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Calfa CJ, Rothe M, Mangat PK, Garrett-Mayer E, Ahn ER, Burness ML, Gogineni K, Rohatgi N, Al Baghdadi T, Conlin A, Gaba A, Hamid O, Krishnamurthy J, Gavini NJ, Gold PJ, Rodon J, Rueter J, Thota R, Grantham GN, Hinshaw DC, Gregory A, Halabi S, Schilsky RL. Sunitinib in Patients With Breast Cancer With FGFR1 or FGFR2 Amplifications or Mutations: Results From the Targeted Agent and Profiling Utilization Registry Study. JCO Precis Oncol 2024; 8:e2300513. [PMID: 38354330 DOI: 10.1200/po.23.00513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 02/16/2024] Open
Abstract
PURPOSE The Targeted Agent and Profiling Utilization Registry Study is a phase II basket trial evaluating the antitumor activity of commercially available targeted agents in patients with advanced cancer and genomic alterations known to be drug targets. Results from cohorts of patients with metastatic breast cancer (BC) with FGFR1 and FGFR2 alterations treated with sunitinib are reported. METHODS Eligible patients had measurable disease, Eastern Cooperative Oncology Group performance status 0-2, adequate organ function, and no standard treatment options. Simon's two-stage design was used with a primary end point of disease control (DC), defined as objective response (OR) or stable disease of at least 16 weeks duration (SD16+) according to RECIST v1.1. Secondary end points included OR, progression-free survival, overall survival, duration of response, duration of stable disease, and safety. RESULTS Forty patients with BC with FGFR1 (N = 30; amplification only n = 26, mutation only n = 1, both n = 3) or FGFR2 (N = 10; amplification only n = 2, mutation only n = 6, both n = 2) alterations were enrolled. Three patients in the FGFR1 cohort were not evaluable for efficacy; all patients in the FGFR2 cohort were evaluable. For the FGFR1 cohort, two patients with partial response and four with SD16+ were observed for DC and OR rates of 27% (90% CI, 13 to 100) and 7% (95% CI, 1 to 24), respectively. The null hypothesis of 15% DC rate was not rejected (P = .169). No patients achieved DC in the FGFR2 cohort (P = 1.00). Thirteen of the 40 total patients across both cohorts had at least one grade 3-4 adverse event or serious adverse event at least possibly related to sunitinib. CONCLUSION Sunitinib did not meet prespecified criteria to declare a signal of antitumor activity in patients with BC with either FGFR1 or FGFR2 alterations. Other treatments and clinical trials should be considered for these patient populations.
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Affiliation(s)
- Carmen J Calfa
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Michael Rothe
- American Society of Clinical Oncology, Alexandria, VA
| | - Pam K Mangat
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | - Tareq Al Baghdadi
- Michigan Cancer Research Consortium, IHA Hematology Oncology, Ypsilanti, MI
| | | | | | - Omid Hamid
- The Angeles Clinic and Research Institute, A Cedars-Sinai Affiliate, Los Angeles, CA
| | | | | | | | - Jordi Rodon
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston, TX
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Miller-Kleinhenz JM, Moubadder L, Beyer KM, Zhou Y, Gaglioti AH, Collin LJ, Gohar J, Do W, Conneely K, Krishnamurti U, Gogineni K, Gabram-Mendola S, D’Angelo O, Henry K, Torres M, McCullough LE. Redlining-associated methylation in breast tumors: the impact of contemporary structural racism on the tumor epigenome. Front Oncol 2023; 13:1154554. [PMID: 37621676 PMCID: PMC10446968 DOI: 10.3389/fonc.2023.1154554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Purpose Place-based measures of structural racism have been associated with breast cancer mortality, which may be driven, in part, by epigenetic perturbations. We examined the association between contemporary redlining, a measure of structural racism at the neighborhood level, and DNA methylation in breast tumor tissue. Methods We identified 80 Black and White women diagnosed and treated for a first-primary breast cancer at Emory University Hospitals (2008-2017). Contemporary redlining was derived for census tracts using the Home Mortgage Disclosure Act database. Linear regression models were used to calculate the association between contemporary redlining and methylation in breast tumor tissue. We also examined epigenetic age acceleration for two different metrics, regressing β values for each cytosine-phosphate-guanine dinucleotide (CpG) site on redlining while adjusting for covariates. We employed multivariable Cox-proportional hazards models and 95% confidence intervals (CI) to estimate the association between aberrant methylation and mortality. Results Contemporary redlining was associated with 5 CpG sites after adjustment for multiple comparisons (FDR<0.10). All genes were implicated in breast carcinogenesis, including genes related to inflammation, immune function and stress response (ANGPT1, PRG4 and PRG4). Further exploration of the top 25 CpG sites, identified interaction of 2 sites (MRPS28 and cg11092048) by ER status and 1 site (GDP1) was associated with all-cause mortality. Contemporary redlining was associated with epigenetic age acceleration by the Hannum metric (β=5.35; CI 95%=0.30,10.4) and showed positive but non-significant correlation with the other clock. Conclusion We identified novel associations between neighborhood contemporary redlining and the breast tumor DNA methylome, suggesting that racist policies leading to inequitable social and environmental exposures, may impact the breast tumor epigenome. Additional research on the potential implications for prognosis is needed.
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Affiliation(s)
| | - Leah Moubadder
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Kirsten M. Beyer
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health & Society, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Anne H. Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, United States
- Center for Health Integration, Population Health Research Institute at The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Lindsay J. Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Jazib Gohar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Whitney Do
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
- Nutrition and Health Sciences Program, Laney Graduate School, Atlanta, GA, United States
| | - Karen Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Keerthi Gogineni
- Department of Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Olivia D’Angelo
- Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States
| | - Kashari Henry
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Mylin Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Lauren E. McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
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Awan S, Saini G, Gogineni K, Luningham JM, Collin LJ, Bhattarai S, Aneja R, Williams CP. Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia. Cancer Med 2023; 12:17331-17339. [PMID: 37439033 PMCID: PMC10501236 DOI: 10.1002/cam4.6341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Little is known regarding the association between insurance status and treatment delays in women with breast cancer and whether this association varies by neighborhood socioeconomic deprivation status. METHODS In this cohort study, we used medical record data of women diagnosed with breast cancer between 2004 and 2022 at two Georgia-based healthcare systems. Treatment delay was defined as >90 days to surgery or >120 days to systemic treatment. Insurance coverage was categorized as private, Medicaid, Medicare, other public, or uninsured. Area deprivation index (ADI) was used as a proxy for neighborhood-level socioeconomic status. Associations between delayed treatment and insurance status were analyzed using logistic regression, with an interaction term assessing effect modification by ADI. RESULTS Of the 14,195 women with breast cancer, 54% were non-Hispanic Black and 52% were privately insured. Compared with privately insured patients, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 79%, 75%, and 27% higher odds of delayed treatment, respectively (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.32-2.43; OR: 1.75, 95% CI: 1.43-2.13; OR: 1.27, 95% CI: 1.06-1.51). Among patients living in low-deprivation areas, those who were uninsured, Medicaid enrollees, and Medicare enrollees had 100%, 84%, and 26% higher odds of delayed treatment than privately insured patients (OR: 2.00, 95% CI: 1.44-2.78; OR: 1.84, 95% CI: 1.48-2.30; OR: 1.26, 95% CI: 1.05-1.53). No differences in the odds of delayed treatment by insurance status were observed in patients living in high-deprivation areas. DISCUSSION/CONCLUSION Insurance status was associated with treatment delays for women living in low-deprivation neighborhoods. However, for women living in neighborhoods with high deprivation, treatment delays were observed regardless of insurance status.
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Affiliation(s)
- Sofia Awan
- School of Public Health, Georgia State UniversityAtlantaGeorgiaUSA
| | - Geetanjali Saini
- Department of Clinical and Diagnostic Sciences, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Keerthi Gogineni
- Department of Hematology–Medical OncologyWinship Cancer Institute, Emory University School of MedicineAtlantaGeorgiaUSA
- Department of SurgeryWinship Cancer Institute, Emory University School of MedicineAtlantaGeorgiaUSA
- Georgia Cancer Center for Excellence, Grady Health SystemAtlantaGeorgiaUSA
| | - Justin M. Luningham
- Department of Biostatistics and Epidemiology, School of Public HealthUniversity of North Texas Health Science CenterFort WorthTexasUSA
| | - Lindsay J. Collin
- Department of Population Health SciencesHuntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
| | - Shristi Bhattarai
- Department of Clinical and Diagnostic Sciences, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ritu Aneja
- Department of Clinical and Diagnostic Sciences, School of Health ProfessionsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Courtney P. Williams
- Department of Medicine, Division of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Wesolowski R, Rugo H, Stringer-Reasor E, Han HS, Specht JM, Dees EC, Kabos P, Vaishampayan U, Wander SA, Lu J, Gogineni K, Spira AI, Schott AF, Abu-Khalaf M, Nayak P, Sullivan BF, Gorbatchevsky I, Layman ANDRM. Abstract PD13-05: PD13-05 Updated results of a Phase 1b study of gedatolisib plus palbociclib and endocrine therapy in women with hormone receptor positive advanced breast cancer: Subgroup analysis by PIK3CA mutation status. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd13-05] [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: 03/06/2023]
Abstract
Abstract
Background: Addition of PI3K/mTOR inhibitor after progression on CDK4/6 inhibitor (CDK4/6i) and endocrine therapy (ET) can potentially restore sensitivity to CDK4/6i and prevent adaptive activation of the PI3K/mTOR pathway. To evaluate this hypothesis, we conducted a Phase Ib study of gedatolisib (G), a dual inhibitor of PI3K/mTOR, palbociclib (P) a CDK4/6i, and ET (with letrozole [LET] or fulvestrant [FUL]) in women with hormone receptor positive (HR+)/HER2- advanced breast cancer (ABC). Manageable toxicity and preliminary antitumor activity were observed in 35 patients(pts) enrolled in the dose escalation portion of the study (Forero-Torres, ASCO 2018) and 103 pts enrolled in the expansion portion of the study (Layman, SABCS 2021). Here, we report updated efficacy and safety data and sub-group analysis by PIK3CA mutation status in the four expansion study arms with a March 3, 2022, data cut-off.
Methods: Pts with HR+/HER2- ABC were treated in four expansion arms: A) G+P+LET as first-line treatment, B) G+P+FUL as 2nd line treatment in pts without prior CDK4/6i; C & D) G+P+FUL as 2nd or 3rd line therapy in pts with prior CDK4/6i. P, LET, and FUL were administered at standard doses. G 180 mg was intravenously administered weekly in Arms A, B, and C and three weeks on/one week off in Arm D. The primary endpoint was investigator assessed objective response rate (ORR). Secondary endpoints included safety, duration of response and progression free survival (PFS).
Results: Of the 103 pts treated with G+P+ ET in the expansion arms (A-D), 100% had measurable disease at baseline, 71% (73/103) lacked PIK3CA mutations (wild type; WT), 27% (28/103) had PIK3CA-mutations (MT), 70% (72/103) had evidence of bone metastases, and 59% (61/103) had liver metastases. The most frequent grade 3 and 4 treatment related AEs (TRAE) with G+P+ET included neutropenia (63%), stomatitis (27%), rash (20%), fatigue (11%) and hyperglycemia (7%). Treatment discontinuation due to TRAEs was 6.5% in Arm A, 15.4% in Arm B, 9.4% in Arm C and 3.7% in Arm D. Efficacy data for each arm is presented in Table 1. Promising ORR and PFS were seen in all arms regardless of PIK3CA mutation status. In Arm D, ORR was 63% overall, 73% in PIK3CA-MT pts, and 60% in PIK3CA-WT pts. Median PFS in Arm D was 12.9 months with a median follow up of 29 months. 60% and 48% of pts in the PIK3CA-MT and PIK3CA-WT Arm D sub-groups, respectively, were progression free at 12 months.
Conclusions: These preliminary data demonstrate promising activity of G+P+ET combination in pts who were CDK4/6i-naïve and in those whose disease progressed on or after CDK4/6i therapy regardless of PIK3CA mutation status. Encouraging results in CDK4/6i treatment naïve patients warrant further evaluation of gedatolisib in combination with CDK4/6i treatment in the front-line setting. Arm D results provide a strong basis for the initiated Phase 3 study (VIKTORIA-1) in pts whose disease progressed on or after CDK4/6i therapy.
Table 1. Efficacy Data by Expansion Arms
Citation Format: Robert Wesolowski, Hope Rugo, Erica Stringer-Reasor, Hyo S. Han, Jennifer M. Specht, E. Claire Dees, Peter Kabos, Ulka Vaishampayan, Seth A. Wander, Janice Lu, Keerthi Gogineni, Alexander I. Spira, Anne F. Schott, Maysa Abu-Khalaf, Pratima Nayak, Brian F. Sullivan, Igor Gorbatchevsky, AND Rachel M. Layman. PD13-05 Updated results of a Phase 1b study of gedatolisib plus palbociclib and endocrine therapy in women with hormone receptor positive advanced breast cancer: Subgroup analysis by PIK3CA mutation status [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD13-05.
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Affiliation(s)
- Robert Wesolowski
- 1James Cancer Hospital and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Hope Rugo
- 2University of California San Francisco, San Francisco, CA
| | | | - Hyo S. Han
- 4H. Lee Moffitt Cancer Center, Tampa, FL
| | | | - E. Claire Dees
- 6University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, Chapel Hill, North Carolina
| | - Peter Kabos
- 7University of Colorado Denver, Aurora, Colorado
| | | | - Seth A. Wander
- 9Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Janice Lu
- 10University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | | | | | - Anne F. Schott
- 13Rogel Cancer Center, University of Michigan Health, Ann Arbor, MI
| | - Maysa Abu-Khalaf
- 14Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, PA
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5
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Luningham JM, Seth G, Saini G, Bhattarai S, Awan S, Collin LJ, Swahn MH, Dai D, Gogineni K, Subhedar P, Mishra P, Aneja R. Association of Race and Area Deprivation With Breast Cancer Survival Among Black and White Women in the State of Georgia. JAMA Netw Open 2022; 5:e2238183. [PMID: 36306134 PMCID: PMC9617173 DOI: 10.1001/jamanetworkopen.2022.38183] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Increasing evidence suggests that low socioeconomic status and geographic residence in disadvantaged neighborhoods contribute to disparities in breast cancer outcomes. However, little epidemiological research has sought to better understand these disparities within the context of location. OBJECTIVE To examine the association between neighborhood deprivation and racial disparities in mortality among Black and White patients with breast cancer in the state of Georgia. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study collected demographic and geographic data from patients diagnosed with breast cancer between January 1, 2004, and February 11, 2020, in 3 large health care systems in Georgia. A total of 19 580 patients with breast cancer were included: 12 976 from Piedmont Healthcare, 2285 from Grady Health System, and 4319 from Emory Healthcare. Data were analyzed from October 2, 2020, to August 11, 2022. EXPOSURES Area deprivation index (ADI) scores were assigned to each patient based on their residential census block group. The ADI was categorized into quartile groups, and associations between ADI and race and ADI × race interaction were examined. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% CIs associating ADI with overall mortality by race. Kaplan-Meier curves were used to visualize mortality stratified across racial and ADI groups. RESULTS Of the 19 580 patients included in the analysis (mean [SD] age at diagnosis, 58.8 [13.2] years), 3777 (19.3%) died during the course of the study. Area deprivation index contributed differently to breast cancer outcomes for Black and White women. In multivariable-adjusted models, living in a neighborhood with a greater ADI (more deprivation) was associated with increased mortality for White patients with breast cancer; compared with the ADI quartile of less than 25 (least deprived), increased mortality HRs were found in quartiles of 25 to 49 (1.22 [95% CI, 1.07-1.39]), 50 to 74 (1.32 [95% CI, 1.13-1.53]), and 75 or greater (1.33 [95% CI, 1.07-1.65]). However, an increase in the ADI quartile group was not associated with changes in mortality for Black patients with breast cancer (quartile 25 to 49: HR, 0.81 [95% CI, 0.61-1.07]; quartile 50 to 74: HR, 0.91 [95% CI, 0.70-1.18]; and quartile ≥75: HR, 1.05 [95% CI, 0.70-1.36]). In neighborhoods with an ADI of 75 or greater, no racial disparity was observed in mortality (HR, 1.11 [95% CI, 0.92-1.36]). CONCLUSIONS AND RELEVANCE Black women with breast cancer had higher mortality than White women in Georgia, but this disparity was not explained by ADI: among Black patients, low ADI was not associated with lower mortality. This lack of association warrants further investigation to inform community-level approaches that may mitigate the existing disparities in breast cancer outcomes in Georgia.
