuximab in patients with locally advanced unresectable non-small-cell lung cancer: Cancer and Leukemia Group B trial 30407. J Clin Oncol 2011; 29:3120-5. [PMID: 21747084 DOI: 10.1200/jco.2010.33.4979] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Cancer and Leukemia Group B conducted a randomized phase II trial to investigate two novel chemotherapy regimens in combination with concurrent thoracic radiation therapy (TRT). PATIENTS AND METHODS Patients with unresectable stage III non-small-cell lung cancer (NSCLC) were randomly assigned to carboplatin (area under the curve, 5) and pemetrexed (500 mg/m(2)) every 21 days for four cycles and TRT (70 Gy; arm A) or the same treatment with cetuximab administered concurrent only with TRT (arm B). Patients in both arms received up to four cycles of pemetrexed as consolidation therapy. The primary end point was the 18-month overall survival (OS) rate; if the 18-month OS rate was ≥ 55%, the regimen(s) would be considered for further study. RESULTS Of the 101 eligible patients enrolled (48 in arm A and 53 in arm B), 60% were male; the median age was 66 years (range, 32 to 81 years); 44% and 35% had adenocarcinoma and squamous carcinoma, respectively; and more patients enrolled onto arm A compared with arm B had a performance status of 0 (58% v 34%, respectively; P = .04). The 18-month OS rate was 58% (95% CI, 46% to 74%) in arm A and 54% (95% CI, 42% to 70%) in arm B. No significant difference in OS between patients with squamous and nonsquamous NSCLC was observed (P = .667). The toxicities observed were consistent with toxicities associated with concurrent chemoradiotherapy. CONCLUSION The combination of pemetrexed, carboplatin, and TRT met the prespecified criteria for further evaluation. This regimen should be studied further in patients with locally advanced unresectable nonsquamous NSCLC.
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Affiliation(s)
- Ramaswamy Govindan
- Washington University School of Medicine, 4960 Children's Place, St Louis, MO 63110, USA.
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Salama JK, Hodgson L, Pang H, Green MR, Urbanic JJ, Blackstock AW, Crawford J, Bogart J, Vokes EE. Predictors of pulmonary toxicity in limited-stage (LS) small cell lung cancer (SCLC) patients treated with concurrent chemotherapy (CTX) and high-dose (70 Gy) daily radiotherapy (RT): A pooled analysis of three CALGB studies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7078] [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: 11/20/2022] Open
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Movsas B, Bae K, Meyers C, Gore E, Bonner J, Sun A, Schild S, Gaspar L, Bogart J, Choy H. Phase III Study of Prophylactic Cranial Irradiation vs. Observation in Patients with Stage III Non–small-cell Lung Cancer: Neurocognitive and Quality of Life Analysis of RTOG 0214. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.030] [Citation(s) in RCA: 7] [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] [Indexed: 11/30/2022]
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Gore EM, Bae K, Wong S, Bonner J, Sun A, Schild S, Gaspar LE, Bogart J, Werner-Wasik M, Choy H. A phase III comparison of prophylactic cranial irradiation versus observation in patients with locally advanced non-small cell lung cancer: Initial analysis of Radiation Therapy Oncology Group 0214. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7506] [Citation(s) in RCA: 8] [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
7506 Background: The incidence of central nervous system (CNS) metastases is high in patients with locally advanced non-small cell lung cancer. Brain as an only site of relapse appears increasingly common as loco-regional and extra-cranial systemic treatment improves. There is not standard agreement as to how to address this risk. Methods: Patients with stage III NSCLC without progression of disease after loco-regional treatment with surgery and/or radiation therapy with or without chemotherapy were eligible. Participants were randomized to prophylactic cranial irradiation (PCI) or observation and stratified by stage (IIIA or B), histology (non-squamous or squamous) and therapy (surgery or no surgery). PCI was delivered once daily at 2Gy per fraction to 30Gy. The primary endpoint of the study was overall survival (OS). Secondary endpoints were disease free survival (DFS) and the impact of PCI on incidence of CNS metastases, neuropsychological function, and quality of life (QoL). Kaplan- Meier estimation with the log-rank test was used for OS and DFS and the logistic regression model was used for calculating the incidence of CNS metastasis. Results: Total accrual was 356 patients of the targeted 1058 between 9/19/02 and 8/30/07. The study was closed early due to slow accrual. 340 patients were evaluable. One year OS (p=0.86, 75.6 % and 76.9% for PCI and observation) and one year DFS (p=0.11, 56.4% and 51.2% for PCI and observation) were not statistically significantly different. However, CNS metastatic rate at 1 year was statistically significantly different with CNS relapse 7.7% vs. 18% for PCI vs. observation (p=0.004). Logistic regression showed that the patients in the observation arm are 2.52 times more likely to develop CNS metastases than those in the PCI arm (odds ratio=2.52, 95% CI=(1.32–4.80)). Conclusions: PCI in patients without progressive disease after loco-regional therapy for III NSCLC significantly decreases the rate of CNS metastases. This study did not show a statistically significant difference in OS or DFS. Forthcoming analysis of the impact of PCI on neuropsychological function and QoL will influence the recommendations regarding the standard use of PCI. No significant financial relationships to disclose.