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Affiliation(s)
- Justin M. Luningham
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Ft Worth
| | - Gaurav Seth
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
| | - Geetanjali Saini
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
| | - Shristi Bhattarai
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
| | - Sofia Awan
- School of Public Health, Georgia State University, Atlanta
| | - Lindsay J. Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Monica H. Swahn
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, Georgia
| | - Dajun Dai
- Department of Geosciences, Georgia State University, Atlanta
| | - Keerthi Gogineni
- Department of Hematology–Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
- Georgia Cancer Center for Excellence, Grady Health System, Atlanta
| | - Preeti Subhedar
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Pooja Mishra
- Georgia Cancer Center for Excellence, Grady Health System, Atlanta
| | - Ritu Aneja
- Department of Biology, College of Arts and Sciences, Georgia State University, Atlanta
- Department of Clinical and Diagnostic Sciences, School of Health Professions, University of Alabama at Birmingham
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Duanmu H, Bhattarai S, Li H, Shi Z, Wang F, Teodoro G, Gogineni K, Subhedar P, Kiraz U, Janssen EAM, Aneja R, Kong J. A spatial attention guided deep learning system for prediction of pathological complete response using breast cancer histopathology images. Bioinformatics 2022; 38:4605-4612. [PMID: 35962988 PMCID: PMC9525016 DOI: 10.1093/bioinformatics/btac558] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/11/2022] [Revised: 06/21/2022] [Accepted: 08/10/2022] [Indexed: 12/24/2022] Open
Abstract
MOTIVATION Predicting pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) patients accurately is direly needed for clinical decision making. pCR is also regarded as a strong predictor of overall survival. In this work, we propose a deep learning system to predict pCR to NAC based on serial pathology images stained with hematoxylin and eosin and two immunohistochemical biomarkers (Ki67 and PHH3). To support human prior domain knowledge-based guidance and enhance interpretability of the deep learning system, we introduce a human knowledge-derived spatial attention mechanism to inform deep learning models of informative tissue areas of interest. For each patient, three serial breast tumor tissue sections from biopsy blocks were sectioned, stained in three different stains and integrated. The resulting comprehensive attention information from the image triplets is used to guide our prediction system for prognostic tissue regions. RESULTS The experimental dataset consists of 26 419 pathology image patches of 1000×1000 pixels from 73 TNBC patients treated with NAC. Image patches from randomly selected 43 patients are used as a training dataset and images patches from the rest 30 are used as a testing dataset. By the maximum voting from patch-level results, our proposed model achieves a 93% patient-level accuracy, outperforming baselines and other state-of-the-art systems, suggesting its high potential for clinical decision making. AVAILABILITY AND IMPLEMENTATION The codes, the documentation and example data are available on an open source at: https://github.com/jkonglab/PCR_Prediction_Serial_WSIs_biomarkers. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Hongyi Duanmu
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | | | - Hongxiao Li
- Department of Mathematics and Statistics and Computer Science, Georgia State University, Atlanta, GA, USA
| | - Zhan Shi
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
| | - Fusheng Wang
- Department of Computer Science, Stony Brook University, Stony Brook, NY, USA
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - George Teodoro
- Department of Computer Science, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Keerthi Gogineni
- Department of Hematology-Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
- Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
| | - Preeti Subhedar
- Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
| | - Umay Kiraz
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Emiel A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Department of Chemistry, Bioscience and Environmental Engineering, University of Stavanger, Stavanger, Norway
| | - Ritu Aneja
- Department of Clinical and Diagnostic Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jun Kong
- Department of Mathematics and Statistics and Computer Science, Georgia State University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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7
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Moubadder L, Collin LJ, Nash R, Switchenko JM, Miller-Kleinhenz JM, Gogineni K, Ward KC, McCullough LE. Drivers of racial, regional, and socioeconomic disparities in late-stage breast cancer mortality. Cancer 2022; 128:3370-3382. [PMID: 35867419 DOI: 10.1002/cncr.34391] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/08/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The authors identified tumor, treatment, and patient characteristics that may contribute to differences in breast cancer (BC) mortality by race, rurality, and area-level socioeconomic status (SES) among women diagnosed with stage IIIB-IV BC in Georgia. METHODS Using the Georgia Cancer Registry, 3084 patients with stage IIIB-IV primary BC (2013-2017) were identified. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) comparing mortality among non-Hispanic Black (NHB) versus non-Hispanic White (NHW), residents of rural versus urban neighborhoods, and residents of low- versus high-SES neighborhoods by tumor, treatment, and patient characteristics. The mediating effects of specific characteristics on the association between race and BC mortality were estimated. RESULTS Among the study population, 41% were NHB, 21% resided in rural counties, and 72% resided in low SES neighborhoods. The authors observed mortality disparities by race (HR, 1.27; 95% CI, 1.13, 1.41) and rurality (HR, 1.14; 95% CI, 1.00, 1.30), but not by SES (HR, 1.04; 95% CI, 0.91, 1.19). In the stratified analyses, racial disparities were the most pronounced among women with HER2 overexpressing tumors (HR, 2.30; 95% CI, 1.53, 3.45). Residing in a rural county was associated with increased mortality among uninsured women (HR, 2.25; 95% CI, 1.31, 3.86), and the most pronounced SES disparities were among younger women (<40 years: HR, 1.46; 95% CI, 0.88, 2.42). CONCLUSIONS There is considerable variation in racial, regional, and socioeconomic disparities in late-stage BC mortality by tumor, treatment, and patient characteristics.
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Affiliation(s)
- Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay J Collin
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jeffrey M Switchenko
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory School of Medicine, Atlanta, Georgia, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Wu R, Gogineni K, Meisel J, Szabo S, Thirunavu M, Friend S, Bercu Z, Sethi I, Natarajan N, Switchenko J, Levy J, Abdalla E, Weakland L, Kalinsky K, Kokabi N. Study Protocol: Efficacy and Safety of Radioembolization (REM) as an Early Modality (EM) Therapy for Metastatic Breast Cancer (BR) to the Liver with Y90 (REMEMBR Y90). Cardiovasc Intervent Radiol 2022; 45:1725-1734. [PMID: 36008574 DOI: 10.1007/s00270-022-03254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The primary objective of the REMEMBR Y90 study is to evaluate the efficacy of Yttrium-90 (Y90) radioembolization in patients with breast cancer metastases to the liver as a 2nd or 3rd line treatment option with systemic therapy by assessing liver-specific and overall progression-free survival. Secondary objectives include quality of life, overall survival benefit, and toxicity in relation to patients' tumor biology. MATERIALS AND METHODS This trial is a multi-center, prospective, Phase 2, open-label, IRB-approved, randomized control trial in the final phases of activation. Eligible patients include those over 18 years of age with metastatic breast cancer to the liver with liver-only or liver-dominant disease, and history of tumor progression on 1-2 lines of chemotherapy. 60 patients will be randomized to radioembolization with chemotherapy versus chemotherapy alone. Permissible regimens include capecitabine, eribulin, vinorelbine, and gemcitabine within 2 weeks of enrollment for every patient. Patients receiving radioembolization will receive lobar or segmental treatment within 1-6 weeks of enrollment depending on their lesion. After final radioembolization, patients will receive clinical and imaging follow-up every 12-16 weeks for two years, including contrast-enhanced computed tomography or magnetic resonance imaging of the abdomen and whole-body positron emission tomography/computed tomography. DISCUSSION This study seeks to elucidate the clinical benefit and toxicity of Y90 in patients with metastatic breast cancer to the liver who are receiving minimal chemotherapy. Given previous data, it is anticipated that the use of Y90 and chemotherapy earlier in the metastatic disease course would improve survival outcomes and reduce toxicity. LEVEL OF EVIDENCE Level 1b, Randomized Controlled Trial. TRIAL REGISTRATION NUMBER NCT05315687 on clinicaltrials.gov.
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Affiliation(s)
- Richard Wu
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Jane Meisel
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Stephen Szabo
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Meenakshi Thirunavu
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Sarah Friend
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Zachary Bercu
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Ila Sethi
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Neela Natarajan
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Jeffrey Switchenko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Jason Levy
- Northside Hospital Cancer Institute, Atlanta, GA, USA
| | - Eddie Abdalla
- Northside Hospital Cancer Institute, Atlanta, GA, USA
| | | | - Kevin Kalinsky
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - Nima Kokabi
- Division of Interventional Radiology and Image Guided Medicine, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
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9
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Moubadder L, Collin LJ, Nash R, Switchenko J, Miller-Kleinhenz J, Gogineni K, Ward KC, McCullough LE. Abstract 3678: Drivers of racial, regional, and socioeconomic disparities in metastatic breast cancer mortality. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Despite an overall decline in breast cancer (BC) mortality due to advancements in cancer therapy, mortality disparities by race, rurality, and socioeconomic status (SES) persist among women diagnosed with metastatic disease in the US. Women residing in high-poverty or rural areas or who are non-Hispanic Black (NHB) experience higher rates of BC mortality relative to their counterparts. Although mortality disparities among late-stage BC patients are well-documented, few studies have examined the drivers of these disparities, which are likely multifactorial. We sought to identify tumor, treatment, and patient characteristics that may contribute to differences in BC mortality by race, rurality, and SES among women diagnosed with a first primary stage IIIB - IV BC in Georgia.Using the Georgia Cancer Registry, we identified 3085 patients with an initial diagnosis of stage IIIB-IV primary BC between January 2013 and December 2017. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) to compare NHB vs. non-Hispanic White (NHW), rural vs. urban residents, and residents of low- vs. high-SES neighborhoods by tumor (stage, grade, ER status, and molecular subtype), treatment (surgery type, receipt of chemotherapy, radiation, hormonal, neoadjuvant, and immunotherapy), and patient (race, insurance, age group, marital status, region, SES) characteristics. Using an extension of the counterfactual framework, we estimated the mediating effects of subtype, stage, SES, rurality, and insurance on the association between race and BC mortality. Among the study population, 41% were NHB, 21% resided in rural counties, and 72% resided in low SES neighborhoods. Overall, we observed mortality disparities by race (HR=1.27, 95% CI: 1.13, 1.41) and rurality (HR=1.14, 95% CI: 1.00, 1.30), but not by SES (HR=1.04, 95% CI: 0.91, 1.19). In the stratified analyses, racial disparities were the most pronounced among women with HER2 overexpressing tumors (HR=2.30, 95% CI: 1.53, 3.45). Residing in a rural neighborhood was associated with increased mortality among uninsured women (HR=2.25, 95% CI: 1.31, 3.86) or receipt of breast-conserving surgery (HR=2.21, 95 CI%: 1.32, 3.71). The most pronounced socioeconomic disparities were among younger women (<40 years: HR=1.46, 95% CI: 0.88, 2.42) and patients who received neoadjuvant therapy (HR=1.44, 95% CI: 1.01, 2.05). The mediation analysis demonstrated that 48% of the effect between race and BC mortality was mediated by subtype.There is considerable variation in racial, regional, and socioeconomic disparities in metastatic BC mortality by tumor, treatment, and patient characteristics. For each, we’ve identified patient groups where disparities are most pronounced. Understanding specific barriers within these patient groups will inform future interventions aimed at reducing disparities in metastatic BC mortality.
Citation Format: Leah Moubadder, Lindsay J. Collin, Rebecca Nash, Jeffrey Switchenko, Jasmine Miller-Kleinhenz, Keerthi Gogineni, Kevin C. Ward, Lauren E. McCullough. Drivers of racial, regional, and socioeconomic disparities in metastatic breast cancer mortality [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3678.
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10
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Yeager KA, Bai J, Gogineni K, Meisel JL, Kweon J, Bruner DW, Waldrop-Valverde D. Pilot Feasibility Study of a Video Intervention to Educate Patients with Breast Cancer About Clinical Trials. J Cancer Educ 2022; 37:387-394. [PMID: 32654039 DOI: 10.1007/s13187-020-01826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this project was to develop and test the feasibility and preliminary efficacy of a video about cancer clinical trials (CCTs) developed for breast cancer patients. We developed 2 brief 7-min videos that focused on breast cancer patients describing their experiences participating in CCTs, supplemented with doctors and research staff explaining key research concepts. One video was culturally tailored to Black patients and the other to White patients. To assess feasibility study, participants and their care providers completed a survey to evaluate their satisfaction with the video. Eligibility criteria for the study included ≥ 21 years of age, English-speaking, no prior experience participating in a CCT, and being potentially eligible for breast CCT enrollment. Preliminary efficacy was evaluated with a pretest-posttest design using a single item asking about intent to enroll in a clinical trial. The mean age of the patient sample (n = 50) was 53.0 years, and 50.0% were Black. Participants reported that the video was in the right length, useful, and easy to understand. Providers' evaluation (n = 5) revealed that viewing the video helped prepare patients for further CCT discussion. Preliminary efficacy showed no statistically significant difference in participant interest in CCT enrollment pre- and post-video. Changes in patients' intent in enrollment were associated with age and education. Culturally adapted video interventions can be helpful in supporting both patients and providers throughout the CCT education process but additional work is needed to improve enrollment into clinical trials.
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Affiliation(s)
- Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA.
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA.
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
| | - Keerthi Gogineni
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
- School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Jane Lowe Meisel
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
- School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Jaime Kweon
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Deborah W Bruner
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA, 30322-4207, USA
| | - Drenna Waldrop-Valverde
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA, 30322, USA
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11
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Han HS, Disis M, Wesolowski R, Fisher C, Gandhi S, Chan N, Gwin W, Gogineni K, Mick R, Rodriguez CS, Hogue D, Liu H, Costa R, Czerniecki B. Abstract OT1-16-01: A multicenter phase II study of vaccines to prevent recurrence in patients with HER-2 positive breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot1-16-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: HER2-positive breast cancer patients are commonly treated with neoadjuvant therapy including HER2-targeted therapy. Patients who have residual invasive disease have less favorable outcomes with an increased risk of recurrent disease than patients with complete pathologic response (pCR). It has also been observed that these non-pCR patients have low or absent anti-HER-2 CD4 Th1 responses. We hypothesized that correcting the anti-HER-2 CD4 Th1 response using vaccines will increase interferon gamma production which we have shown is a potent inducer of apoptosis and senescence in HER2-positive breast cancer. This study will be evaluating safety and immunogenicity of two vaccines (multivalent anti-oncodriver DNA vaccine (WOKVAC) or HER-2-pulsed dendritic cell vaccine (DC1)). Methods: This is a multi-center, phase 2, randomized study to determine the safety and tolerability of HER2 vaccines (DC1 and WOKVAC), assess immunogenicity, and evaluate recurrence free survival. Patients with HER2-positive early breast cancer (stage I-III) are eligible if they have residual invasive disease in the breast or axilla at surgery after receiving neoadjuvant chemotherapy plus HER2 -targeted therapy. Patients are randomly assigned in a 1:1 ratio to receive 1 of 2 adjuvant HER2 vaccines, either DC1 or WOKVAC for 1 year. A permuted-block randomization scheme was used with stratification according to residual cancer burden (RCB) (1+2 vs 3). The primary end points are safety and immunogenicity (immune response rate measured by ELISPOT). Each treatment arm will be assessed separately. Any statistical comparison between arms is purely exploratory, as this study is neither designed nor powered for comparative hypotheses. Secondary endpoints include recurrence-free survival. Exploratory analyses include the assessment of prognostic and predictive biomarkers including circulating tumor cells, serum HER2 levels, and other immune markers. The enrollment began in 2018 and we plan to accrue the total of 110 patients. ClinicalTrials.gov Identifier: NCT03384914
Citation Format: Hyo S Han, Mary Disis, Robert Wesolowski, Carla Fisher, Shipra Gandhi, Nancy Chan, William Gwin, Keerthi Gogineni, Rosemarie Mick, Christina Sierra Rodriguez, Deanna Hogue, Hien Liu, Ricardo Costa, Brian Czerniecki. A multicenter phase II study of vaccines to prevent recurrence in patients with HER-2 positive breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-16-01.
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Affiliation(s)
- Hyo S Han
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Carla Fisher
- Indiana University Schoold of Medicine, Indianapolis, IN
| | - Shipra Gandhi
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Nancy Chan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NY
| | | | | | - Rosemarie Mick
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Deanna Hogue
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Hien Liu
- Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ricardo Costa
- Moffitt Cancer Center and Research Institute, Tampa, FL
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12
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Gogineni K, Kalinsky K. Individualizing Adjuvant Therapy in Women With Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Node-Positive Breast Cancer. JCO Oncol Pract 2022; 18:247-251. [PMID: 35108074 DOI: 10.1200/op.21.00780] [Citation(s) in RCA: 1] [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: 12/12/2022] Open
Affiliation(s)
- Keerthi Gogineni
- Emory School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kevin Kalinsky
- Emory School of Medicine, Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
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13
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Gohar J, Do WL, Miller-Kleinhenz J, Conneely K, Krishnamurti U, D'Angelo O, Gogineni K, Torres M, Gabram-Mendola S, McCullough LE. Neighborhood characteristics and breast tumor methylation: using epigenomics to explore cancer outcome disparities. Breast Cancer Res Treat 2022; 191:653-663. [PMID: 34978015 DOI: 10.1007/s10549-021-06430-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Social exposures may drive epigenetic alterations that affect racial disparities in breast cancer outcomes. This study examined the association between neighborhood-level factors and DNA methylation in non-Hispanic Black and White women diagnosed with breast cancer. METHODS Genome-wide DNA methylation was measured using the EPIC array in the tumor tissue of 96 women. Linear regression models were used to examine the association between nine neighborhood-level factors and methylation, regressing β values for each cytosine-phosphate guanine dinucleotide (CpG) site on neighborhood-level factors while adjusting for covariates. Neighborhood data were obtained from the Opportunity Atlas. We used a false discovery rate (FDR) threshold < 0.05, and for CpGs below this threshold, we examined interactions with race. We employed multivariable Cox proportional-hazards models to estimate whether aberrant methylation was associated with all-cause mortality. RESULTS 26 of the CpG sites were associated with job density or college education (FDR < 0.05). Further exploration of these 26 CpG sites revealed no interactions by race, but a single probe in TMEM204 was associated with all-cause mortality. CONCLUSION We identified novel associations between neighborhood-level factors and the breast tumor DNA methylome. Our data are the first to show that dysregulation in neighborhood associated CpG sites may be associated with all-cause mortality. Neighborhood-level factors may contribute to differential tumor methylation in genes related to tumor progression and metastasis. This contributes to the increasing body of evidence that area-level factors (such as neighborhood characteristics) may play an important role in cancer disparities through modulation of the breast tumor epigenome.
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Affiliation(s)
- Jazib Gohar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Whitney L Do
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Jasmine Miller-Kleinhenz
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Karen Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Olivia D'Angelo
- Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Keerthi Gogineni
- Department of Medical Oncology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.
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14
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Miller-Kleinhenz JM, Moubadder L, Beyer KM, Zhou Y, Gaglioti AH, Gohar J, Collin LJ, Henry K, Conneely KM, Krishnamurti U, D'Angelo O, Gogineni K, Torres M, Gabram-Mendola S, McCullough LE. Abstract PR-03: Neighborhood-level redlining-associated methylation in breast tumors: The impact of structural racism on the tumor epigenome. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-pr-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Structural racism has been associated with breast cancer mortality. Exposure to adverse inequities may drive epigenetic perturbations that affect racial disparities in breast cancer outcomes. This study examined the association between neighborhood-level redlining and DNA methylation in non-Hispanic Black and White women diagnosed with breast cancer. Methods: Genome-wide DNA methylation was measured using the EPIC array in the tumor tissue of 84 women. Linear regression models were used to examine the association between neighborhood-level redlining and methylation, regressing β values for each cytosine-phosphate-guanine dinucleotide (CpG) site on redlining while adjusting for covariates. Redlining was derived for census tracts using the Home Mortgage Disclosure Act database. We used a false discovery rate (FDR) threshold <0.1, and for CpGs below this threshold, we examined interactions with Estrogen Receptor (ER) status. We employed multivariable Cox-proportional hazard models to estimate whether aberrant methylation was associated with all-cause mortality. Results: 36 of the CpG sites were associated with neighborhood-level redlining (FDR<0.1). The majority of genes are implicated in carcinogenesis including genes in immune function (BANP, IGDCC3, GPR15), oncogenic signaling (IGFALS, RNLS, RTP3), and angiogenesis (ANGPT1). Further exploration of these 36 CpG sites revealed no interactions by ER status, no probes were associated with all-cause mortality. Conclusions: We identified novel associations between neighborhood-level redlining and the breast tumor DNA methylome. Our data are the first to show that structural racism impacts the breast tumor epigenome.
Citation Format: Jasmine M Miller-Kleinhenz, Leah Moubadder, Kirsten M. Beyer, Yuhong Zhou, Anne H. Gaglioti, Jazib Gohar, Lindsay J. Collin, Kashari Henry, Karen M. Conneely, Uma Krishnamurti, Olivia D'Angelo, Keerthi Gogineni, Mylin Torres, Sheryl Gabram-Mendola, Lauren E. McCullough. Neighborhood-level redlining-associated methylation in breast tumors: The impact of structural racism on the tumor epigenome [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PR-03.
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Affiliation(s)
| | | | | | - Yuhong Zhou
- 2Medical College of Wisconsin, Wauwatosa, WI,
| | | | - Jazib Gohar
- 4Michigan State University, East Lansing, MI,
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15
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Duanmu H, Bhattarai S, Li H, Cheng CC, Wang F, Teodoro G, Janssen EAM, Gogineni K, Subhedar P, Aneja R, Kong J. Spatial Attention-Based Deep Learning System for Breast Cancer Pathological Complete Response Prediction with Serial Histopathology Images in Multiple Stains. Med Image Comput Comput Assist Interv 2021; 12908:550-560. [PMID: 36222817 PMCID: PMC9535677 DOI: 10.1007/978-3-030-87237-3_53] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In triple negative breast cancer (TNBC) treatment, early prediction of pathological complete response (PCR) from chemotherapy before surgical operations is crucial for optimal treatment planning. We propose a novel deep learning-based system to predict PCR to neoadjuvant chemotherapy for TNBC patients with multi-stained histopathology images of serial tissue sections. By first performing tumor cell detection and recognition in a cell detection module, we produce a set of feature maps that capture cell type, shape, and location information. Next, a newly designed spatial attention module integrates such feature maps with original pathology images in multiple stains for enhanced PCR prediction in a dedicated prediction module. We compare it with baseline models that either use a single-stained slide or have no spatial attention module in place. Our proposed system yields 78.3% and 87.5% of accuracy for patch-, and patient-level PCR prediction, respectively, outperforming all other baseline models. Additionally, the heatmaps generated from the spatial attention module can help pathologists in targeting tissue regions important for disease assessment. Our system presents high efficiency and effectiveness and improves interpretability, making it highly promising for immediate clinical and translational impact.
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Affiliation(s)
| | | | - Hongxiao Li
- Georgia State University, Atlanta, GA 30302, USA
| | | | - Fusheng Wang
- Stony Brook University, Stony Brook, NY 11794, USA
| | - George Teodoro
- Federal University of Minas Gerais, Belo Horizonte 31270-010, Brazil
| | - Emiel A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Ritu Aneja
- Georgia State University, Atlanta, GA 30302, USA
| | - Jun Kong
- Georgia State University, Atlanta, GA 30302, USA
- Emory University, Atlanta, GA 30322, USA
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16
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Collin LJ, Yan M, Jiang R, Gogineni K, Subhedar P, Ward KC, Switchenko JM, Lipscomb J, Miller-Kleinhenz J, Torres M, Lin J, McCullough LE. Receipt of Guideline-Concordant Care Does Not Explain Breast Cancer Mortality Disparities by Race in Metropolitan Atlanta. J Natl Compr Canc Netw 2021; 19:1242-1251. [PMID: 34399407 PMCID: PMC8847540 DOI: 10.6004/jnccn.2020.7694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/18/2020] [Accepted: 12/02/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Racial disparities in breast cancer mortality in the United States are well documented. Non-Hispanic Black (NHB) women are more likely to die of their disease than their non-Hispanic White (NHW) counterparts. The disparity is most pronounced among women diagnosed with prognostically favorable tumors, which may result in part from variations in their receipt of guideline care. In this study, we sought to estimate the effect of guideline-concordant care (GCC) on prognosis, and to evaluate whether receipt of GCC modified racial disparities in breast cancer mortality. PATIENTS AND METHODS Using the Georgia Cancer Registry, we identified 2,784 NHB and 4,262 NHW women diagnosed with a stage I-III first primary breast cancer in the metropolitan Atlanta area, Georgia, between 2010 and 2014. Women were included if they received surgery and information on their breast tumor characteristics was available; all others were excluded. Receipt of recommended therapies (chemotherapy, radiotherapy, endocrine therapy, and anti-HER2 therapy) as indicated was considered GCC. We used Cox proportional hazards models to estimate the impact of receiving GCC on breast cancer mortality overall and by race, with multivariable adjusted hazard ratios (HRs). RESULTS We found that NHB and NHW women were almost equally likely to receive GCC (65% vs 63%, respectively). Failure to receive GCC was associated with an increase in the hazard of breast cancer mortality (HR, 1.74; 95% CI, 1.37-2.20). However, racial disparities in breast cancer mortality persisted despite whether GCC was received (HRGCC: 2.17 [95% CI, 1.61-2.92]; HRnon-GCC: 1.81 [95% CI, 1.28-2.91] ). CONCLUSIONS Although receipt of GCC is important for breast cancer outcomes, racial disparities in breast cancer mortality did not diminish with receipt of GCC; differences in mortality between Black and White patients persisted across the strata of GCC.
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Affiliation(s)
- Lindsay J. Collin
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112
| | - Ming Yan
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA
| | - Renjian Jiang
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Winship Cancer Institute of Emory University
| | - Keerthi Gogineni
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Preeti Subhedar
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Kevin C. Ward
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Winship Cancer Institute of Emory University
| | - Jeffrey M. Switchenko
- Winship Cancer Institute of Emory University,Department of Biostatistics and Bioinformatics; Rollins School of Public Health; Emory University; Atlanta, GA, 30322, USA
| | - Joseph Lipscomb
- Winship Cancer Institute of Emory University,Department of Health Policy and Management; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA
| | - Jasmine Miller-Kleinhenz
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA
| | - Mylin Torres
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Jolinta Lin
- Winship Cancer Institute of Emory University,Emory University School of Medicine; Atlanta, GA, 30322, USA
| | - Lauren E. McCullough
- Department of Epidemiology; Rollins School of Public Health, Emory University; Atlanta, GA, 30322, USA,Winship Cancer Institute of Emory University
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17
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Affiliation(s)
| | | | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory University School of Medicine; Atlanta, GA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA
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18
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Calfa C, Rothe M, Mangat PK, Garrett-Mayer E, Ahn E, Gogineni K, Rohatgi N, Burness ML, Gaba A, Hamid O, Albaghdadi T, Conlin A, Gold P, Rodon J, Thota R, Schilsky RL. Abstract CT173: Sunitinib (S) in patients (pts) with metastatic breast cancer (mBC) with FGFR1 mutations or amplifications: Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) Study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: TAPUR is a phase II basket study evaluating anti-tumor activity of commercially available targeted agents in pts with advanced cancers with genomic alterations. S is an oral multi-kinase inhibitor that inhibits Fibroblast Growth Factor Receptor family members 1-4 (FGFR1-4) in biochemical and cellular assays and is FDA approved in several tumor types. Results in a cohort of mBC pts with FGFR1 mutations (mut) or amplifications (amp) treated with S are reported.
Methods: Eligible pts had mBC, no standard treatment (tx) options, measurable disease, ECOG Performance Status (PS) 0-2, and adequate organ function. Genomic testing was performed in CLIA-certified, CAP-accredited site selected labs. Pts received S 50 mg orally daily for four weeks followed by two weeks off, until tumor progression. Simon 2-stage design tested the null disease control (DC) - defined as partial (PR), complete response (CR) or stable disease at 16+ weeks (SD 16+) - rate of 15% vs. 35% (power = 0.85; α = 0.10). If ≥2 of 10 pts in stage 1 have DC, 18 more pts are enrolled. If ≥7 of 28 pts have DC, the null DC rate is rejected. Secondary endpoints are progression-free survival (PFS), overall survival (OS) and safety.
Results: Thirty pts with mBC with FGFR1 mut (1 pt), amp (28 pts), or both (1 pt) were enrolled from Oct 2016 to June 2019. 3 were not evaluable and excluded from efficacy analyses. Demographics and outcomes are summarized in Table 1. Two partial responses (PR) and 5 SD16+ (FGFR1 amp only) were observed for DC and OR rates of 29% (95% CI: 13%, 42%) and 7% (95% CI: 1%, 24%), respectively, and the null DC rate of 15% was rejected (p=0.09). S related grade 3-5 TAEs (Table 1) were consistent with the product label for S except encephalopathy.