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Affiliation(s)
- E. M. Gore
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - K. Bae
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - S. Wong
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - J. Bonner
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - A. Sun
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - S. Schild
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - L. E. Gaspar
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - J. Bogart
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - M. Werner-Wasik
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
| | - H. Choy
- Medical College of Wisconsin, Milwaukee, WI; Department of Statistics, Radiation Therapy Oncology Group; Division of Neoplastic Diseases, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL; Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ; Department of Radiation Oncology, University of Colorado Cancer
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Govindan R, Bogart J, Wang X, Hodgson L, Kratzke R, Vokes EE. Phase II study of pemetrexed, carboplatin, and thoracic radiation with or without cetuximab in patients with locally advanced unresectable non-small cell lung cancer: CALGB 30407. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7505] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7505 Background: Cisplatin, etoposide and concurrent thoracic radiation has remained the standard treatment for locally advanced unresectable non small cell lung cancer (NSCLC) over the past two decades. The Cancer and Leukemia Group B (CALGB) conducted a phase II study using a novel chemotherapy regimen administered in systemically active doses with thoracic radiation (CALGB 30407). We previously reported the preliminary safety results (ASCO 2008, abstract 7518). Methods: Eligible patients with previously untreated stage III NSCLC received thoracic radiation (70 Gy) along with carboplatin (AUC 5) and pemetrexed 500 mg/m2 on day 1 administered intravenously every 21 days for 4 cycles (arm A) or the same chemotherapy regimen with weekly cetuximab for 6 weeks concurrent with radiation (arm B). All patients received four additional cycles of pemetrexed (500 mg/m2 every 21 days) as consolidation therapy. The primary endpoint was the percentage of patients who lived longer than 18 months after starting initial treatment. We planned to study the regimen (s) further if the 18 month survival rates equaled or exceeded 55%. Results: Characteristics of the 99 eligible pts (48 in arm A and 51 arm B) enrolled from 09/05 to 1/08: male 62%, 22% were 70 yrs or older. The most common histological type was adenocarcinoma (46% in Arm A and 41% in Arm B). Updated toxicity data (grade 3 or greater, %) by arms (arm A/arm B) for 106 pts: neutropenia 40/47; febrile neutropenia 8/6, thrombocytopenia 36/34, nausea/vomiting 8/10, esophagitis 32/24, skin rash 2/21 and fatigue 22/17. The median follow up time is 17 months. Preliminary efficacy data by arms (arm A/arm B) for 99 pts: complete or partial response 73% (95% CI 59–83)/71% (95% CI 57–81%), median failure free survival (months) 12.9 (95% CI 8.6–18.0)/10.3 (95% CI 8.7–18.9); 18 month survival 57% (95% CI 41–79)/47% (95% CI 33–67) and median survival (months) 22.3/18.7. Conclusions: The combination of pemetrexed, carboplatin and thoracic radiation has met the protocol-specified criteria for further study. Although it does not appear that the addition of cetuximab confers additional benefit in this setting, further follow-up is necessary. [Table: see text]
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Affiliation(s)
- R. Govindan
- Washington University School of Medicine, St. Louis, MO; State University of New York, New York, NY; Duke University, Durham, NC; University of Minnesota, Minneapolis, MN; University of Chicago, Chicago, IL
| | - J. Bogart
- Washington University School of Medicine, St. Louis, MO; State University of New York, New York, NY; Duke University, Durham, NC; University of Minnesota, Minneapolis, MN; University of Chicago, Chicago, IL
| | - X. Wang
- Washington University School of Medicine, St. Louis, MO; State University of New York, New York, NY; Duke University, Durham, NC; University of Minnesota, Minneapolis, MN; University of Chicago, Chicago, IL