Conclusions: Monotherapy S showed modest anti-tumor activity and clinically significant TAEs in heavily pre-treated pts with mBC with FGFR1 amplification.
Table 1.Demographics, Efficacy (N=27) and Toxicity Outcomes (N=30)Median age, yrs (range)61 (28, 81)Female, %97ECOG PS, %047137217Prior systemic regimens, %1-210≥390Hormone Receptor (HR) & HER2 Status, %HR (+) HER2 (-)77HR (-) HER2(-)13HR (+) HER2 (+)7Not reported3DC rate, % (OR or SD16+) (95% CI)29 (13, 42)OR rate, % (95% CI)7 (1, 24)Median PFS, wks (95% CI)8.7 (8.1, 15.7)Median OS, wks (95% CI)33.9 (23.0, 49.0)Number of Pts with Treatment-related AEs/SAEs (TAEs, maximum grade reported)Grade 211Grade 329Grade 4321Skin infection (SAE)2Cytopenia, encephalopathy (SAE), febrile neutropenia (SAE), increased alkaline phosphatase, Palmar-plantar erythrodysesthesia syndrome, vomiting3Cytopenia, hypertension
Citation Format: Carmen Calfa, Michael Rothe, Pam K. Mangat, Elizabeth Garrett-Mayer, Eugene Ahn, Keerthi Gogineni, Nitin Rohatgi, Monika L. Burness, Anu Gaba, Omid Hamid, Tareq Albaghdadi, Alison Conlin, Philip Gold, Jordi Rodon, Ramya Thota, Richard L. Schilsky. Sunitinib (S) in patients (pts) with metastatic breast cancer (mBC) with FGFR1 mutations or amplifications: Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT173.
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Affiliation(s)
- Carmen Calfa
- 1University of Miami Comprehensive Cancer Center, Miami, FL
| | - Michael Rothe
- 2American Society of Clinical Oncology, Alexandria, VA
| | - Pam K. Mangat
- 2American Society of Clinical Oncology, Alexandria, VA
| | | | - Eugene Ahn
- 3Cancer Treatment Centers of America, Zion, IL
| | | | | | | | | | | | | | | | | | | | - Ramya Thota
- 13Intermountain Precision Genomics Cancer Research Clinic, Murray, UT
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Garrido-Castro AC, Keenan TE, Li T, Lange P, Callahan C, Guerriero J, Tayob N, Anderson L, Stover DG, Gogineni K, Carey LA, Nanda R, Winer EP, Mittendorf EA, Tolaney SM. Saci-IO HR+: Randomized phase II trial of sacituzumab govitecan (SG) +/- pembrolizumab in PD-L1+ hormone receptor-positive (HR+) / HER2- metastatic breast cancer (MBC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps1102] [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
TPS1102 Background: Immune checkpoint inhibitors (ICIs) have not yet benefited most patients with MBC. In HR+ MBC, the first randomized trial combining an ICI with chemotherapy demonstrated no clinical benefit with the addition of pembrolizumab to eribulin.1 The optimal ICI combination agent to overcome primary resistance in HR+ MBC is unknown. One promising agent is the anti-Trop-2-SN-38 antibody drug conjugate (ADC) SG, which led to median progression-free survival (PFS) of 5.5 months in HR+ MBC refractory to endocrine therapy.2 This ADC may boost anticancer immunity by binding immune cell receptors to promote antibody-dependent cellular cytotoxicity.3 In addition, the SN-38 payload of SG is the active metabolite of irinotecan, which depletes regulatory T cells, upregulates MHC class I and PD-L1 expression, and augments the antitumor activity of anti-PD-1/L1 antibodies in murine tumor models.4 The irinotecan analogue camptothecin also enhances CD8+ cytotoxic T cell effector functions and antitumor immune responses by inhibiting NR4A transcription factors,5 which have recently been shown to play a central role in inducing the T cell dysfunction associated with chronic antigen stimulation in solid tumors. Methods: This is a multi-center 1:1 randomized phase II trial to investigate whether the addition of pembrolizumab (200 mg IV every 3 weeks) to SG (10 mg/kg IV days 1+8 every 21 days) improves PFS compared to SG alone in HR+ HER2- MBC that is PD-L1+ by central assessment with 22C3 combined positive score (CPS) ≥ 1 (NCT04448886). Key eligibility criteria include at least 1 prior hormonal therapy and no more than 1 prior chemotherapy for HR+ MBC. Eligible patients must have evaluable disease, and previously treated brain metastases are permitted. Exclusion criteria include prior treatment with SG, irinotecan, and PD-1/L1 inhibitors. Based on a sample size of 110 patients, the trial has 80% power to detect a 3-month difference in median PFS from 5.5 months in the SG-alone cohort to 8.5 months in the SG + pembrolizumab cohort with a one-sided alpha of 0.1. Participants undergo mandatory baseline and on-treatment research biopsies if their disease is safely accessible. Tumor biopsies will be evaluated for Trop-2, immune cells, inhibitory checkpoints, transcriptomic signatures, and genomic alterations. Stool specimens will be submitted for microbiome analyses, and health-related quality of life will be assessed. The trial is currently open and enrolling patients. References: 1) Tolaney SM et al. JAMA Oncol 6, 1598-1605 (2020). 2) Kalinksy K et al. Ann Oncol 12, 1709-1718 (2020). 3) Cardillo TM et al. Bioconjug Chem 26, 919-931 (2015). 4) Iwai T et al. Oncotarget 9, 31411-31421 (2018). 5) Hibino S et al. Cancer Res 78, 3027-3040 (2018). Clinical trial information: NCT04448886 .
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Affiliation(s)
| | | | - Tianyu Li
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | - Nabihah Tayob
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
| | | | - Daniel G. Stover
- Ohio State University Comprehensive Cancer Center, Division of Medical Oncology, Columbus, OH
| | - Keerthi Gogineni
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA
| | | | - Rita Nanda
- University of Chicago Medical Center, Chicago, IL
| | - Eric P. Winer
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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20
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Abousaud AI, Barbee MS, Davis CC, Caulfield SE, Wang Z, Boykin A, Carthon BC, Gogineni K. Safety and efficacy of extended dosing intervals of denosumab in patients with solid cancers and bone metastases: a retrospective study. Ther Adv Med Oncol 2021; 12:1758835920982859. [PMID: 33488782 PMCID: PMC7768832 DOI: 10.1177/1758835920982859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
Aim More than half of patients with breast, lung, or prostate cancer who have bone metastases have evidence of skeletal-related events (SREs). Denosumab is a fully human monoclonal antibody that binds to and neutralizes receptor activator of nuclear factor kappa-B ligand (RANKL) on osteoblasts and their precursors. The United States Food and Drug Administration (FDA)-approved dose of denosumab is 120 mg every 4 weeks; however, other schedules have been used in practice for patient convenience. Evidence for the safety and efficacy of alternative dosing intervals is lacking. Patient & Methods Adult patients with solid cancers and bone metastases who received at least two doses of denosumab 120 mg were reviewed. Patients were grouped based on an average denosumab dosing interval of <5 weeks (short-interval) versus 5-11 weeks (medium-interval) versus ⩾12 weeks (long-interval). The primary outcome was the time to first SRE while on denosumab between the short- and medium-interval groups. The secondary outcomes were overall survival (OS), efficacy comparisons between the other groups, and safety events. Results There was no significant difference in median time to first SRE between the short- and medium-interval denosumab groups [33.2 versus 28.4 months, hazard ratio (HR): 1.13, 95% confidence interval (CI): 0.66-1.92, p = 0.91] or the medium- and long-interval dosing groups (28.4 versus 32.2 months, HR: 1.15, 95% CI: 0.66-2.01, p = 0.62). Median OS was not found to differ significantly between any of the groups. There were significantly more hospitalizations in the short-interval dosing group than the other groups (55.2% versus 33.8% versus 30.4%, p < 0.001). Conclusion Extending denosumab dosing intervals does not appear to negatively impact time to first SRE and is associated with fewer hospitalizations in real-world patients with solid cancers and bone metastases.
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Affiliation(s)
- Aseala I Abousaud
- Department of Pharmaceutical Services, Emory Healthcare, 5665 Peachtree Dunwoody Road NE, Atlanta, GA 30342, USA
| | - Meagan S Barbee
- Global Medical Information Specialist, Oncology at Med Communications Inc
| | - Christine C Davis
- Department of Pharmaceutical Services, Emory Healthcare, Atlanta, GA, USA
| | - Sarah E Caulfield
- Department of Pharmaceutical Services, Emory Healthcare, Atlanta, GA, USA
| | - Zeyuan Wang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health
| | - Alexa Boykin
- Medical Science Liason, Novocure Inc., Atlanta, GA, USA
| | - Bradley C Carthon
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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21
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Bhattarai S, Saini G, Gogineni K, Aneja R. Quadruple-negative breast cancer: novel implications for a new disease. Breast Cancer Res 2020; 22:127. [PMID: 33213491 PMCID: PMC7678108 DOI: 10.1186/s13058-020-01369-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/08/2020] [Indexed: 02/07/2023] Open
Abstract
Based on the androgen receptor (AR) expression, triple-negative breast cancer (TNBC) can be subdivided into AR-positive TNBC and AR-negative TNBC, also known as quadruple-negative breast cancer (QNBC). QNBC characterization and treatment is fraught with many challenges. In QNBC, there is a greater paucity of prognostic biomarkers and therapeutic targets than AR-positive TNBC. Although the prognostic role of AR in TNBC remains controversial, many studies revealed that a lack of AR expression confers a more aggressive disease course. Literature characterizing QNBC tumor biology and uncovering novel biomarkers for improved management of the disease remains scarce. In this comprehensive review, we summarize the current QNBC landscape and propose avenues for future research, suggesting potential biomarkers and therapeutic strategies that warrant investigation.
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Affiliation(s)
- Shristi Bhattarai
- Department of Biology, Georgia State University, 100 Piedmont Ave, Atlanta, GA, 30303, USA
| | - Geetanjali Saini
- Department of Biology, Georgia State University, 100 Piedmont Ave, Atlanta, GA, 30303, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, 100 Piedmont Ave, Atlanta, GA, 30303, USA.
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22
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McDaniels BA, Hianik RS, Bellcross C, Shaib WL, Switchenko J, Dixon MD, Meisel JL, Gogineni K, Pentz RD. The Impact of Genetic Counseling Educational Tools on Patients' Knowledge of Molecular Testing Terminology. J Cancer Educ 2020; 35:864-870. [PMID: 31062281 PMCID: PMC6834865 DOI: 10.1007/s13187-019-01535-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Molecular testing is increasingly being integrated into cancer management. Despite rapid advancements, little work has been done to explore strategies for communicating with patients undergoing molecular tumor testing. This study evaluated the impact of genetic counseling educational tools on improving patients' understanding of key terms related to molecular testing. A genetic counseling intern designed a picture book to explain six words found in prior research to be difficult to understand (mutation, germline mutation, somatic mutation, biomarker, molecular testing, and targeted therapy). Participants who had previously discussed molecular testing with their oncologist were asked to define the terms. The same participants then received an explanation of each term either from the intern using the picture book in person or from a video presentation of the picture book. They were then asked to redefine each term afterward. The difference between the number of terms defined correctly pre- and post-intervention was compared between presentations. Sixty-three patients with melanoma, colon, lung, or breast cancer were recruited. After both interventions, correct understanding rates improved for all six terms, with significant improvement for germline mutation (p < 0.001), somatic mutation (p < 0.001), biomarker (p < 0.001), and molecular testing (p < 0.001). Understanding of targeted therapy improved significantly (p = 0.011) for the video presentation only. Mean change in knowledge scores did not differ between the two interventions (intern presentation 3.2 vs. video 2.9, p = 0.428). Our data suggest that genetic counseling educational tools can increase patient understanding of terms used to describe molecular testing.
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Affiliation(s)
- Brianna A McDaniels
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA.
| | | | - Cecelia Bellcross
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
| | - Walid L Shaib
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Jeffrey Switchenko
- Rollins School of Public Health Emory University, Atlanta, GA, 30322, USA
| | - Margie D Dixon
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Jane L Meisel
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Keerthi Gogineni
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
| | - Rebecca D Pentz
- Emory University School of Medicine, 201 Dowman Dr., Atlanta, GA, 30322, USA
- Winship Cancer Institute, Atlanta, GA, 30322, USA
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23
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Torres MA, Gogineni K, Howard DH. Intensity-Modulated Radiation Therapy in Breast Cancer Patients Following the Release of a Choosing Wisely Recommendation. J Natl Cancer Inst 2020; 112:314-317. [PMID: 31647560 DOI: 10.1093/jnci/djz198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/29/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022] Open
Abstract
In 2013, the American Society for Radiation Oncology recommended against the routine use of intensity-modulated radiation therapy (IMRT) in breast cancer patients. We evaluated trends in the use of IMRT before and after the release of the recommendation. Using Surveillance, Epidemiology, and End Results Medicare data, we identified 13 457 breast cancer patients diagnosed between 2012 and 2015 who received breast-conserving surgery and postsurgery, whole-breast, IMRT, or three-dimensional conformal radiotherapy. We find that the use of IMRT decreased by 4.6 (95% confidence interval [CI] = 3.6 to 5.6; two-sided P < .001) percentage points in hospital-based clinics. In freestanding radiotherapy clinics, which had baseline rates of IMRT use that were more than 20 percentage points higher than in hospital-based clinics, use of IMRT declined by 6.1 (95% CI = 3.5 to 8.7; two-sided P < .001) percentage points. Use of IMRT declined following the release of the recommendation, but a large share of patients treated in freestanding clinics continue to receive IMRT.
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Affiliation(s)
- Mylin A Torres
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - David H Howard
- Emory University School of Medicine, Atlanta, Georgia.,Department of Health Policy and Management, Emory University, Atlanta, Georgia
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24
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Maliniak ML, Cheriyan AM, Sherman ME, Liu Y, Gogineni K, Liu J, He J, Krishnamurti U, Miller-Kleinhenz J, Ashiqueali R, He J, Yacoub R, McCullough LE. Detection of crown-like structures in breast adipose tissue and clinical outcomes among African-American and White women with breast cancer. Breast Cancer Res 2020; 22:65. [PMID: 32552729 PMCID: PMC7298873 DOI: 10.1186/s13058-020-01308-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 02/17/2020] [Accepted: 06/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background Crown-like structures in breast adipose tissue (CLS-B), composed of necrotic adipocytes encircled by macrophages, are associated with obesity and hypothesized to worsen breast cancer prognosis; however, data are sparse, particularly in multi-racial populations. Methods We assessed specimens for CLS-B from 174 African-American and 168 White women with stage I–III breast cancer treated by mastectomy. Benign breast tissue from an uninvolved quadrant was immunohistochemically stained for CD68 to determine CLS-B presence and density (per cm2 of adipose tissue). Demographic and lifestyle factors, collected via medical record review, were analyzed for associations with CLS-B using logistic regression. Multivariable Cox proportional hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between CLS-B and overall (OS) or progression-free (PFS) survival. Results Detection of any CLS-B was similar between African-American (32%) and White (29%) patients with no evidence of an association between race and CLS-B in multivariable models (OR = 0.82, 95% CI = 0.49–1.36). Detection of CLS-B was associated with obesity (OR = 4.73, 95% CI = 2.48–9.01) and age ≥ 60 years at diagnosis (OR = 1.78, 95% CI = 0.99–3.21). There was some evidence of associations with parity and current smoking status. Detection of CLS-B was not associated with OS (HR = 1.02, 95% CI = 0.55–1.87) or PFS (HR = 0.99, 95% CI = 0.59–1.67). Conclusions Our results show a strong, positive association between BMI and CLS-B in non-tumor tissue similar to previous findings. Detection of CLS-B did not vary by race and was not associated with worse OS or PFS.