| | - L. Hodgson
- Washington University School of Medicine, St. Louis, MO; State University of New York, New York, NY; Duke University, Durham, NC; University of Minnesota, Minneapolis, MN; University of Chicago, Chicago, IL
| | - R. Kratzke
- Washington University School of Medicine, St. Louis, MO; State University of New York, New York, NY; Duke University, Durham, NC; University of Minnesota, Minneapolis, MN; University of Chicago, Chicago, IL
| | - E. E. Vokes
- Washington University School of Medicine, St. Louis, MO; State University of New York, New York, NY; Duke University, Durham, NC; University of Minnesota, Minneapolis, MN; University of Chicago, Chicago, IL
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Govindan R, Bogart J, Wang X, Liu D, Kratzke RA, Vokes EE. A phase II study of pemetrexed, carboplatin and thoracic radiation with or without cetuximab in patients with locally advanced unresectable non-small cell lung cancer: CALGB 30407—Early evaluation of feasibility and toxicity. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7518] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bogart J, Watson D, Seagren S, Blackstock AW, Wang X, Lenox R, Vokes E, Turrisi AT, Green MR. Accelerated conformal radiotherapy for stage I non-small cell lung cancer (NSCLC) in patients with pulmonary dysfunction: A CALGB phase I study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7556 Background: The optimal treatment for medically inoperable stage I NSCLC has not been defined. Methods: CALGB 39904 is a prospective phase I study assessing accelerated once-daily radiotherapy for early stage NSCLC. The primary objectives were to define the maximally accelerated course of conformal radiotherapy; and to describe the short-term and long-term toxicity of therapy. Entry was limited to patients with clinical stage T1N0 and T2N0 NSCLC (< 4 cm) with pulmonary dysfunction (FEV1 <40% predicted, DLCO 45mmHg, V02 max <15m1/kg/min, O2 requirement). The nominal total radiotherapy dose was held constant at 70 Gy, while the number of daily fractions in each successive cohort was reduced (table). Results: The study was activated on 12/15/2000, and closed on 7/29/2005. Forty patients were accrued with 8 on each cohort. One patient on cohort 5 declined protocol treatment leaving 39 eligible patients. Patients were generally female (53%), white (83%), and ECOG performance status = 1 (67%). The median age was 74 (range 48 to 87), and the majority of the patients (73%) had T1N0M0 disease. Treatment was well tolerated without grade 4+ toxicity. There was one hematologic toxicity (lymphopenia) in cohort 2, and one non-hematologic toxicity each in cohort 3 (dyspnea) and cohort 4 (pain).The major repsonse rate was 74% (31% complete response, 43 % partial response), and 26% of patients had stable disease. After a median follow-up of 38.1 months, 21 patients remain alive. The actuarial median survival of all eligible patients is 38.5 months (95% confidence interval= 19.45 to NE). Conclusion: Accelerated conformal radiotherapy was well tolerated in a high-risk population with clinical stage I NSCLC. Outcomes are comparable to prospective reports of alternative therapies, including stereotactic body radiosurgery and limited resection,with less apparent severe toxicity. Further investigation of this approach is warranted. No significant financial relationships to disclose. [Table: see text]
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Affiliation(s)
- J. Bogart
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - D. Watson
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - S. Seagren
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - A. W. Blackstock
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - X. Wang
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - R. Lenox
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - E. Vokes
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - A. T. Turrisi
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
| | - M. R. Green
- SUNY Upstate Medcl Univ, Syracuse, NY; CALGB Statistical Center, Durham, NC; UCSD, San Diego, CA; Wake Forest School of Medicine, Winston- Salem, NC; University of Chicago, Chicago, IL; Wayne State University, Detroit, MI; Care Alliance Roper Hospital, Charleston, SC