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Affiliation(s)
- Maret L Maliniak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aswathy Miriam Cheriyan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark E Sherman
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Keerthi Gogineni
- Winship Cancer Institute of Emory University, Atlanta, GA, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jiaqi Liu
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Jiabei He
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ryan Ashiqueali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jinjing He
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Rami Yacoub
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. .,Winship Cancer Institute of Emory University, Atlanta, GA, USA.
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25
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Mittal K, Toss MS, Wei G, Kaur J, Choi DH, Melton BD, Osan RM, Miligy IM, Green AR, Janssen EAM, Søiland H, Gogineni K, Manne U, Rida P, Rakha EA, Aneja R. A Quantitative Centrosomal Amplification Score Predicts Local Recurrence of Ductal Carcinoma In Situ. Clin Cancer Res 2020; 26:2898-2907. [PMID: 31937618 PMCID: PMC7299818 DOI: 10.1158/1078-0432.ccr-19-1272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/07/2019] [Accepted: 01/09/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study is to predict risk of local recurrence (LR) in ductal carcinoma in situ (DCIS) with a new visualization and quantification approach using centrosome amplification (CA), a cancer cell-specific trait widely associated with aggressiveness. EXPERIMENTAL DESIGN This first-of-its-kind methodology evaluates the severity and frequency of numerical and structural CA present within DCIS and assigns a quantitative centrosomal amplification score (CAS) to each sample. Analyses were performed in a discovery cohort (DC, n = 133) and a validation cohort (VC, n = 119). RESULTS DCIS cases with LR exhibited significantly higher CAS than recurrence-free cases. Higher CAS was associated with a greater risk of developing LR (HR, 6.3 and 4.8 for DC and VC, respectively; P < 0.001). CAS remained an independent predictor of relapse-free survival (HR, 7.4 and 4.5 for DC and VC, respectively; P < 0.001) even after accounting for potentially confounding factors [grade, age, comedo necrosis, and radiotherapy (RT)]. Patient stratification using CAS (P < 0.0001) was superior to that by Van Nuys Prognostic Index (VNPI; HR for CAS = 6.2 vs. HR for VNPI = 1.1). Among patients treated with breast-conserving surgery alone, CAS identified patients likely to benefit from adjuvant RT. CONCLUSIONS CAS predicted 10-year LR risk for patients who underwent surgical management alone and identified patients who may be at low risk of recurrence, and for whom adjuvant RT may not be required. CAS demonstrated the highest concordance among the known prognostic models such as VNPI and clinicopathologic variables such as grade, age, and comedo necrosis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Centrosome
- Combined Modality Therapy
- Female
- Follow-Up Studies
- Gene Amplification
- Humans
- Mastectomy, Segmental/methods
- Middle Aged
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Prognosis
- Radiotherapy, Adjuvant/methods
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Karuna Mittal
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Michael S Toss
- University of Nottingham and Nottingham University Hospitals, Nottingham, United Kingdom
| | - Guanhao Wei
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Jaspreet Kaur
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Da Hoon Choi
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Brian D Melton
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Remus M Osan
- Department of Biology, Georgia State University, Atlanta, Georgia
| | - Islam M Miligy
- University of Nottingham and Nottingham University Hospitals, Nottingham, United Kingdom
| | - Andrew R Green
- University of Nottingham and Nottingham University Hospitals, Nottingham, United Kingdom
| | - Emiel A M Janssen
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Håvard Søiland
- Department of Breast and Endocrine Surgery, Stavanger University Hospital, Stavanger, Norway
| | | | - Upender Manne
- Department of Pathology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, Georgia.
- Novazoi Theranostics, Inc., Rolling Hills Estates, California
| | - Emad A Rakha
- University of Nottingham and Nottingham University Hospitals, Nottingham, United Kingdom.
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, Georgia.
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26
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Cheriyan AM, Sherman ME, Liu Y, Gogineni K, Liu J, He J, Krishnamurti U, Ashiqueali R, He J, Yacoub R, Miller-Kleinhenz J, McCullough LE, Maliniak ML. Abstract C074: Presence of crown-like structures in breast adipose tissue and clinical outcomes among African-American and White breast cancer patients. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-c074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Crown-like structures in breast adipose tissue (CLS-B), indicative of proinflammatory conditions, are most frequently observed among obese (body mass index, BMI ≥30 kg/m2) women and may contribute to poor prognosis in this group. African-American (AA) women have disproportionately higher rates of obesity than White women, and at least one prior study suggests the prevalence of CLS-B may be higher among AA women. However, most previous studies have examined CLS-B within affected tissues, which may reflect inflammation in the tumor microenvironment, and few have examined the association between CLS-B and clinical outcomes by race. Methods: We examined the presence of CLS-B detected by CD68 immunohistochemistry in normal adjacent breast tissue from a quadrant uninvolved by tumor obtained via mastectomy among 174 African-American women and 168 White women with stage I—III breast cancer diagnosed at Emory University Hospitals (2007—2012). We also investigated associations between CLS-B and other demographic and lifestyle factors at diagnosis (e.g., BMI, smoking status, age at menarche, parity, lactation, menopausal status, hormone replacement therapy use, and family history of breast cancer). Patients were followed for an average of seven years after diagnosis for recurrence and survival. Multivariable Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI) for associations between CLS-B presence and progression-free survival (PFS), controlling for BMI and other potential confounders. Results: Median age at diagnosis for both AA and White women was 54 years, with more than 60% postmenopausal among both groups. AA women were more likely than White women to be obese (52% vs. 24%) and have ER- tumors (30% vs. 12%). Presence of any CLS-B was similar between AA (32%) and White (29%) patients. In multivariable models, we did not find any association between CLS-B and race (HR=1.14, 95% CI: 0.72, 1.82) with the only statistically significant factors being BMI (≥30 vs. 18.5-<25 kg/m2: HR=4.36, 95% CI: 2.17, 8.76) and parity (1+ vs. 0 births: HR=0.43, 95% CI: 0.21, 0.91). Over follow-up, 46 breast cancer recurrences and 52 deaths (23 from breast cancer) occurred. Overall, the presence of CLS-B was not associated with PFS (multivariable HR: 0.97, 95% CI: 0.58, 1.62). When examined by race, there was a difference in the direction of the association between CLS-B and PFS among AA women (HR=1.25, 95% CI: 0.64, 2.46) compared to White women (HR=0.75, 95% CI: 0.33, 1.71), although this difference was not statistically significant (P=0.86). Conclusion: Our results show a strong, positive association between BMI and CLS-B in non-tumor tissue and an inverse association with parity. We did not observe a difference in CLS-B presence by race nor did we find CLS-B to be associated with worse progression-free survival, which is in contrast to previous studies that have examined the presence of CLS-B within specimens in close proximity to the tumor.
Citation Format: Aswathy M Cheriyan, Mark E Sherman, Yuan Liu, Keerthi Gogineni, Jiaqi Liu, Jiabei He, Uma Krishnamurti, Ryan Ashiqueali, Jinjing He, Rami Yacoub, Jasmine Miller-Kleinhenz, Lauren E McCullough, Maret L Maliniak. Presence of crown-like structures in breast adipose tissue and clinical outcomes among African-American and White breast cancer patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C074.
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Affiliation(s)
| | | | - Yuan Liu
- 1Emory University, Atlanta, GA, USA,
| | | | - Jiaqi Liu
- 3Winship Cancer Institute, Atlanta, GA, USA
| | - Jiabei He
- 1Emory University, Atlanta, GA, USA,
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Collin LJ, Jiang R, Ward KC, Gogineni K, Subhedar PD, Sherman M, Gaudet MM, Breitkopf CR, D'Angelo O, Gabram-Mendola S, Siegel J, Aneja R, Gaglioti A, McCullough LE. Abstract C053: Identification of factors contributing to breast cancer mortality disparities in the metropolitan Atlanta area. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp18-c053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Racial disparities in breast cancer outcomes persist in the US, in which black women are more likely to die from breast cancer than white women. Despite levels of mammographic screening comparable to the US, Atlanta has a disproportionate burden of late-stage breast tumors and higher mortality rates, especially among black women. To better understand this disparity, we sought to identify tumor, treatment, and patient characteristics that may contribute to the observed differences in breast cancer mortality between black and white women in the metropolitan Atlanta area.
Methods: In this study, patients were identified from the Georgia Cancer Registry. We included 4943 non-Hispanic white and 3580 non-Hispanic black women with an initial diagnosis of stage I-IV primary breast cancer between January 2010 and December 2014 in Atlanta. Cox proportional hazard regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) to compare black vs. white breast cancer mortality by tumor (stage, grade, ER status, and molecular subtype), treatment (surgery type, receipt of chemotherapy, radiation, hormone therapy, and trastuzumab), and patient (insurance, marital status, SES, and location of service) characteristics. We performed a mediation analysis to evaluate the contribution of subtype, stage, and socioeconomic status (SES) as mediators on the path between race and breast cancer mortality.
Results: Compared with white breast cancer patients, black women were younger with tumors that were higher stage, higher grade, and more likely to be larger, node positive and triple negative. In fully adjusted models, black women diagnosed with Luminal A subtype were 58% more likely to die of breast cancer compared to their white counterparts (HR=1.58, 95%CI 1.31-2.00). Similarly, black women with private insurance were 60% more likely to die of breast cancer (HR=1.61, 95%CI 1.25-1.98), and black women in the highest SES group were more than twice as likely to die from breast cancer (HR=2.26, 95%CI 1.26-4.06) than white women with comparable SES. The smallest disparities in breast cancer mortality by race were observed among women without insurance, in the lowest SES index, or those diagnosed with triple-negative breast cancer. The mediation analysis showed 84.8% of the effect between race and breast cancer mortality was through stage, subtype, and SES.
Conclusion: Our results indicate variation in racial disparities in breast cancer mortality by tumor and patient characteristics. Consistent with previous reports, our mediation results suggest that later stage and triple-negative subtype among black women are major contributors of the observed disparity. However, our results also shed new light on the disparity, suggesting that the largest disparities are observed among women with ER+ tumors amenable to adjuvant therapies and are most pronounced among women of high SES. More research is needed to understand the drivers of disparities in these treatable tumors.
Citation Format: Lindsay J. Collin, Renjian Jiang, Kevin C. Ward, Keerthi Gogineni, Preeti D. Subhedar, Mark Sherman, Mia M. Gaudet, Carmen Radecki Breitkopf, Olivia D'Angelo, Sheryl Gabram-Mendola, Jolie Siegel, Rana Aneja, Anne Gaglioti, Lauren E. McCullough. Identification of factors contributing to breast cancer mortality disparities in the metropolitan Atlanta area [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C053.
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Mittal K, Li H, Wylie D, Kaur J, Kolachina R, Sahoo B, Wei G, Toss MS, Green AR, Arasappan D, Yang J, Yankeelov T, Bhattarai S, Rakha EA, Gogineni K, Kong J, Kowalski J, Aneja R. Molecular profiling and quantitative image analysis reveal spatial intratumor heterogeneity in TNBC. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12536] [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
e12536 Background: Triple negative breast cancer (TNBC) is a molecularly complex and heterogeneous subtype with distinct biological features and clinical behavior. Extensive intra-tumor heterogeneity is suspected to be a major cause of therapeutic failure. Spatially-distinct parts of the tumor harbor diverse and divergent clonal populations of cancer cells. Thus it is likely increasing the likelihood that some of those clones resist treatment, expand in numbers and eventually, repopulate the tumor leading to recurrence and spread. Therefore, a deeper understanding of this complexity is fundamental to gaining insights into this clinically important issue. In this study, we used RNA sequencing and machine learning approaches to examine the molecular and phenotypic/cellular profiles of various tumor samples from the same patient tumor to reveal spatial intra-tumor heterogeneity in TNBCs. Methods: We used 34 samples (2-4 samples from each patient tumor) from a total of 11 unique TNBC patients. RNA-sequencing was performed to quantify differential gene expression and machine learning (ML) approaches (deep learning regression modeling) were used to quantify the percentage of tumor and tumor-infiltrating lymphocytes (TILs) in the H&E stained tissue sections. The extent of concordance/discordance between the multiple tumor samples that originated from the same patient was analyzed by analyzing the intra- and inter-patient variance of normalized tumor cell, TIL % and gene expression. We also performed pathway analysis to identify signaling pathways dysregulated within (intra-tumoral heterogeneity) and between tumors (inter-tumoral heterogeneity) and performed molecular subtype analysis. Results: We observed that gene expression variance as higher within-patient (intra-tumor) compared to between-patient (inter-tumor). Tumor samples from 70% of patients showed different molecular subtypes representing extensive intra-tumor heterogeneity. Our ML-based image analysis showed that intra-patient tumor cell and TILs density/percentage variance was greater than inter-patient variance. In addition, patients with high within-patient gene expression variability had a high tumor and TIL variance. Among the within-patient expression variability, the genes associated with the PLK1 and Notch signaling were enriched. Conclusions: Our results suggest that TNBCs exhibit higher intra-tumor gene expression and cellular variance compared to inter-tumor gene expression and cellular variance suggesting higher intra-tumor heterogeneity in TNBCs.
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Affiliation(s)
| | | | - Dennis Wylie
- Center for Biomedical Support University of Texas at Austin, Austin, TX
| | | | | | | | | | - Michael S Toss
- University of Nottingham and Nottingham University Hospitals, Nottingham, United Kingdom
| | | | - Dhivya Arasappan
- Center for Biomedical Research Support, University of Texas at Austin, Austin, TX
| | | | | | - Shristi Bhattarai
- Georgia State University, Atlanta, United States Minor Outlying Islands
| | - Emad A. Rakha
- University of Nottingham, Nottingham, United Kingdom
| | | | - Jun Kong
- Georgia State University, Atlanta, GA
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Abolghasemi D, Ho T, Short J, Subhedar P, Okoli J, Gogineni K, Lin JY, Yu DS, Carter T, Yang S, Gabram SGA. Improving provider practice patterns in ordering FDG PET/CT for breast cancer patients at a safety-net hospital. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e14027] [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
e14027 Background: Accurate staging is critical in determining treatment strategies in the management of breast cancer (BC) patients. FDG PET/CT is used to identify the presence of metastatic disease. The criteria for FDG PET/CT utilization is variable, including in any patient with nodal positivity, any patients with systemic symptoms, to those with Stage III disease or higher.. This practice variation has results in different patterns of ordering FDG PET/CT. The preliminary results of a Quality Oncology Practice Initiative (QOPI) audit performed in our Cancer Center in 2017 prompted concern for the over utilization of FDG PET/CT in our BC patients. We performed an initial audit of these practices in 2017 and confirmed these findings. The goal of this study was to re-measure our adherence to NCCN guidelines in 2019 after an educational session complimented by use of a checklist. Methods: A retrospective review was conducted for all BC patients who had FDG PET/CT ordered as initial treatment planning from 1/2017-12/2017. This revealed a 33% rate of failure to meet NCCN guidelines. We then educated our team about the NCCN guidelines for initial PET/CT ordering during our weekly multi-disciplinary conferences, created a test ordering checklist and compared the effect of this education on the use of PET/CT in patients treated at our institution from 1/2019-12/2019. Results: 65 female BC patients had an FDG PET/CT ordered to assist in initial treatment recommendation in 2017. Overall, 66.2% (n = 43) of patients met NCCN indications while 33.8% (n = 22) did not. In comparison to 2017 data, 71 female breast cancer patients had an FDG PET/CT ordered in 2019. Overall, 67 patients (94.4%) met NCCN criteria indications for undergoing FDG PET/CT while only 5 patients (5.6%) did not. Conclusions: Review of FDG PET/CT scans ordered for initial treatment in 2017 revealed that about one third of scans were ordered outside of NCCN guideline recommendations. After an educational session and implementation of a test ordering checklist, we found a marked reduction in the use of FDG PET/CT outside of NCCN guideline recommendations. Although our study is limited by small sample sizes, we identified a practice area that deviated from national recommendations and were able to improve our internal compliance in national guidelines through education and system modification.