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BaŞol BM, Uzoh CE, Talieh H, Wang T, Guo G, Erdemli S, Cornejo M, Bogart J, Basol EC. PLANAR COPPER PLATING AND ELECTROPOLISHING TECHNIQUES. CHEM ENG COMMUN 2006. [DOI: 10.1080/00986440500267410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ready N, Janne P, Herndon J, Bogart J, Crawford J, Edelman M, Wang X, Gu L, Green MR, Vokes EE. Chemoradiotherapy (CRT) and gefitinib (G) in stage III non-small cell lung cancer (NSCLC): A CALGB stratified phase II trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7046] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7046 Background: G is a small molecule inhibitor of EGFR with activity in advanced NSCLC and preclinical evidence of being a radiosenitizer. Methods: Patients with stage III NSCLC were assigned to stratum 1 (PS 0–1>5% weight loss and/or PS 2) or stratum 2 (PS 0–1weight loss < 5%). Both strata received induction paclitaxel (P) 200 mg/m2 and carboplatin (C) AUC of 6 IV every three weeks for 2 cycles plus G 250 mg PO/day. G was removed 4/05 from induction therapy as stage IV studies showed no benefit from adding G to P and C. Stratum 1 then received RT 200 cGy for 33 fractions (total dose 6,600 cGy) and G 250 mg PO /day. Stratum 2 received the same RT with concurrent G 250 mg/day, and P 50 mg/m2 plus C AUC of 2 weekly for 7 doses. Maintenance G was started after all toxicities were grade ≤2. Results: Activation was 5/02 and administrative closure 5/04 due to results from SWOG S0023. 64 patients were accrued and 59 (20 stratum 1, 39 stratum 2) were eligible and analyzed: median age 67, male 74%, adeno 30%, squamous 45%, other 25%, IIIA 51%, IIIB 49%. There was no clear increase for acute high-grade infield toxicities compared to CRT alone (reported PASCO 2004). Best response for stratum 1 was PR 29% for induction (RR 29%, 95% CI 10%-56%) and CR 5%, PR 45% full treatment (RR 50%, 95% CI 27%-73%); for stratum 2 PR 13% for induction (RR 13%, 95% CI 3%-34%) and CR 5%, PR 76% full treatment (RR 81%, 95% CI 65%-92%). Stratum 1 “poor risk” median failure free survival (FFS) was 11.5 months (95% CI 5.6–21.2), one year survival 60% (95% CI 33%-79%) and median overall survival (OS) 19.0 months (95% CI 7.2–21.2). Stratum 2 “good risk” median FFS was 9.2 months (95% CI 6.7–12.0), one year survival 47% (95% CI 30%–63%) and median OS was 12.0 months (95% CI 8.5–18.6). EGFR and Ras mutation analysis on tumor biopsies (n = 50) will be presented. Conclusions: Small sample size prevented planned data analysis. Survival of “good risk” patients on stratum 2 (CRT + G) was disappointing. The promising survival of the small number of “poor risk” patients on stratum 1 (RT + G) justifies a follow-up phase II trial of induction chemotherapy followed by RT with a concurrent small molecule EGFR inhibitor. [Table: see text]
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Affiliation(s)
- N. Ready
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - P. Janne
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - J. Herndon
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - J. Bogart
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - J. Crawford
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - M. Edelman
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - X. Wang
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - L. Gu
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - M. R. Green
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - E. E. Vokes
- Rhode Island Hospital, Providence, RI; Dana-Farber Cancer Institute, Boston, MA; Duke University Medical Center, Durham, NC; State University New York Upstate Medical Center, Syracuse, NY; University of Maryland, Baltimore, MD; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
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Blackstock AW, Socinski MA, Bogart J, Gu L, Wang X, Green M, Vokes EE. Induction (Ind) plus concurrent (Con) chemotherapy with high-dose (74 Gy) 3-dimensional (3-D) thoracic radiotherapy (TRT) in stage III non-small cell lung cancer (NSCLC): Preliminary report of Cancer and Leukemia Group B (CALGB) 30105. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7042] [Citation(s) in RCA: 5] [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