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Affiliation(s)
| | - Tran Ho
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Jennifer Short
- Winship Cancer Institute of Emory University, Atlanta, GA
| | | | - Joel Okoli
- Morehouse School of Medicine, Atlanta, GA
| | | | - Jolinta Y Lin
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - David S. Yu
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Teralyn Carter
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Steven Yang
- Winship Cancer Institute of Emory University, Atlanta, GA
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Ekpo P, Torres MA, Rupji M, Switchenko JM, Subhedar P, Gogineni K, Bhave MA. Outcomes for black versus white women with stage IV breast cancer enrolled on investigator-initiated clinical trials at Emory. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1086] [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
1086 Background: Black women are 40% more likely to die from their breast cancer compared to White women. Inadequate representation of Blacks in clinical trials may contribute to health care inequity. Emory’s Winship Cancer Institute (WCI) in Atlanta serves a significant Black population and has a unique opportunity to engage these underrepresented patients in clinical trials. We aimed to assess clinical outcomes in Black versus White women with metastatic breast cancer (MBC) enrolled on investigator-initiated clinical trials (IITs) at Emory. Methods: Black and White women with MBC enrolled on IITs conducted at WCI between 1/2009 and 1/2019 were retrospectively evaluated. Descriptive statistics were generated for all patient characteristics. Univariate analyses and a multiple logistic regression model were used to assess the effect of age and race on clinical response, length of time on trial, number of therapy lines prior to trial enrollment, and toxicity on trial. Overall survival was assessed using Kaplan Meier analysis. Results: Sixty-two women with MBC were included [White, n = 41 (66%), and Black, n = 21 (34%), p = 0.55]. Over 90% of women were enrolled on phase II clinical trials and received targeted therapy. Mean age at clinical trial consent was 53.2 and 55.9 years in Black and White women, respectively (p = 0.36). While the majority of women had hormone-receptor positive disease, a higher percentage of Blacks had triple negative breast cancer (29% vs. 17% in Whites, p = 0.39). Black women had fewer lines of systemic therapy prior to trial enrollment (2.86 vs. 4.3, respectively, p = 0.017) and were enrolled on trial for less time than White women (5.67 mo vs. 7.83 mo, respectively, p = 0.22). There were no differences in toxicity rates among patients enrolled on IITs based on race. Black women were more likely to have progressive disease (PD) on trial (45% in Blacks vs. 20% in Whites, p = 0.05). While there was no significant difference in overall survival (p = 0.482), there was a trend towards shorter survival in Black women (51.3 mos vs. 64 mos, respectively). Conclusions: Black women with MBC who enrolled on IIT trials at Emory had worse treatment response and a trend towards poorer survival compared to White women. More research is needed to determine whether this is due to adverse biology. These results reinforce the need for exploration of biomarkers of response by race and ethnicity and improved representation of Blacks in clinical trials to inform real world efficacy.
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Affiliation(s)
| | - Mylin Ann Torres
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Manali Rupji
- Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | | | - Manali A. Bhave
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
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Do WL, Conneely K, Gabram-Mendola S, Krishnamurti U, D'Angelo O, Miller-Kleinhenz J, Gogineni K, Torres M, McCullough LE. Obesity-associated methylation in breast tumors: a possible link to disparate outcomes? Breast Cancer Res Treat 2020; 181:135-144. [PMID: 32236829 DOI: 10.1007/s10549-020-05605-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/18/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE As a primary risk factor and modifier of breast cancer incidence and prognosis, obesity may contribute to race disparities in breast cancer outcomes. This study examined association between obesity and DNA methylation in non-Hispanic Black and White women diagnosed with breast cancer. METHODS Genome-wide DNA methylation was measured in the breast cancer tumor tissue of 96 women using the EPIC array. To examine the association between obesity and tumor methylation, linear regression models were used-regressing methylation β value for each cytosine and guanine (CpG) site on body mass index adjusting for covariates. Significance was set at false discovery rate (FDR) < 0.05. In the top 20 CpG sites, we explored the interactions with race and estrogen receptor (ER) status. We used multivariable Cox-proportional hazard models to examine whether methylation in the top 20 sites was associated with all-cause mortality. RESULTS While none of the CpG sites passed the FDR threshold for significance, among the top 20 CpG sites, we observed interactions with race (TOMM20) and ER status (PSMB1, QSOX1 and PHF1). The same CpG sites in TOMM20, PSMB1, and QSOX1 were associated with all-cause mortality. CONCLUSIONS We identified novel interactions between obesity-associated methylation and both race and ER status in genes that have been associated with tumor regulation. Our data suggest that dysregulation in two sites may associate with all-cause mortality.
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Affiliation(s)
- Whitney L Do
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA.
| | - Karen Conneely
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | | | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Olivia D'Angelo
- Department of Surgery, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Jasmine Miller-Kleinhenz
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, 30322, USA
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Collin LJ, Troeschel AN, Liu Y, Gogineni K, Borger K, Ward KC, McCullough LE. A balancing act: racial disparities in cardiovascular disease mortality among women diagnosed with breast cancer. ACTA ACUST UNITED AC 2020; 4. [PMID: 32954254 DOI: 10.21037/ace.2020.01.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The cardiotoxic effects of breast cancer therapies are well documented in clinical trials. However, clinical trials often underrepresent those at highest risk for cardiovascular disease (CVD)related outcomes and have limited generalizability to the larger breast cancer population. In addition, racial differences in treatment-associated CVD mortality have yet to be explored. In this study, we sought to quantify the relationship between breast cancer therapies and CVD mortality, and explore whether this effect differed between non-Hispanic black (NHB) and white (NHW) women. Methods Using data from the Georgia Cancer Registry, we identified women diagnosed with a first primary invasive breast cancer [2010-2014], residing in the metropolitan Atlanta area (n=3,580 NHB; n=4,923 NHW), and followed them for mortality through December 31, 2018. Exposures of interest included therapies with potential cardiotoxic effects including chemotherapy and hormone therapy, which are routinely collected by the GCR. Individual agents are not captured within the GCR, therefore trastuzumab was identified using natural language processing of textual descriptions. We used propensity score weighted Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between each treatment modality and CVD mortality among the overall cohort and by race. Results In the overall cohort, similar hazards of CVD mortality were found among women treated with chemotherapy (HR =1.10, 95% CI: 0.62, 1.96) and hormone therapy (HR =0.94, 95% CI: 0.59, 1.50), compared to women who did not receive the respective treatments. In contrast, women treated with trastuzumab had a higher hazard of CVD mortality compared to women not treated with trastuzumab (HR =2.05, 95% CI: 0.76, 5.52). In race-specific models, hormone therapy was associated with a higher hazard of CVD mortality among NHB women (HR =2.18, 95% CI: 0.78, 6.12), but not NHW women (HR =0.66, 95% CI: 0.39, 1.13). Similar, albeit attenuated, associations were found for chemotherapy. We were unable to investigate race-specific effects of trastuzumab due to low prevalence and insufficient number of events. Conclusions In our study, we observed more pronounced associations of chemotherapy and hormone therapy with CVD mortality among NHB women, for whom we know have greater CVD-related comorbidities at breast cancer diagnosis. Patients may benefit from treatment plans that find a balance between curative breast cancer treatment and prevention of CVD-related events and mortality. CVD-related outcomes may be most relevant for women with hormone receptor positive disease due to shared risk factors (e.g., obesity, tobacco use, physical activity) and longer survival.
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Affiliation(s)
- Lindsay J Collin
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Alyssa N Troeschel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yuan Liu
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Keerthi Gogineni
- Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.,Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kylee Borger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Collin LJ, Yan M, Jiang R, Ward KC, Crawford B, Torres MA, Gogineni K, Subhedar PD, Puvanesarajah S, Gaudet MM, McCullough LE. Oncotype DX recurrence score implications for disparities in chemotherapy and breast cancer mortality in Georgia. NPJ Breast Cancer 2019; 5:32. [PMID: 31583272 PMCID: PMC6763428 DOI: 10.1038/s41523-019-0129-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/21/2019] [Indexed: 12/29/2022] Open
Abstract
Among women diagnosed with stage I-IIIa, node-negative, hormone receptor (HR)-positive breast cancer (BC), Oncotype DX recurrence scores (ODX RS) inform chemotherapy treatment decisions. Differences in recurrence scores or testing may contribute to racial disparities in BC mortality among women with HR+ tumors. We identified 12,081 non-Hispanic White (NHW) and non-Hispanic Black (NHB) BC patients in Georgia (2010-2014), eligible to receive an ODX RS. Logistic regression was used to estimate the odds of chemotherapy receipt by race and ODX RS. Cox proportional hazard regression was used to calculate the hazard ratios (HRs) comparing BC mortality rates by race and recurrence score. Receipt of Oncotype testing was consistent between NHB and NHW women. Receipt of chemotherapy was generally comparable within strata of ODX RS-although NHB women with low scores were slightly more likely to receive chemotherapy (OR = 1.16, 95% CI 0.77, 1.75), and NHB women with high scores less likely to receive chemotherapy (OR = 0.77, 95% CI 0.48, 1.24), than NHW counterparts. NHB women with a low recurrence score had the largest hazard of BC mortality (HR = 2.47 95% CI 1.22, 4.99) compared to NHW women. Our data suggest that additional tumor heterogeneity, or other downstream treatment factors, not captured by ODX, may be drivers of racial disparities in HR+ BC.
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Affiliation(s)
- Lindsay J. Collin
- Department of Epidemiology, Emory University Atlanta, Atlanta, GA 30322 USA
| | - Ming Yan
- Department of Epidemiology, Emory University Atlanta, Atlanta, GA 30322 USA
| | - Renjian Jiang
- Department of Epidemiology, Emory University Atlanta, Atlanta, GA 30322 USA
| | - Kevin C. Ward
- Department of Epidemiology, Emory University Atlanta, Atlanta, GA 30322 USA
- Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA 30322 USA
| | - Brittany Crawford
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208 USA
| | - Mylin A. Torres
- Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA 30322 USA
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Keerthi Gogineni
- Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA 30322 USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Preeti D. Subhedar
- Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA 30322 USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | | | | | - Lauren E. McCullough
- Department of Epidemiology, Emory University Atlanta, Atlanta, GA 30322 USA
- Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA 30322 USA
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Collin LJ, Jiang R, Ward KC, Gogineni K, Subhedar PD, Sherman ME, Gaudet MM, Breitkopf CR, D’Angelo O, Gabram-Mendola S, Aneja R, Gaglioti AH, McCullough LE. Racial Disparities in Breast Cancer Outcomes in the Metropolitan Atlanta Area: New Insights and Approaches for Health Equity. JNCI Cancer Spectr 2019; 3:pkz053. [PMID: 32328557 PMCID: PMC7049995 DOI: 10.1093/jncics/pkz053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/01/2019] [Accepted: 07/22/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Racial disparities in breast cancer (BC) outcomes persist where non-Hispanic black (NHB) women are more likely to die from BC than non-Hispanic white (NHW) women, and the extent of this disparity varies geographically. We evaluated tumor, treatment, and patient characteristics that contribute to racial differences in BC mortality in Atlanta, Georgia, where the disparity was previously characterized as especially large. METHODS We identified 4943 NHW and 3580 NHB women in the Georgia Cancer Registry with stage I-IV BC diagnoses in Atlanta (2010-2014). We used Cox proportional hazard regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) comparing NHB vs NHW BC mortality by tumor, treatment, and patient characteristics on the additive and multiplicative scales. We additionally estimated the mediating effects of these characteristics on the association between race and BC mortality. RESULTS At diagnosis, NHB women were younger-with higher stage, node-positive, and triple-negative tumors relative to NHW women. In age-adjusted models, NHB women with luminal A disease had a 2.43 times higher rate of BC mortality compared to their NHW counterparts (95% CI = 1.99 to 2.97). High socioeconomic status (SES) NHB women had more than twice the mortality rates than their white counterparts (HR = 2.67, 95% CI = 1.65 to 4.33). Racial disparities among women without insurance, in the lowest SES index, or diagnosed with triple-negative BC were less pronounced. CONCLUSIONS In Atlanta, the largest racial disparities are observed in luminal tumors and most pronounced among women of high SES. More research is needed to understand drivers of disparities within these treatable features.
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Affiliation(s)
| | - Renjian Jiang
- Department of Epidemiology, Emory University, Atlanta, GA
| | - Kevin C Ward
- Department of Epidemiology, Emory University, Atlanta, GA
| | | | | | - Mark E Sherman
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA
| | - Anne H Gaglioti
- National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
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Collin LJ, Crawford B, Yan M, Jiang R, Ward K, Torres M, Gogineni K, Subhedar P, McCullough LE. Abstract 3298: Oncotype DX recurrence score: Implications for disparities in receipt of chemotherapy and breast cancer-specific mortality in Georgia. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-3298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Among women diagnosed with stage I-IIIa, node negative or positive (1-3), hormone receptor positive (HR+) and HER2 negative breast cancer (BC), the Oncotype DX recurrence score is used to guide chemotherapy treatment decisions. There is limited evidence on differences in the distribution of recurrence scores among non-Hispanic Black women (NHB), and whether this could contribute to the well-documented racial disparities in BC-specific mortality. The objective of this study was to evaluate the role of Oncotype DX recurrence score on racial disparities in BC-specific mortality between black and white women in Georgia.
Methods: In this study, patients were identified from the Georgia Cancer Registry. We included 4562 non-Hispanic White (NHW) and 1353 NHB women with an initial diagnosis of stage I-III HR+ breast cancer in Georgia (2010-2014), with a corresponding Oncotype DX recurrence score from Genomic Health, Inc. Logistic regression was used to estimate the odds of chemotherapy receipt between NHB and NHW women by Oncotype DX recurrence score (low [<18], medium [18-30], and high [≥31]). Cox proportional hazard regression was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) comparing BC-specific mortality rates by both race and recurrence score.
Results: Compared with NHW breast cancer patients, NHB women were more likely to be classified with a high recurrence score (11% vs. 7%), and less likely to be classified with a low risk of recurrence (53% vs. 59%). In the age-adjusted models, NHB women with a high recurrence score were less likely to receive chemotherapy (OR=0.60, 95%CI 0.35, 1.04), however there was no difference in receipt of chemotherapy between NHB and NHW women with low or medium recurrence risk scores. After adjusting for age, we observed that NHB women with a low recurrence score had 3.05 times the hazard of BC-specifc mortality (95%CI 1.29, 7.04) compared to NHW women. Among women with a medium or high recurrence score we did not observe a racial disparity in BC mortality (HRhigh vs. low=1.49, 95%CI 0.51, 4.37).
Conclusion: Our results indicate variation in receipt of chemotherapy by race, particularly among NHB women with a high Oncotype DX score. However, we observed the most pronounced racial disparity in BC-specific mortality among women with low Oncotype Dx recurrence scores. These findings should be replicated in larger studies with robust numbers of NHB women. Additional research is needed to understand differences in chemotherapy treatment decisions and validation of the Oncotype DX recurrence score cut points in diverse populations.
Citation Format: Lindsay J. Collin, Brittany Crawford, Ming Yan, Renjian Jiang, Kevin Ward, Mylin Torres, Keerthi Gogineni, Preeti Subhedar, Lauren E. McCullough. Oncotype DX recurrence score: Implications for disparities in receipt of chemotherapy and breast cancer-specific mortality in Georgia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3298.
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Affiliation(s)
| | | | | | | | | | - Mylin Torres
- 3Emory University School of Medicine, Atlanta, GA
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Troeschel AN, Liu Y, Collin LJ, Bradshaw PT, Ward KC, Gogineni K, McCullough LE. Race differences in cardiovascular disease and breast cancer mortality among US women diagnosed with invasive breast cancer. Int J Epidemiol 2019; 48:1897-1905. [DOI: 10.1093/ije/dyz108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Breast cancer (BC) survivors are at increased risk of cardiovascular disease (CVD) due to shared risk factors with BC and cardiotoxic treatment effects. We aim to investigate racial differences in mortality due to CVD and BC among women diagnosed with invasive BC.
Methods
Data from 407 587 non-Hispanic Black (NHB) and White (NHW) women diagnosed with malignant BC (1990–2014) were obtained from the Surveillance, Epidemiology, and End Results database. Cumulative incidence of mortality due to CVD and BC was calculated by race and age (years). Cox models were used to obtain hazard ratios (HR) and 95% confidence intervals (95%CI) for the association of race/ethnicity with cause-specific mortality.
Results
The 20-year cumulative incidence of CVD-related mortality was higher among younger NHBs than NHWs (e.g. age 55–69: 13.3% vs 8.9%, respectively). NHBs had higher incidence of BC-specific mortality than NHWs, regardless of age. There was a monotonic reduction in CVD-related mortality disparities with increasing age (age <55: HR = 3.71, 95%CI: 3.29, 4.19; age 55–68: HR = 2.31, 95%CI: 2.15, 2.49; age 69+: HR = 1.24, 95%CI: 1.19, 1.30). The hazard of BC-specific mortality among NHBs was approximately twice that of NHWs (e.g. age <55: HR = 1.98, 95%CI: 1.92, 2.04).
Conclusions
There are substantial differences in mortality due to CVD and BC between NHB and NHW women diagnosed with invasive BC. Racial differences were greatest among younger women for CVD-related mortality and similar across age groups for BC-specific mortality. Future studies should identify pathways through which race/ethnicity affects cause-specific mortality, to inform efforts towards reducing disparities.
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Affiliation(s)
- Alyssa N Troeschel
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yuan Liu
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay J Collin
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Patrick T Bradshaw
- Berkeley School of Public Health, University of California, Berkeley, California, USA
| | - Kevin C Ward
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Keerthi Gogineni
- Winship Cancer Institute, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
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Paplomata E, Zelnak A, Santa-Maria CA, Liu Y, Gogineni K, Li X, Moreno CS, Chen Z, Kaklamani V, O’Regan RM. Use of Everolimus and Trastuzumab in Addition to Endocrine Therapy in Hormone-Refractory Metastatic Breast Cancer. Clin Breast Cancer 2019; 19:188-196. [DOI: 10.1016/j.clbc.2018.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/17/2018] [Accepted: 12/26/2018] [Indexed: 12/25/2022]
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Regnante JM, Richie NA, Fashoyin-Aje L, Vichnin M, Ford M, Roy UB, Turner K, Hall LL, Gonzalez E, Esnaola N, Clark LT, Adams HC, Alese OB, Gogineni K, McNeill L, Petereit D, Sargeant I, Dang J, Obasaju C, Highsmith Q, Lee SC, Hoover SC, Williams EL, Chen MS. US Cancer Centers of Excellence Strategies for Increased Inclusion of Racial and Ethnic Minorities in Clinical Trials. J Oncol Pract 2019; 15:e289-e299. [DOI: 10.1200/jop.18.00638] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE: Participation of racial and ethnic minority groups (REMGs) in cancer trials is disproportionately low despite a high prevalence of certain cancers in REMG populations. We aimed to identify notable practices used by leading US cancer centers that facilitate REMG participation in cancer trials. METHODS: The National Minority Quality Forum and Sustainable Healthy Communities Diverse Cancer Communities Working Group developed criteria by which to identify eligible US cancer centers—REMGs comprise 10% or more of the catchment area; a 10% to 50% yearly accrual rate of REMGs in cancer trials; and the presence of formal community outreach and diversity enrollment programs. Cancer center leaders were interviewed to ascertain notable practices that facilitate REMG accrual in clinical trials. RESULTS: Eight cancer centers that met the Communities Working Group criteria were invited to participate in in-depth interviews. Notable strategies for increased REMG accrual to cancer trials were reported across five broad themes: commitment and center leadership, investigator training and mentoring, community engagement, patient engagement, and operational practices. Specific notable practices included increased engagement of health care professionals, the presence of formal processes for obtaining REMG patient/caregiver input on research projects, and engagement of community groups to drive REMG participation. Centers also reported an increase in the allocation of resources to improving health disparities and increased dedication of research staff to REMG engagement. CONCLUSION: We have identified notable practices that facilitate increased participation of REMGs in cancer trials. Wide implementation of such strategies across cancer centers is essential to ensure that all populations benefit from advances in an era of increasingly personalized treatment of cancer.
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Affiliation(s)
| | | | | | | | - Marvella Ford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | | | | | | | | | | | | | | | | | - Lorna McNeill
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Julie Dang
- University of California, Davis Comprehensive Cancer Center, Davis, CA
| | | | | | | | | | | | - Moon S. Chen
- University of California, Davis Comprehensive Cancer Center, Davis, CA
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Litton J, Symmans F, Gogineni K, Saltzman M, Telli M, Usha L, Chakrabarti J, Tudor I, Quek R, Czibere A. NEOTALA: an open-label, single-arm, multi-center, phase 2 study of talazoparib for neoadjuvant treatment of germline BRCA1/2 mutation patients with early-stage triple negative breast cancer (TNBC). Breast 2019. [DOI: 10.1016/s0960-9776(19)30271-1] [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: 11/28/2022] Open
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Litton J, Symmans F, Gogineni K, Saltzman M, Telli ML, Usha L, Chakrabarti J, Tudor IC, Quek RG, Czibere A. Abstract OT3-03-02: A phase 2, open-label, single-arm, multi-center study of talazoparib for neoadjuvant treatment of germline BRCA1/2 mutation patients with early-stage triple-negative breast cancer (TNBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-03-02] [Citation(s) in RCA: 1] [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: 11/16/2022]
Abstract
Abstract
Background: Approximately 15% of all breast cancers are triple negative and deleterious BRCA1/2 mutations are found in ˜11% of unselected TNBC. In the phase 3 EMBRACA trial (NCT01945775), the poly (ADP-ribose) polymerase (PARP) inhibitor talazoparib was superior to chemotherapy in prolonging progression-free survival in BRCA1/2 mutation patients with advanced breast cancer. A recent pilot study (NCT02282345) of 20 patients, explored the feasibility of neoadjuvant talazoparib in BRCA1/2 mutation patients; pathologic complete response (pCR) was reported at 53% with 6 months of single agent talazoparib.
Trial Design: This phase 2, single-arm, open-label, multi-center study has a Simon 2-stage design. Eligible pts have stage I-III invasive TNBC (ER and PR <10%), with germline BRCA1/2 mutations who are suitable for neoadjuvant therapy. Pts will receive talazoparib 1 mg daily for 24 weeks, followed by breast surgery, which should occur within 4 to 6 weeks of the last dose. Ultrasound will be performed serially to assess tumor response. The primary objective is to evaluate pCR after 24 weeks of neoadjuvant talazoparib. pCR (ypT0/is ypN0) will be assessed by independent central review. Safety will also be assessed. Pts will be followed for at least 5 years to assess long term outcomes (event-free and overall survival). After surgery, any further adjuvant therapy will be given at the discretion of the treating physician. Pt reported outcomes will be assessed electronically including the global health status/quality of life, functions, and symptoms using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23. Plasma pharmacokinetic (PK) samples for determination of talazoparib concentrations will be collected at defined timepoints to describe the steady-state PK of talazoparib. Exploratory biomarker research will also take place. Approximately 122 men and women will be enrolled in the study, of which 112 evaluable pts are planned. With 112 evaluable pts and one interim futility look, the null hypothesis that the true pCR rate is 35% will be tested against a 1-sided alternative. This design yields a 1-sided type 1 error rate of 2.5% and power of 90% when the true pCR rate is 50%. An interim analysis will be performed to evaluate the efficacy of talazoparib after 28 evaluable pts undergo talazoparib treatment for 24 weeks, followed by surgery, and are assessed for pCR by central review. This trial is currently recruiting and is registered at clinicaltrials.gov (NCT03499353).
Funding: This study is sponsored by Pfizer, Inc.
Citation Format: Litton J, Symmans F, Gogineni K, Saltzman M, Telli ML, Usha L, Chakrabarti J, Tudor IC, Quek RG, Czibere A. A phase 2, open-label, single-arm, multi-center study of talazoparib for neoadjuvant treatment of germline BRCA1/2 mutation patients with early-stage triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-03-02.
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Affiliation(s)
- J Litton
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - F Symmans
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - K Gogineni
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - M Saltzman
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - ML Telli
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - L Usha
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - J Chakrabarti
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - IC Tudor
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - RG Quek
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
| | - A Czibere
- MD Anderson Cancer Center, Houston, TX; Emory University – Winship Cancer Institute (WCI), Atlanta, GA; Innovative Medical Research of South Florida, Aventura, FL; Stanford University School of Medicine, Stanford, CA; Rush University Medical Center, Chicago, IL; Pfizer Ltd, Surrey, United Kingdom; Pfizer, Inc., San Francisco, CA; Pfizer, Inc., Cambridge, MA
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Ross KH, Gogineni K, Subhedar PD, Lin JY, McCullough LE. Obesity and cancer treatment efficacy: Existing challenges and opportunities. Cancer 2019; 125:1588-1592. [PMID: 30633328 DOI: 10.1002/cncr.31976] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Katherine H Ross
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Keerthi Gogineni
- Department of Medical Oncology, School of Medicine, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Preeti D Subhedar
- Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Surgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Jolinta Y Lin
- Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Radiation Oncology, School of Medicine, Emory University, Atlanta, Georgia
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Troeschel AN, Liu Y, Collin L, Ward K, Gogineni K, McCullough L. Abstract 4247: Racial/ethnic differences in all-cause and cause-specific mortality patterns among a cohort of invasive U.S. breast cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
It is important to explore racial differences in mortality patterns due to breast cancer (BC), cardiovascular disease (CVD) and all-causes (AC) among women diagnosed with breast cancer in the U.S. Data from 891,635 non-Hispanic black (NHB) and white (NHW) women diagnosed with malignant breast cancer from 1990-2014 were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database. Cumulative incidences for mortality due to BC and CVD were calculated at 2, 5, 10 and 20 years post-diagnosis by race and age (dichotomized at the study mean, 62.5 years). A Cox hazard model was used to obtain hazard ratios (HR) for all-cause mortality and the subdistribution hazards model was used for mortality due to BC and CVD, accounting for the presence of competing risks, along with their corresponding 95% confidence intervals (CI). A total of 300,445 deaths occurred over 6,319,054 person-years. Among women aged <62.5 years at diagnosis, the cumulative incidence of BC death and CVD death at 2, 5, 10, and 20 years was 5.2%, 10.6%, 15.3%, 19.5% and 0.2%, 0.6% 1.2%, 2.5%, respectively, for NHWs and 10.0%, 19.9%, 27.9%, 34.8% and 0.5%, 1.3%, 2.7%, 5.3% for NHBs. Results for BC were similar among women diagnosed >62.5 years, while there appeared to be no racial differences in CVD-death. Among women diagnosed at age <62.5 years, NHBs had an increased hazard of mortality due to BC (HR=2.03, 95% CI: 1.97, 2.08), CVD (HR=2.64, 95% CI: 2.38, 2.94), and AC (HR=2.84, 95% CI: 2.77, 2.91) during the first 2 years post-diagnosis. This association decreased over time for mortality due to BC (5-10 years: HR=1.76; 10-15 years: HR=1.58) and AC (5-10 years: HR=1.54; 10-15 years: HR=1.07, 15+ years: HR=0.93) but remained relatively stable for CVD (15+ years: HR=2.47). Among women diagnosed at age >62.5 years, NHBs had an increased hazard of mortality due to BC (HR=2.13, 95% CI: 2.06, 2.19), CVD (HR=1.33, 95% CI: 1.25, 1.40) and AC (HR=1.51, 1.48, 1.55) during the first 2 years post-diagnosis. The association decreased for BC (2-5 years: HR=1.55; 5-10 years: HR=1.15; 10-15 years: HR=0.88; 15+ years: HR=0.64) and CVD (2-5 years: HR=1.1.06; 5-10 years: HR=1.00; 10-15 years: HR=0.85; 15+ years: HR=0.65) while the association with AC mortality initially decreased, then remained relatively stable (5-10 years: HR=1.20). Results suggest NHB women diagnosed at younger ages have the highest cumulative incidence of mortality due to BC, CVD and AC over the 25-year follow-up period. In addition, among women diagnosed at younger ages, NHBs appeared to have a two-fold increase in hazards of AC, BC and CVD mortality during the years immediately following BC diagnosis compared to NHWs. The increased hazard for CVD mortality among younger NHBs remained relatively stable over time, whereas the hazards for AC and BC mortality attenuated over time. Results were less pronounced among women diagnosed at older ages.
Citation Format: Alyssa N. Troeschel, Yuan Liu, Lindsay Collin, Kevin Ward, Keerthi Gogineni, Lauren McCullough. Racial/ethnic differences in all-cause and cause-specific mortality patterns among a cohort of invasive U.S. breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4247.
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Smith DJ, Sauter C, Zhang C, Chen Z, Gogineni K. Abstract B34: Patterns of BRCA testing at a safety net compared to a university hospital. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1538-7755.disp17-b34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction: The criteria for coverage of BRCA testing vary by insurance company, and out-of-pocket costs can be prohibitive for many. Previous studies investigating rates of BRCA testing analyzed patient populations consisting of predominantly white women and women with private insurance. This study compares the differences in rates of BRCA testing among women diagnosed with breast cancer at a safety net hospital affiliated with an academic medical center and a tertiary-care university hospital in order to determine any factors associated with or predictive of testing differences.