7042 Background: Combined chemoradiotherapy is the standard of care in stage III NSCLC. At standard TRT doses, local failures remain problematic and strategies exploiting the dose-response aspect of TRT are warranted. 3-D TRT allows escalation of TRT dose with acceptable toxicity (Socinski et al, J Clin Oncol 22:4341, 2004) and may enhance survival by improving loco-regional control. Methods: This is a two-arm randomized phase II trial evaluating 74 Gy with Con chemotherapy: Arm A- 2 cycles of Ind carboplatin (C) (AUC 6) and paclitaxel (P) (225 mg/m2) followed by weekly Con C (AUC 2/wk) and P (45 mg/m2) and 74 Gy; Arm B- 2 cycles of Ind C (AUC 5) and gemcitabine (G) (1000 mg/m2 d1,8) followed by Con G (35 mg/m2 twice weekly) and 74 Gy. The primary endpoint was a survival rate of ≥50% at 18 months after treatment initiation or med survival time (MST) of ≥18 mos. Results: 69 pts were entered (43 Arm A, 26 Arm B)- med age 61 yrs (39–77), 77% male, PS 0:1 42%:58%, stage IIIA:B 52%:48%. Ind therapy on both arms was well tolerated with no pts experiencing disease progression. ARM A- Overall response rate (RR) to all therapy was 61.9%. Gr 3–4 toxicities during Con therapy were anemia (15%), neutropenia (26%), esophagitis (9%), fatigue (9%), neuropathy (3%) and pulmonary (12%). There was 1 (3%) Gr 5 cardiac event. With med follow-up of 16.4 mos, the med progression-free survival (PFS) is 15.2 mos. The MST is not mature enough to estimate as only 15 deaths have occurred. ARM B- Closed early due to 3 (13%) Gr 5 pulmonary events. Overall RR to all therapy was 66.6%. Gr 3–4 toxicities during Con therapy were anemia (13%), fatigue (35%), esophagitis (35%), hemoptysis (4%), pulmonary (26% plus the 3 Gr 5 events). With med follow-up of 22 mos, the med PFS is 7.7 mos and the MST is 13.9 mos. There was a correlation between Gr 3–5 pulmonary toxicity and V20 ≥ 38% (p<0.05). Conclusions: 1) High dose 3-D TRT is feasible within CALGB, 2) the details of TRT (V20) are important with regard to toxicity, 3) the survival of pts on Arm A appears promising. [Table: see text]
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Affiliation(s)
- A. W. Blackstock
- Wake Forest University, Winston Salem, NC; University of North Carolina, Chapel Hill, NC; University of Syracuse, Syracuse, NY; Duke University Statistical Center, Durham, NC; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - M. A. Socinski
- Wake Forest University, Winston Salem, NC; University of North Carolina, Chapel Hill, NC; University of Syracuse, Syracuse, NY; Duke University Statistical Center, Durham, NC; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - J. Bogart
- Wake Forest University, Winston Salem, NC; University of North Carolina, Chapel Hill, NC; University of Syracuse, Syracuse, NY; Duke University Statistical Center, Durham, NC; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - L. Gu
- Wake Forest University, Winston Salem, NC; University of North Carolina, Chapel Hill, NC; University of Syracuse, Syracuse, NY; Duke University Statistical Center, Durham, NC; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - X. Wang
- Wake Forest University, Winston Salem, NC; University of North Carolina, Chapel Hill, NC; University of Syracuse, Syracuse, NY; Duke University Statistical Center, Durham, NC; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - M. Green
- Wake Forest University, Winston Salem, NC; University of North Carolina, Chapel Hill, NC; University of Syracuse, Syracuse, NY; Duke University Statistical Center, Durham, NC; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
| | - E. E. Vokes
- Wake Forest University, Winston Salem, NC; University of North Carolina, Chapel Hill, NC; University of Syracuse, Syracuse, NY; Duke University Statistical Center, Durham, NC; Medical University of South Carolina, Charleston, SC; University of Chicago, Chicago, IL
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Abstract
We describe a pediatric patient with histiocytic sarcoma involving the T6 and L4 vertebral bodies and the lungs. His tumor progressed during chemotherapy designed for Langerhans' cell histiocytosis and sarcoma. High-dose radiation, on the other hand, was effective.