Methods: Retrospective chart review was performed using a dataset obtained from the Georgia Tumor Registry of women seen at Grady Memorial Hospital (GMH) and Emory University Hospital (EUH) between 2010 and 2014 who were diagnosed with breast cancer between the ages of 20-70. Of the 1,142 EUH cases, 652 charts were randomly selected and all 532 GMH cases have been reviewed to date. Demographic information collected included age, race, insurance status, type of insurance, and mean and median household income based on zip code of residence. Records were reviewed for documentation of referral to genetic counseling, if testing was performed, and testing results. National Comprehensive Cancer Network (NCCN) guidelines for BRCA testing were used in the study to identify high-risk patients. Data analysis was performed using univariate analysis and multivariable logistic regression.
Results: Data from 529 EUH charts and 468 GMH charts were included in the final analysis. Among GMH patients, 81.4% were black/African American, 5.6% were white/Caucasian, and 7.9% were Hispanic/Latina. Mean age at diagnosis was 49.3 (SD 8.1). Mean household income for GMH patients was $60,292 (SD $22,975). At time of diagnosis, 37.2% of GMH patients had Medicaid, 7.7% had Medicare, 24.4% had private insurance, and 29.9% were uninsured. Among EUH patients, 35.7% were black, 56.9% were white, and 1.1% were Latina. Mean age at diagnosis was 48.84 (SD 7.61). Mean household income of EUH patients was $82,284 (SD $30,422). At time of diagnosis, 13.4% of EUH patients had Medicaid, 1.3% had Medicare, 84.3% had private insurance, and 0.8% were uninsured. Black patients were more likely to be high risk. High-risk patients were tested at a higher rate than low-risk patients (38% vs 8%, p <0.001). There was a higher proportion of high-risk patients at GMH than EUH, although this did not meet statistical significance (p= 0.075). There was a higher rate of BRCA testing among women at EUH vs GMH (35% vs 15%, p < 0.001) and white women vs black women (36% vs 18%, p < 0.001). BRCA testing also occurred at a higher rate among women with private insurance and women who lived in zip codes with a higher median income. However, this difference was not statistically significant in the multivariable logistic regression.
Conclusion: Hospital- and race-related disparities in rates of BRCA testing exist despite both hospitals being staffed by the same university-based oncology faculty. The data also suggest disparities related to insurance status and income. This raises concern for financial and logistical barriers impeding genetic counseling and testing in a safety net hospital setting despite a higher proportion of high-risk patients. Analysis is ongoing to determine whether high-risk patients are less likely to undergo BRCA testing in a safety net hospital compared to a university hospital setting. Interventions to increase BRCA testing and counseling among high-risk breast cancer patients must be adapted to meet the challenges of resource-poor settings.
Citation Format: Demetria J. Smith, Christopher Sauter, Chao Zhang, Zhengjia Chen, Keerthi Gogineni. Patterns of BRCA testing at a safety net compared to a university hospital [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B34.
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Affiliation(s)
| | | | - Chao Zhang
- 2Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Zhengjia Chen
- 2Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
| | - Keerthi Gogineni
- 2Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
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Smith DJ, Sauter CT, Zhang C, Chen Z, Gogineni K. Abstract P4-06-10: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-06-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- DJ Smith
- Emory School of Medicine, Atlanta, GA; Hospital of the University of Pennsylvania, Philadelphia, PA; Winship Cancer Institute of Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - CT Sauter
- Emory School of Medicine, Atlanta, GA; Hospital of the University of Pennsylvania, Philadelphia, PA; Winship Cancer Institute of Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - C Zhang
- Emory School of Medicine, Atlanta, GA; Hospital of the University of Pennsylvania, Philadelphia, PA; Winship Cancer Institute of Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - Z Chen
- Emory School of Medicine, Atlanta, GA; Hospital of the University of Pennsylvania, Philadelphia, PA; Winship Cancer Institute of Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
| | - K Gogineni
- Emory School of Medicine, Atlanta, GA; Hospital of the University of Pennsylvania, Philadelphia, PA; Winship Cancer Institute of Emory University, Atlanta, GA; Rollins School of Public Health, Emory University, Atlanta, GA
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Strauss WM, Carter C, Simmons J, Klem E, Goodman N, Vahidi B, Romero J, Masterman-Smith M, O'Regan R, Gogineni K, Schwartzberg L, Austin LK, Dempsey PW, Cristofanilli M. Analysis of tumor template from multiple compartments in a blood sample provides complementary access to peripheral tumor biomarkers. Oncotarget 2018; 7:26724-38. [PMID: 27049831 PMCID: PMC5042010 DOI: 10.18632/oncotarget.8494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/14/2016] [Indexed: 01/13/2023] Open
Abstract
Targeted cancer therapeutics are promised to have a major impact on cancer treatment and survival. Successful application of these novel treatments requires a molecular definition of a patient's disease typically achieved through the use of tissue biopsies. Alternatively, allowing longitudinal monitoring, biomarkers derived from blood, isolated either from circulating tumor cell derived DNA (ctcDNA) or circulating cell-free tumor DNA (ccfDNA) may be evaluated. In order to use blood derived templates for mutational profiling in clinical decisions, it is essential to understand the different template qualities and how they compare to biopsy derived template DNA as both blood-based templates are rare and distinct from the gold-standard. Using a next generation re-sequencing strategy, concordance of the mutational spectrum was evaluated in 32 patient-matched ctcDNA and ccfDNA templates with comparison to tissue biopsy derived DNA template. Different CTC antibody capture systems for DNA isolation from patient blood samples were also compared. Significant overlap was observed between ctcDNA, ccfDNA and tissue derived templates. Interestingly, if the results of ctcDNA and ccfDNA template sequencing were combined, productive samples showed similar detection frequency (56% vs 58%), were temporally flexible, and were complementary both to each other and the gold standard. These observations justify the use of a multiple template approach to the liquid biopsy, where germline, ctcDNA, and ccfDNA templates are employed for clinical diagnostic purposes and open a path to comprehensive blood derived biomarker access.
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Affiliation(s)
| | - Chris Carter
- Cynvenio Biosystems, Westlake Village, CA, 91361, USA
| | - Jill Simmons
- Cynvenio Biosystems, Westlake Village, CA, 91361, USA
| | - Erich Klem
- Cynvenio Biosystems, Westlake Village, CA, 91361, USA
| | | | - Behrad Vahidi
- Cynvenio Biosystems, Westlake Village, CA, 91361, USA
| | - Juan Romero
- Cynvenio Biosystems, Westlake Village, CA, 91361, USA.,Current address: Xencor, Inc, Monrovia, CA, 91016, USA
| | | | - Ruth O'Regan
- Department of Hematology and Medical Oncology, Winship Cancer Center, Emory University, Atlanta, GA, 30322, USA
| | - Keerthi Gogineni
- Division of Hematology/Oncology, University of Wisconsin, Madison, WI, 53792, USA
| | | | - Laura K Austin
- Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA,19107, USA
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Zeichner SB, Zeichner RL, Gogineni K, Shatil S, Ioachimescu O. Cognitive Behavioral Therapy for Insomnia, Mindfulness, and Yoga in Patients With Breast Cancer with Sleep Disturbance: A Literature Review. Breast Cancer (Auckl) 2017; 11:1178223417745564. [PMID: 29434470 PMCID: PMC5802619 DOI: 10.1177/1178223417745564] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022]
Abstract
The number of patients with breast cancer diagnosed with sleep disturbance has grown substantially within the United States over the past 20 years. Meanwhile, there have been significant improvements in the psychological treatment of sleep disturbance in patients with breast cancer. More specifically, cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and yoga have shown to be 3 promising treatments with varying degrees of benefit, supporting data, and inherent limitations. In this article, we will outline the treatment approach for sleep disturbance in patients with breast cancer and conduct a comprehensive review of CBT-I, mindfulness, and yoga as they pertain to this patient population.
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Affiliation(s)
- Simon B Zeichner
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Rachel L Zeichner
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.,Atlanta VA Clinic, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sharon Shatil
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Octavian Ioachimescu
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Paplomata E, Gogineni K, Meisel J, Santa-Maria C, Yuan L, Kramer J, Bill Li X, Zelnak A, Pakkala S, Kaklamani V, O'Regan R. Abstract P6-16-03: Phase 2 trial of everolimus and/or trastuzumab in hormone refractory, hormone receptor (HR)-positive, HER2-normal metastatic breast cancer (MBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-16-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Increased signaling through growth factor pathways including PI3K/Akt/mTOR and HER2 have been implicated in hormone resistance. Everolimus (EVE) improves outcomes when added to endocrine therapy for patients with HR-positive MBC. This study evaluated the efficacy of everolimus (EVE) and trastuzumab (TRAS) in hormone refractory HER2-normal metastatic breast cancer.
Methods: Eligible patients had HR-positive, HER2/neu-negative (IHC +1 or +2, HER2-non-amplified) MBC that had progressed within 6 months of the most recent endocrine therapy. Patients continued on the most recent endocrine therapy they received and were randomized to receive EVE 10 mg oral daily or TRAS IV (8 mg/kg loading dose followed by 6 mg/kg every 3 weeks). At progression, the other agent was added (TRAS in the EVE arm and EVE in the TRAS arm). Patients were followed until disease progression or death.
Results: 54 eligible patients were included in the analysis, and were randomized to EVE (n=30) or TRAS (n=24). 33% of patients were on fulvestrant, 31% exemestane, 22% tamoxifen and 7% letrozole, which were continued. The median PFS was 5.7 months for EVE vs. 2 months for TRAS until first progression or death with hazard ratio of 0.45 (95% CI 0.25-0.81, p=0.008). Among 48 patients who had disease progression, EVE was added to 16 patients who were originally treated by TRAS, and TRAS was added to 12 patients who were originally treated by EVE; the median time to the second progression was 6.3 months for the arm where EVE was added vs. 3.1 months in the arm where TRAS was added. Three patients were taken off study due to decrease in ejection fraction.
Conclusions: This trial demonstrates the efficacy of EVE alone or in combination with TRAS in patients with hormone refractory HR-positive, HER2-negative metastatic breast cancer, who remained on the endocrine therapy they had experienced disease progression on. This suggests that mTOR inhibition has the potential of restoring sensitivity to endocrine therapy and potentially allows the re-use of endocrine agents. Updated results and correlative studies will be presented. Clinical trial information: NCT00912340.
Citation Format: Paplomata E, Gogineni K, Meisel J, Santa-Maria C, Yuan L, Kramer J, Bill Li X, Zelnak A, Pakkala S, Kaklamani V, O'Regan R. Phase 2 trial of everolimus and/or trastuzumab in hormone refractory, hormone receptor (HR)-positive, HER2-normal metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-16-03.
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Affiliation(s)
- E Paplomata
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - K Gogineni
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - J Meisel
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - C Santa-Maria
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - L Yuan
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - J Kramer
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - X Bill Li
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - A Zelnak
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - S Pakkala
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - V Kaklamani
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
| | - R O'Regan
- Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Atlanta Cancer Care, Atlanta, GA; University of Texas Health Science Center San Antonio, San Antonio; University of Wisconsin
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Affiliation(s)
- Keerthi Gogineni
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
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Abstract
IMPORTANCE Surveyed physicians tend to place responsibility for high medical costs more on "demanding patients" than themselves. However, there are few data about the frequency of demanding patients, clinical appropriateness of their demands, and clinicians' compliance with them. OBJECTIVE To assess how frequently patients demand or request medical tests or treatments, what types they demand, the clinical appropriateness of their demands, and how frequently clinicians comply. DESIGN, SETTING, AND PARTICIPANTS Immediately after visits, clinicians--physicians, fellows, nurse practitioners, and physician assistants--were interviewed about whether the patient made a demand or request and their type and appropriateness. Interviews occurred in oncology outpatient facilities at 3 Philadelphia-area hospitals between October 2013 and June 2014. MAIN OUTCOMES AND MEASURES The 4 main outcomes were (1) frequency of patient demands for medical tests or treatments, (2) the types of tests or treatments demanded, (3) clinicians' assessment of the clinical appropriateness of the demands, and (4) how frequently clinicians complied. RESULTS There were 5050 patient-clinician encounters involving 3624 patients and 60 clinicians. Overall, of the 5050 encounters, 440 (8.7%) included a patient demand or request for a medical intervention. Clinicians complied with 365 of the clinically appropriate demands (83.0%). In only 50 of the 440 encounters with demands (11.4%) did the patient demand or request clinically inappropriate interventions. Clinicians complied with 7 of these inappropriate demands or requests (14%). Clinicians complied with inappropriate demands or requests in only 0.14% (7 of 5050) of encounters. Of the 440 patient demands, 216 (49.1%) were for imaging studies; 68 (15.5%) were for palliative treatments, excluding chemotherapy or radiation; and 60 (13.6%) were for laboratory tests. In a multivariable model, having lung/head and neck cancer (odds ratio [OR], 1.74; 95% CI, 1.26-2.41), receiving active treatments (OR, 1.40; 95% CI, 1.11-1.77), and a fair- or poor-quality patient-clinician relationship (OR, 2.82; 95% CI, 1.13-7.07) were associated with patients making demands or requests (all P < .01). CONCLUSIONS AND RELEVANCE Patient demands occur in 8.7% of patient-clinician encounters in the outpatient oncology setting. Clinicians deem most demands or requests as clinically appropriate. Clinically inappropriate demands occur in 1% of encounters, and clinicians comply with very few. At least in oncology, "demanding patients" seem infrequent and may not account for a significant proportion of costs.
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Affiliation(s)
- Keerthi Gogineni
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Katherine L Shuman
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Derek Chinn
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nicole B Gabler
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ezekiel J Emanuel
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia4Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia5Office of the Provost, University of P
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Zeichner SB, Terawaki H, Gogineni K. A Review of Systemic Treatment in Metastatic Triple-Negative Breast Cancer. Breast Cancer (Auckl) 2016; 10:25-36. [PMID: 27042088 PMCID: PMC4807882 DOI: 10.4137/bcbcr.s32783] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [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] [Received: 01/08/2016] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/19/2022]
Abstract
Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR)- and human epidermal growth factor receptor 2 (HER2)-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC) disease. Although there have been many new treatment options approved by the Food and Drug Administration for ER/PR-positive and Her2/neu-amplified metastatic breast cancer, relatively few new agents have been approved for patients with mTNBC. There have been several head-to-head chemotherapy trials performed within the metastatic setting, and much of what is applied in clinical practice is extrapolated from chemotherapy trials in the adjuvant setting, with taxanes and anthracyclines incorporated early on in the patient's treatment course. Select synergistic combinations can produce faster and more significant response rates compared with monotherapy and are typically used in the setting of visceral threat or symptomatic disease. Preclinical studies have implicated other possible targets and mechanisms in mTNBC. Ongoing clinical trials are underway assessing new chemotherapeutic strategies and agents, including targeted therapy and immunotherapy. In this review, we evaluate the standard systemic and future treatment options in mTNBC.
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Affiliation(s)
- Simon B Zeichner
- Department of Hematology & Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Hiromi Terawaki
- Department of Hematology & Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Keerthi Gogineni
- Department of Hematology & Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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