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Affiliation(s)
- Samuel Buonocore
- Department of Pediatrics, State University of New York, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA
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Vokes EE, Crawford J, Bogart J, Socinski MA, Clamon G, Green MR. Concurrent Chemoradiotherapy for Unresectable Stage III Non-Small Cell Lung Cancer. Clin Cancer Res 2005; 11:5045s-5050s. [PMID: 16000612 DOI: 10.1158/1078-0432.ccr-05-9008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the last two decades, several approaches to multimodality therapy have been investigated in patients with advanced unresectable non-small cell lung cancer. These include induction chemotherapy and concurrent chemoradiotherapy. Both approaches have been shown to be superior to radiation therapy alone. However, in several randomized trials, concomitant chemoradiotherapy was shown to be superior to the induction chemotherapy approach. It has been hypothesized that the addition of systemic dose sequential chemotherapy to concurrent chemoradiotherapy, either as induction or as consolidation chemotherapy, might further improve survival rates. Recently, the Cancer and Leukemia Group B reported on a randomized phase III trial directly evaluating the addition of two cycles of carboplatin and paclitaxel to concurrent chemoradiotherapy. In this study, induction chemotherapy failed to further improve survival rates of concurrent chemoradiotherapy. A previously conducted randomized phase II study also suggested no benefit from the addition of induction chemotherapy to concomitant chemoradiotherapy. Favorable phase II data have been published supporting the use of consolidation chemotherapy. However, to date, no large randomized study evaluating a possible benefit from consolidation chemotherapy has been completed. In addition to evaluating optimal sequencing strategies of combined modality therapy, current investigations are also focusing on the integration of novel agents, including chemotherapeutic and targeted therapies. Currently ongoing trials involving novel approaches are reviewed here.
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Affiliation(s)
- Everett E Vokes
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637-1470, USA.
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Blackstock A, Socinski M, Gu L, Wang X, Bogart J, Fitzgerald T, Green M, Vokes E. O-038 Initial pulmonary toxicity evaluation of chemoradiotherapy (CRT) utilizing 74 Gy 3-dimensional (3-D) thoracic radiation in stage III non-small cell lung cancer (NSCLC): A Cancer and Leukemia Group B (CALGB) randomized phase II trial. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80170-9] [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: 11/17/2022]
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Blackstock AW, Socinski MA, Gu L, Rosenman J, Wang X, Bogart J, Vokes E, Green M. Initial pulmonary toxicity evaluation of chemoradiotherapy (CRT) utilizing 74 Gy 3-dimensional (3-D) thoracic radiation in stage III non-small cell lung cancer (NSCLC): A Cancer and Leukemia Group B (CALGB) randomized phase II trial. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. W. Blackstock
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
| | - M. A. Socinski
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
| | - L. Gu
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
| | - J. Rosenman
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
| | - X. Wang
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
| | - J. Bogart
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
| | - E. Vokes
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
| | - M. Green
- Wake Forest Univ, Winston Salem, NC; Univ of North Carolina at Chapel Hill, Chapel Hill, NC; Duke Univ Medcl Ctr, Durham, NC; Syracuse Univ, Syracuse, NY; Univ of Chicago, Chicago, IL; Medcl Univ of South Carolina, Charleston, SC
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